To analyze the causes of reoperation in patients with hepatolithiasis and to investigate the choice of surgical approach.

The data of 136 patients (men 60, women 76) who underwent reoperation due to hepatolithiasis from January 1997 to December 2007 were reviewed. The classification of hepatolithiasis were: type Ⅰ101 cases (74.3%), type Ⅱa 5 cases (3.7%), type Ⅱb 27 cases (19.8%) and type Ⅱc 3 cases (2.2%).

The causes of reoperation included remnant bile stone (22.8%), recurrence of bile stone (38.3%), failed to correct the stricture of intrahepatic bile duct(16.9%) or dilatation of extrahepatic bile duct (13.2%), and emergent cases of primary operation(8.8%). The procedures of reoperation were choledochotomy+ "T" tube drainage (24.3%), hepatectomy(2.2%), choledochotomy+Oddis sphincteroplasty(3.7%), choledochotomy+hepatectomy+ "T" tube drainage(21.3%), choledochotomy+ choledochojejunostomy(29.4%), and choledochotomy+hepatectomy+ choledochojejunostomy(19.1%). The main perioperative complications included bile leakage (4.4%), subphrenic abscess (2.2%), bleeding of bilio-enteric anastomosis (0.7%), pulmonary infection(1.5%), and infection of incision(5.1%). The perioperative mortality was 0.7%. Fourteen patients had remnant bile stones after reoperation. The recurrent rate of bile stone was 18.8% during follow up.

Full estimation of the status of hepatolithiasis and ample preparation should be done before reoperation. In order to decrease the recurrent rate of hepatolithiasis, hepatectomy may be choosed as far as possible.

原发性胆囊癌是胆道常见恶性肿瘤，恶性程度高，早期诊断困难，预后极差。掌握原发性胆囊癌的流行病学特征，对改善胆囊癌的诊断、预防及治疗都有着重大的意义。

To study the relation between nodular goiter and thyroid cancer.

Immunohistochemical method was used to detect expression of p27 protein in 58 cases of nodular goiter, 15 cases of nodular goiter with hyperplastic nodule, 44 cases of thyroid cancer and 20 cases of normal thyroid tissue.

The positive expression rate of p27 protein was 60.5% in normal thyroid tissue, 38.6% in nodular goiter, 34.1% in thyroid cancer and 0 in nodular goiter with hyperplastic nodule. The positive expression rate of p27 protein in both nodular goiter and thyroid cancer was significantly higher than this in nodular goiter with hyperplastic nodule (P<0.01).

Nodular goiter with hyperplastic nodule may be a premalignant lesion, nodular goiter had malignant potential.

To evaluate the safety and efficacy of precise hepatectomy techniques in hepatolithus.

Ninety-two patients with hepatolithus undergoing hepatectomy from January 2008 to October 2012 were reviewed retrospectively. Thirty-two patients received irregular hepatectomy (control group) and 60 received precise hepatectomy (experimental group), and the intraoperative and postoperative indexes such as operative time, intraoperative blood loss, postoperative liver function, length of hospital stay, incidence of complications and clearance rate of calculus were analyzed.

In experimental group, the operative time was longer [(262.2±54.2)min vs (174.8 ±54.8)min, t=30.727, P<0.01], but the patients had reduced intraoperative blood loss [(438.5±89.6)ml vs (680.6±74.7)ml, t=-86.465, P<0.01], faster recovery of liver function [ALT value on POD 7, (50.1±7.4) U/L vs (320.7±11.8) U/L, t=-96.470, P<0.01], less postoperative complications(11.7% vs 40.6%, χ²=10.227, P<0.01), higher clearance rate of calculus(100.0% vs 75.0%, χ²=16.429, P<0.01)and shortened length of hospital stay [(15.9±5.4) d vs(23.4±4.3) d, t=-50.103, P<0.01].

Precise hepatectomy is safe and effective in the treatment of hepatolithus without much injury to patients. Precise hepatectomy can significantly decrease postoperative complications, length of hospital stay, and accelerate the early rehabilitation.

To determine the accuracy of biological markers expression in core needle biopsies(CNB) compared with surgically excised specimens(SES) and the influence of preoperative chemotherapy on these markers expression.

