˫�Ǻ���������ֱ�������е�Ӧ�ã���236�����棩

目的：评价双吻合器技术在结直肠吻合尤其是低位结直肠吻合术中的作用。方法：回顾性分析自1995年5月至2002年5月间共计236例直肠癌应用双吻合器技术行结直肠吻合的经验。结果：全组术中直肠闭合和结直肠的吻合过程均顺利。术后发生吻合口瘘8例（3．3％），吻合口狭窄7例（2．5％），伤口感染2例（0．8％），无手术死亡。结论：双吻合器技术能帮助外科医生顺利完成以往手法缝合不易或难以完成的低位结直肠吻合术。     

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??Endoscopic retrograde cholangiopancreatography (ERCP)-based operation in treating blunt pancreatic trauma??A report of 10 cases ZHAO Ming-ning?? WU Wen-guang, TAO Yi-jing, et al. Department of General Surgery??Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine??Institute of Biliary Tract Disease??Shanghai Jiao Tong University School of Medicine??Shanghai 200092, China
Corresponding author??WANG Xue-feng??E-mail??wxxfd@live.cn
Abstract Objective To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in treating blunt pancreatic trauma??BPT??. Methods The clinical data of 10 cases of BPT underwent ERCP-based management between August 2006 and December 2011 in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. The pancreatic injuries were assessed with the American Association for the Surgery of Trauma (ASST) grading system. Pancreatic injuries in 10 cases were graded including 1 case of grade I??3 of grade ??4 of grade ?? and 2 of grade ??. Results Ten cases of BPT all survived after ERCP-based treatment. Four cases of grade??/?? injury were cured after endoscopic naso-pancreatic drainage. Four with grade ?? injury were placed with pancreatic stent??in which one underwent endoscopic ultrasound (EUS)-guided transgastric drainage of peripancreatic fluid detected by contrast-enhanced CT??and two developed pancreatic pseudocyst identified by postoperative CT and cured by EUS-guided transgastric puncture. Two cases of grade ?? injury were treated by concurrent placement of pancreatic stent and biliary stent??including one cured by EUS-guided puncture and drainage of peripancreatic fluid. All the stents were dislodged 3 months after implantation. Conclusion ERCP-based treatment for BPT depends on strict control of indications. Therapeutic strategy of ERCP should be established on the grade of pancreatic injury which is determined by clinical assessment, CT and ERCP imaging comprehensively.     

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??A one-stage percutaneous tract dilation technique in percutaneous transhepatic cholangioscopy (PTCS) for patients with bile duct stones: A report of 35 cases LOU Jian-ying, CHEN Wei, WANG Ji, et al. Department of Hepato-Pancreato-Biliary Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
Corresponding author: LIANG Ting-bo, E-mail: liangtingbo@zju.edu.cn
Abstract Objective To evaluate the safety, efficiency, indications and procedure of percutaneous transhepatic cholangioscopy (PTCS), using a one-stage percutaneous tract dilation technique, in patients with intrahepatic and/or common bile duct stones. Methods The medical records of 35 cases of intrahepatic and/or common bile duct stones treated by PTCS, using a one-stage tract dilation technique, from January, 2015 to April, 2017 in the Second Affiliated Hospital of Zhejiang University School of Medicine were studied retrospectively. All the patients were treated with lithotripsy and basket stone removal through PTCS using one-stage percutaneous tract dilation technique after percutaneous transhepatic cholangial drainage (PTCD). The perioperative morbitity, stone clearance rate, and stone recurrence rate were analyzed. Results The intrahepatic biliary duct and common bile duct were successfully accessed in all 35 cases using ultrasound-guided one-stage percutaneous tract dilation PTCS technique. The stones were completely removed (level A) in 65.7% (23/35) of the cases including 18 cases of intrahepatic stones and 5 cases of common bile duct stones. The stones were almost cleared (level B) in 22.9% (8/35) of intrahepatic stones cases. Stone clearance was achieved in 31 (88.6%) cases (level A and B). One case suffered PTCD site bleeding and one case had percutaneous transhepatic tract rupture during the secondary stone removal procedure. There were no other serious procedure-related complications such as life-threatened bleeding, bile leak and conversion to laparotomy. With follow-up of 1-28 months, 6 (26.1%) of 23 cases of level-A stones clearance had recurrent intrahepatic stones and cholangitis. Conclusion PTCS using one-stage dilation of the tract, is an effective, safe and alternative minimal invasive method forintrahepatic and/or common bile duct stones when surgery or peroral approach is not indicated.     