One hundred and fifty-two of 170 patients were analyzed. Ninty-nine women received neoadjuvant chemotherapy, and 53 patients underwent immediate surgery. Estrogen(ER) and progesterone receptor(PR), Her2, Ki67, p53 and Topo Ⅱ in biopsy tissue and surgically removed specimens were assessed using immunohistochemistry staining and calculated accuracy and kappa value.

The assessment of biological markers expression can be performed on CNB and correlated well with subsequent SES regardless of patients with or without preoperative chemotherapy (K > 0.6), although the concordance rate in patients without preoperative chemotherapy was found to be higher for biomarkers expression compared to women with preoperative chemotherapy. The accuracy of CNB was 87%-91% in patients without neoadjuvant, and 78%-95% with neoadjuvant. No significant deference was observed about the effect of neoadjuvant chemotherapy on ER, PR, Her2, Ki67and p53, except Topo Ⅱ.

The agreement of breast cancer biomarkers expression detected in CNB and SES is high. The accuracy of biomarkers measurement in CNB is good. The effect of neoadjuvant chemotherapy on biological markers is small.

探讨腹腔镜下保胆取石术治疗有功能的胆囊结石的安全性及有效性。

2006年4月至2009年1月采用腹腔镜下保胆取石术治疗经严格筛选的有功能胆囊结石80例，术后随访3~39个月，对消化道症状及胆囊壁厚度、胆囊功能的主观和客观指标进行分析。

腹腔镜下保胆取石术后消化道症状完全消失，胆囊壁厚度由术前的（2.30±0.40）mm，变为术后6个月的（1.50±0.30）mm(P<0.05），术后1年为（1.40±0.30）mm（P<0.05），较术前明显变薄，胆囊收缩面积由术前的（0.32 ±0.05）cm³，提高到术后6个月的（0.39±0.06）cm³（P < 0.05），术后1年的（0.40±0.07）cm³（P < 0.05），无术中副损伤或术后严重并发症,无中转开腹及死亡病例。

与以往公认的腹腔镜胆囊切除术和开腹胆囊切除术相同,腹腔镜下保胆取石术治疗有功能的胆囊结石是一种安全、有效的术式,并且副损伤少。

To investigate the different nursing points and strategies by evaluating the postoperative status of patients in two different ways of bile reinfusion.

Forty-nine choledocholith patients were divided to nasogastric-tube group (nineteen cases) and jejunal-fistula-tube group (thirty cases). the fever time, first-flatus time, uncomfortable status, diarrhea and tube obstruction status between the two groups were recorded.

The jejunal-fistula-tube group had longer fever time compare with the nasogastric-tube group, the nasogastric-tube group had higher portion in uncomfortable and tube obstruction, there was no difference in first-flatus time and diarrhea between the two groups;

Besides performing the careful procedures of bile reinfusion, we should focus on nursing points adjustment according to status in different bile reinfusion ways.

To systematically evaluate the therapeutic effect of portasystemic shunt (PSS) and gastroesophageal devascularization (GD) on portal hypertension (PH) after liver cirrhosis.

The literatures about the therapeutic effect of PSS and GD on PH after cirrhosis were collected from Medline, Elsevier, China National Knowledge Infrastructure (CNKI) and Wanfang databases from 1989 to 2008. RevMan 5.0 software was used for data analysis.

According to the included criteria, 10 clinical trials were selected finally. The combined results of Meta-analysis with fixed effect model showed that the Operative Mortality was similar [RR=1.04, 95% CI(0.74-1.47), P >0.05]; Recurrent variceal bleeding rate of PSS was lower than GD[RR=0.48, 95% CI(0.39-0.59), P<0.01]; Encephalopathy rate of PSS was higher than GD[RR=2.85, 95% CI(2.14-3.80), P<0.01], while post operative mortality of PSS was higher than GD[RR=1.25, 95% CI(1.01-1.55), P<0.05].

PSS and GD may be used in the treatment of PH, but in comparing with PSS, GD has a better effect on PH after cirrhosis.

To investigate the effect of catharsis therapy and cognitive behavior intervention on anxiety and depression in breast cancer patients receiving postoperative chemotherapy.

Ninety-seven breast cancer patients receiving postoperative chemotherapy were randomly divided into experimental group (47cases) and control group (50 cases) . The control group received routine care, while the experimental group received routine care and comprehensive intervention mainly including catharsis therapy, cognitive education and relaxation training. The anxiety and depression of those patients were evaluated with Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS) before and after intervention. The changes of anxiety and depression were compared between the two groups.

After intervention,the scores of anxiety and depression in the experimental group were significantly lower(P<0.01).

The anxiety and depression of breast cancer patients receiving postoperative chemotherapy can be eased by catharsis therapy and cognitive behavior intervention.

To evaluate the correlation between the prognosis and the early lactate clearance in patients with hemorrhagic hypovolemic shock.

Prospective observation and collecting the data of 92 patients with hemorrhagic hypovolemic shock. APACHE II score, the mortality and the lactate clearance after 6hours were measured. The patients were analyzed with respect to survival and nonsurvival, low lactate clearance and high lactate clearance.

There was no statistical difference between the two groups in age, sex, APACHE II score and the baseline of lactate. The early lactate clearance in survival group was significantly more than that in the nonsurvival group, (29.8±15.2)% vs (9.8±9.1)%, P<0.01. The mortality was in high lactate clearance group significantly less than that in the low lactate group, 11.3% vs 42.9%, P<0.01.

The early lactate clearance is a good prognostic factor of hemorrhagic hypovolemic shock.

To assess the value of ultrasonically activated scalpel and high frequency electrotome under laparoscopy and laparotomy in treatment of adhesive intestinal obstruction.

Clinical data of twenty-seven adhesive intestinal obstruction patients operated by ultrasonically activated scalpel under laparoscopy in our hospital from Jun. 1999 to Jun. 2010 were retrospectively analyzed and they were compared with 23 patients who underwent electroscalpel enterolysis and 30 cases who underwent laparotomy at the same period.

The operative duration were (62.1 ± 17.7) min in the group of ultrasonically activated scalpel, (98.0±37.0) min in the group of electroscalpel enterolysis, and (115.0 ± 20.2) min in the group of laparotomy. The volume and time were remarkably descendent in the group of ultrasonically activated scalpel comparing to the group of electroscalpel enterolysis. So it was in the group of electroscalpel enterolysis, comparing to the group of laparotomy (P < 0.01) . Mean bleeding were (13.9 ± 4.4) ml, (35.0 ± 6.4) ml and (150.0 ± 35.0) ml, respectively. And the mean length of stay were (3.2 ± 0.5) d, (6.1 ± 1.0) d and (11.8 ± 4.0) d, which was remarkably descendent in the group of ultrasonically activated scalpel or electroscalpel enterolysis comparing to the group of laparotomy (P < 0.01) . There was no complication in the group of ultrasonically activated scalpel, 2 cases happened in the group of electroscalpel enterolysis and 7 cases in the group of laparotomy. They were remarkably differential in groups (P < 0.05) .

Enterolysis using laparoscope and ultrasonically activated scalpel to treat adhesive intestinal obstruction is safe and feasible. It has the advantages of short operative time and hospital stay, less invasion and complications, and lower recurrence rate.

To analysis and evaluation classification of enteral nutrition products in China for clinical research and scientific references.

Analysis the product categories from the relevant government departments, nutrition associations and European guideline.

The product categories from different departments are various and changes over the years continuously.

Scientific classification strongly influenced the effective management, monitoring efficacy, assessment of the impact health insurance and continued introduction of new varieties.

To assess nutritional status, the prevalence of nutritional risk, and nutritional support in hospitalized patients from four teaching hospitals in Guangzhou, to determine gender or age associated difference in the prevalence of nutritional risk.

A total of 2550 patients admitted during April 2008 to December 2011 from six departments (Gastroenterology, Pulmonology, Neurology, Nephrology, General Surgery and Thoracic Surgery) were screened using the Nutritional Risk Screening 2002 tool.

Overall prevalence of undernutrition and nutritional risk was 17.8% and 41.5%, respectively. The department of pulmonology enjoyed the highest prevalence of undernutrition (28.2%) and nutritional risk (55.9%) . The prevalence of nutritional risk was significantly higher in≥70 years old patients than patients who were<70 years old (64.2% vs 32.6%, χ² =212, P = 0.000) . No gender difference in the prevalence of nutritional risk was observed in general. Totally 47.6% of "at risk" and 19.4% of "not at risk" patients received nutritional support. Parenteral nutrition accounted for 88.7% of the nutritional support.

Nutritional Risk Screening 2002 is a powerful tool and should be recommended to use at admission. A large proportion of hospitalized patients were at nutritional risk or undernutrition in Guangzhou. Patients≥70 were more likely to be at nutritional risk. Inappropriate assignment of nutritional interventions and unrestrained usage of parenteral nutrition were observed in nutritional therapy. Precise evaluation of a patient ^, s nutritional condition and subsequent rational assignment of nutritional support are warranted.