3DMax��Ƭ�ڸ�ǻ�����ɹ����޲����е�Ӧ�ã���68�����棩

??Clinical application of 3DMax patch in the laparoscopic inguinal hernia repair??a report of 68 cases CHEN Dan-lei??LI Ji-hui, ZHENG Cheng-zhu??et al. Minimally Invasive Surgery Center, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China Corresponding author??ZHENG Cheng-zhu??E-mail: fredzhengzz@hotmail.com Abstract Objective To evaluate the clinical value of 3DMax patch in the laparoscopic inguinal hernia repair. Methods The clinical data of 68 cases of laparoscopic inguinal hernia repair using 3DMax patch between October 2006 and July 2008 at the Minimally Invasive Surgery Center, Changhai Hospital of the Second Military Medical University were analyzed retrospectively. Results Among 68 cases, 4, 45 and 16 cases were stype ??, ?? and ?? respectively. Fifty-three, 13 and 2 cases were indirect hernia, direct hernia and Cloguet's hernia respectively. Sixty-seven cases were performed laparoscopic repair successfully. TAPP and TEP were performed in 19 and 48 cases. One case was converted to open surgery due to difficulty to draw back the omenta inside the hernia sac. The operation time was from 30 to 65min with the mean of 40min. The mean time of post-operation hospital stay was 2 days. Scrotum seroma was occurred in 2 cases. Small bowel obstruction reoperation was performed in 1 case. No recurrence was found during the follow-up period of 3-24 months. Conclusion Laparoscopic inguinal hernia repair has the advantage of minor injury, quicker recovery and lower recurrence rate compared with open surgery. The application of 3DMax patch makes the operative procedure more convenient, and makes the complication incidence more lower.     

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??Application of right hemihepatectomy in the treatment of hepatolithiasis??A report of 48 cases YIN Xiao-Yu??LIU Xin??CHEN Wei??et al. Department of Pancreatobiliary Surgery??the First Affiliated Hospital??Sun Yat-Sen University??Guangzhou 510080??China
Corresponding author??YIN Xiao-Yu??E-mail??yinxy@medmail.com.cn
Abstract Objective To investigate the safety and long-term outcomes of right hemihepatectomy in treating the patients with hepatolithiasis??which was confined to or mainly involved in the right semi-liver. Methods The clinical data of forty-eight patients with hepatolithiasis who underwent right hemihepatectomy between January 2010 and December 2014 in the First Affiliated Hospital??Sun Yat-Sen University were recruited in the study??and the clinical data and follow-up data were analyzed to evaluate its safety and long-term outcomes. Results There was a total of 48 cases of hepatolithiasis undergone right hemihepatectomy??with 17 males and 31 females??and a median age of 56 years. Sixteen of them had histories of previous biliary surgery. In addition to right hemihepatectomy??the other operative procedures included hepaticojejunostomy in 13 cases??exploration of common bile duct with T tube drainage in 33 cases. There was no perioperative death??and postoperative morbidity was 25%(12/48)??including bile leakage in 6 cases??intra-abdominal infection in 4 cases??wound infection in 4 cases??mild hepatic dysfunction in 1 case and pleural effusion in 1 case. The residual stones were revealed by postoperative T-tube cholangiography in 9 cases (18.8%) and completely extracted viapostoperative choledochoscopy in 7 cases. Forty-two (87.5%) cases were successfully followed up with a median follow-up time of 33.3 months. About 92.8% of them (39/42) remained stone-free. Conclusion Right hemihepatectomy is a safe and effective treatment for hepatolithiasis??which is confined to or mainly involved in the right semi-liver??with advantages of low incidences of residue stone and stone recurrence??     

ERCP��ҽԴ�Ե��������е����Ƽ�ֵ����117�����棩

??Treatment value of ERCP in bile duct injury after operation: A report of 117 cases ZHANG Hui, ZHOU Wen-ce, LI Xun, et al. Second Department of General Surgery, the First Hospital of Lanzhou University; Center of ERCP Diagnosis and Treatment in the First Hospital of Lanzhou University, Hepatobiliary and Pancreatic Surgery Research Institute of Gansu Province; Key Laboratory of Cell Therapy and Regenerative Medicine of Gansu Province, Lanzhou 730000, China
Corresponding author: ZHOU Wen-ce, E-mail:zhouwc@lzu.edu.cn
Abstract Objective To investigate the application value of ERCP technique in bile duct injury Methods The clinical data of 117 cases of bile duct injury treated with ERCP in the Second Department of General Surgery, the First Hospital of Lanzhou University from January 2007 to August 2016 were analyzed retrospectively. The effect of ERCP in the treatment of different Strasberg types of bile duct injury was analyzed retrospectively. Results All the 117 cases were treated with ERCP, of which type Strasberg-A 56 cases, type C 10 cases, type D 17 cases and type E 34 cases (E1 13 cases, E2 10 cases, E3 5 cases and E4 6 cases) repectively.Eighty-seven cases of ERCP had good curative effect; successful rate of ERCP surgery was 74.4% (87/117). ERCP treatment was nasal biliary drainage combined with plastic biliary stent or metal stent. The postoperative follow-up lasted for 1 years. The effective rate of Strasberg-A,-C,-D,-E type was 100% (56/ 56),33.3% (3/10), 94.1% (16/17) and, 35.3% (12/34) repectively. A total of 30 cases were treated with PTCD drainage and open operations after the endoscopic treatment failure. Among the 87 cases in which the ERCP were successfully implemented, 11 cases had postoperative acute cholangitis and 8 cases had acute pancreatitis after ERCP; all of which were cured by conservative treatment; no other complications occurred. Conclusion ERCP has a good effect on biliary tract injury with Strasberg-A .-D type and is less effective in Strasberg-C type combined with right hepatic duct injury. For some Strasberg- E3,-E4 type stenosis and a few Strasberg-E1,-E2 type severe stenosis, ERCP efficacy need to be improved.     

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在胆囊切除术中 ,手术人员对胆囊动脉的处理都十分注意 ,但对胆囊床大出血 ,往往重视不够。本文就我院发生的 4例胆囊床大出血 ,分析并介绍其发生原因和防治方法。1　病例介绍例 1 女 ,82岁。因胆囊结石胆囊炎、胆总管结石胆管炎急诊行胆囊切除、胆总管切开取石、Ｔ管引流术。术前心电图示心肌缺血。术中见胆囊肿大充血 ,并嵌入肝内 ,在切除胆囊过程中 ,由于剥离过深达肝实质 ,导致肝组织破裂 ,出血不止 ,以热盐水纱布反复压迫 ,并见有活动性出血予反复缝扎止血 ,均未能奏效。最后经肝门阻断 ,肝脏创面填塞明胶海绵 ,连带残留胆囊壁缝扎后血…     

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??Application of vacum-assisted closure in open abdomen with enteroatmospheric fistulae??A report of 45 cases LI Wu-han, ZHAO Yun-zhao, ZHAO Ri-sheng, et al. Research Institute of General Surgery??Clinical School of Medical College of Nanjing University; Department of General Surgery, Nanjing General Hospital of Nanjing Military Command of PLA??Nanjing 210002??China
Corresponding author: ZHAO Yun-zhao, E-mail??yzzhaomd@gmail.com
Abstract Objective To investigate the feasibility and therapeutic efficacy of vacum-assisted closure in open abdomen with enteroatmospheric fistulae. Methods The clinical data of 45 cases of intestinal fistulae and complicated intra-abdominal infection received open abdomen from February 2012 to February 2015 in Department of General Surgery, Nanjing General Hospital of Nanjing Military Command of PLA were analyzed retrospectively. Comparison of the effect of vaccum-assisted closure and polypropylene patch for temporary abdomen closure. Results Application of vaccum-assisted closure in open abdomen with enteroatmospheric fistulae shorten the time from opening abdomen to skin grafting, the length of stay in ICU and hospital significantly, and increased the rate of primary fascial closure. Conclusion Vaccum-assisted closure is an effective treatment for open abdomen with enteroatmospheric fistulae.     