To investigate the clinical effect of benign breast mass resected by ultrasound-guided Mammotome minimal invasive biopsy system.

Four hundred and ten benign breast masses of 235 cases ranged from 0.5~5.0 cm were enrolled in study. The masses with the diameter lager than 3.0 cm were at the same time cut-off with a incision 1.5 cm long besides areola of breast to see if there were remnants. All cases were followed up for 6~9 months after the operations.

All masses were completely removed. Hematoma formation of 5 cases, skin depression of 2 cases and recurrence of 3 cases were observed.

Ultrasound-guided Mammotome minimally invasive system is suitable for resection of 0.5~3.0 cm benign breast masses. Making a short incision beside the mass can cut down the rate of residual when removing the mass larger the 3.0 cm with ultrasound-guided Mammotome minimally invasive system.

To investigate the operational mode of differentiated thyroid carcinoma(DTC) in different condition and its relationship with prognosis.

Retrospective analysis the clinical data of 325 cases of DTC treated from 1993 to 2000, and according the main factors influencing prognosis, we do stratified analysis using multivariate cox regression model by corrected confounded factors, to evaluate the relationship between surgical operational mode and prognosis of DTC.

The factors that influenced the prognosis of DTC included gender, age, recurrence, clinicopathological stage, primary tumor size, and treatment pattern (P< 0.05), but only age, treatment pattern and clinicopathological stage influenced the prognosis of DTC according to Cox multivariate analysis(P<0.05). Stratified by age, hemithyroideetomys with isthmus resections was the best way in the higher age group, and taking total thyroidectomy as reference, it's OR was 0.320. But in the lower age group, there was no significant statistical difference in operational mode. Taking clinicopathological stage as a stratified factor, hemithyroideetomy was a good choice(OR=0.228) in stageⅠ, but in the higer stage, subtotal thyroidectomy seemed better(OR=0.561).

Age, operational mode and clinicopathological stage are main factors that influenced the prognosis of DTC. We should select the best surgical operational mode by take the patient's tolerance as consideration, according to age and clinicopathological stage.

观察对肝癌择期手术患者加强人文关怀后焦虑、抑郁的情况，了解肝癌患者对护士施行人文关怀的评价，为更好地实施符合肝癌患者心理需求与期望的护理人文关怀行为提供依据。

本研究将2004年1月至2008年12月行肝癌切除术、左/右肝叶切除术的112例患者随机分为试验组和对照组，对照组按护理常规进行护理，试验组在对照组基础上予以人文关怀护理，运用SAS、SDS评估和比较两组患者的心理状态变化。

实施人文关怀前，试验组和对照组的患者焦虑和抑郁率无统计学差异。实施人文关怀后，试验组和对照组患者的焦虑和抑郁发生率差异有高度统计学意义（P<0.01）。试验组患者的焦虑和抑郁率明显下降。

肝癌手术患者存在明显的焦虑、抑郁心理，人文关怀护理有助于缓解肝癌手术患者的心理焦虑和抑郁情绪，提高其生活质量，具有很好的临床应用价值。

To compare the pulmonary complications between the standard classic liver transplantation and classic liver transplantation with retrograde reperfusion via vena cana.

One hundred and sixty-nine patients with end-stage liver disease underwent liver transplantation from January 2003 to December 2008 were retrospectively analyzed in our hospital. The patients were divided into standard classic liver transplantation group of 46 cases (group A) and retrograde reperfusion liver transplantation group of 123 cases (group B), according to the operation way of liver transplantation. The rate of the pulmonary complication was observed in the two groups in different Meld scores. The perioperative factors of pulmonary complication were investigated.

There were significant differences in pulmonary complication rate between the two groups in the situation of Meld score ≤15 points and 15-25 points. Compared with group A, patients with total intraoperative infusion>10 L and the total blood products >4 L in group B obviously reduced(P = 0.023 and P = 0.040). However, the patients whose negative fluid balance >300 ml in 2 days of the first 3 days after operation in group B obviously increased (P = 0.048).

Compared with the standard classic liver transplantation, the classic liver transplantation with retrograde reperfusion via vena cana may significantly reduce the incidence of postoperative pulumonary complications.