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??Pathogen distribution and drug resistance in patients with intro-abdominal infection??A report of 310 cases DAI Xiao-ming*??SHI Kun??WU Xiang-dong??et al. *Intensive Care Unit??the First Affiliated Hospital of Dalian Medical University??Dalian 116011??China
Corresponding author??TAN Guang??E-mail??tanguang009@sina.com
Abstract Objective To investigate the distributions and antimicrobial resistances of the bacteria in abdominal drainage fluid in intro-abdominal infection??IAI??. Methods The abdominal drainage fluid specimen of 310 cases of IAI admitted from January 2012 to December 2014 in the First Affiliated Hospital of Dalian Medical University was collected. The bacterial distributions and antimicrobial resistances were analyzed. Results A total of 578 clinical isolates were collected??of which gram-negative organiams, gram-positive cocci and fungi accounted for 65.2% ??377 strains????27.0% ??156 strains??and 7.8% ??45 strains?? respectively. The top five most prevalent isolated pathogens were escherichia coli??19.6%????klebsiella pneumonia??11.4%??, acinetobacter baumannii??10.2%????enterococcus faecium??8.1%????pseudomonas aeruginosa??7.3%??. The resistance rate of E. faecium to most antibiotics was higher than that of E. faecalis. The resistance rates of E.faecium and E. faecalis against to ampicillin, ciprofloxacin, levofloxacin and erythromycin were all above 80%??and the sensitive rates of sulfamethoxazole and chloromycetin against staphylococcus were above 90%. No strain was found resistant to vancomycin or linezolid. The prevalence of ESBLs in enterobacteriaceae was above 55%, and the sensitive rates were higher in carbapenems, amikacin and β-Lactamase inhibitors, but severely resistant to the third generation cephalosporin. The prevalence rate of carbapenem-resistant enterobacteriaceae (CRE) was increasing year by year. The resistance rates of minocycline and cefperrazone-sulbactam against acinetobacter baumannii were 11.9% and 37.3%??which of other antimicrobial drugs were above 60%??of carbapenem was above 70%??of ceftriaxone and cefotaxime above 80%, of gentamicin above 90%. The sensitive rates of carbapenem??ceftazidime??cefepime??piperacillin sodium and tazobactam sodium??amikacin against pseudomonas aeruginosa were higher than those against acinetobacter baumannii. Conclusion The enterobacteriaceae and non-fermentative bacterias are the chief bacteria in IAI. Multi-drug resistant bacteria is serious??and the resistance rate is increasing year by year. Extensive and dynamical monitoring of pathogens resistance should be performed and rational use of antibiotics are advocated.     

�����ļ��Գ����������о�����267�����棩

??Diagnosis and treatment of acute intestinal obstruction from single center??A report of 267 cases ZHU Li-jing, HAN Xu, QIN Xin-yu, et al. Department of General Surgery, Zhongshan Hospital Fudan University; Research Institute of General Surgery of Fudan University, Shanghai 200032, China
Corresponding author: LOU Wen-hui, E-mail:wenhuilou@aliyun.com
Abstract Objective To analyze the clinical spectrum, diagnosis and treatment of acute intestinal obstruction in Zhongshan Hospital Fudan University. Methods The clinical data of 267 cases of acute intestinal obstruction admitted from January 1, 2011 to December 31, 2012 in Department of General Surgery, Zhongshan Hospital Fudan University were analyzed retrospectively. Results There were 267 cases diagnosed with acute intestinal obstruction including 141 cases (52.8%) of adhesive intestinal obstruction and some other causes followed by colon tumor (49 cases, 18.4%), rectal tumor (17 cases, 6.4%), all types of hernia (10 cases, 3.7%), peritonitis (7 cases, 2.6%), intestinal obstruction by gallstone, meconium and persimmon bezoar (7 cases, 2.6%), and other rare causes (36 cases, 13.5%). The top three kinds of previous surgery leading to adhesive intestinal obstruction were listed as followed: 46 cases (32.6%) of colorectal tumor resection, 28 cases (19.9%) of subtotal gastrectomy or total gastrectomy, 21 cases (14.9%) of appendectomy. Of 141 cases of adhesive intestinal obstruction, 82 cases (58.2%) were required surgical intervention eventually, and the remaining 55 cases (39.0%) were received conservative treatments and recovered. Conclusion Adhesive intestinal obstruction is the leading cause of acute intestinal obstruction in the cases from Zhongshan Hospital Fudan University. Resection of colorectal cancer is the most common cause of adhesive intestinal obstruction. More than half cases of all adhesive intestinal obstruction need reoperation.     

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腹部切口骨化是指腹部手术后瘢痕内骨组织形成 ,为骨化性肌炎的一个亚型 ,临床罕见。英文文献中迄今报道80余例 ,国内至今仅有 3例报道。我院曾发现 3例。现报告如下。1　病历简介　　例 1 男性 ,5 3岁。因胃癌于 1980年行根治性胃大部切除术。术中取上腹正中切口 ,术后切口一期愈合。术后 8个月于腹部瘢痕上部触及坚硬之条索状肿物。 1个月后 (术后9个月 ) ,以“胃癌切口种植”的诊断再次手术。术中发现原切口皮下有一约 10ｃｍ× 0 5ｃｍ肿物 ,与剑突相连 ,有类似骨膜、骨皮质及骨松质的结构。术后病理检查示 :脂肪结缔组织、部分纤维化…     

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原发于十二指肠的肿瘤较为少见，而十二指肠平滑肌瘤则更为罕见。现结合我院近年来经手术与病理所证实的3例十二指肠平滑肌瘤引起的上消化道出血报告如下，并进行分析讨论。     

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??Surgical strategies of duodenal gastrointestinal stromal tumor??A report of 34 cases WU Xiao-yan, LIU Gang, LIU Jian, et al. Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
Corresponding author: LIU Tong, E-mail: liutonga@126.com
Abstract Objective To explore the clinical features and selective surgical procedures for duodenal gastrointestinal stromal tumor (GIST). Methods The clinical pathological data and follow-up data of 34 cases of duodenal GIST performed surgery from January 2009 to December 2014 in Tianjin Medical University General Hospital were analyzed retrospectively. All the cases were performed surgical resection??including 8 cases of pancreaticoduodenectomy (PD) and 26 cases of limited resection (LR). Related clinical information between PD and LR groups were compared by statistical analysis. Results There was no statistical difference in intraoperative blood loss, tumor size, complication incidence, postoperative recurrence free survival and tumor risk classification between PD and LR group. LR was significantly associated with a shorter operation time and a shorter hospital stay compared to PD [??185±102??min vs.??420±135??min????24±15??d vs.??33±16??d]. The choice for PD depends on the tumor margin away from the position of duodenal papilla and involvement of the pancreas. Conclusion Operative procedure of duodenal GIST depends on the tumor margin away from the duodenal papilla and involvement of the pancreas. If the tumor margin is greater than 2 cm away from duodenal papilla and without pancreatic invasion, LR would be the preferred choice of operative procedure.     

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??Clinical features and diagnosis of parathyroid adenoma with cystic degeneration??A report of 8 cases ZHAO Hai-ying, CUI Yong, ZHOU Yong, et al. Department of General Surgery, Affiliated Shengjing Hospital, China Medical University??Shenyang 110004, China
Corresponding author??LIU Jin-gang, E-mail??liujg@sj-hospital.org
Abstract Objective To evaluate the clinical features and diagnosis of parathyroid adenoma with cystic degeneration. Methods The clinical data of 8 cases of parathyroid adenoma with cystic degeneration and 50 cases of parathyroid adenoma without cystic degeneration performed surgery and identified by pathology between January 2003 and August 2012 in Department of General Surgery, Affiliated Shengjing Hospital of China Medical University were analyzed retrospectively. The serum calcium, serum parathyroid hormone (PTH), parathyroid crisis, lesion size and diagnosis methods between cystic degeneration group and no cystic degeneration group were compared and analyzed. Results There was no difference in serum calcium, serum PTH and incidence of parathyroid crisis between two groups. The mean largest diameter of lesion in cystic degeneration group was ??37.1±13.8??mm, in no cystic degeneration group it was ??23.6±11.4??mm, there was statistical difference between two groups (P??0.01). In all parathyroid adenomas, the sensitivity, accuracy, positive predictive value in ultrasonography, CT and MIBI scintigraphy was 82.1%, 79.3%, 95.8%; 66.7%, 66.7%, 100.0%; 71.4%, 68.2% and 93.8% respectively. There was no statistical difference among the three groups. The sensitivity of ultrasonography in cystic degeneration group was 37.5%, lower than it in no cystic degeneration group (89.6%), there was statistical difference between two groups (P??0.01). Conclusion In both parathyroid adenoma with cystic degeneration group and no cystic degeneration group, the clinical feature is the same. There is no difference in serum calcium and serum PTH, and cystic degeneration does not increase the incidence of parathyroid crisis, while size is larger in cystic degeneration group. When cystic degeneration happened, the misdiagnosis increases, it should use both ultrasonography and MIBI scintigraphy for the diagnosis.     

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目的 探讨血管疾病所致急腹症的诊断和治疗。方法 对1997年6月至2002年8月间经治的15例血管源性急腹症的临床资料进行回顾性分析。结果 以中老年病人为多见，常并存心脏、血管疾病。临床表现差异较大，容易漏诊、误诊。平均确诊时间11h，手术治疗11例，非手术治疗4例，死亡2例，致残l例。结论 重视病史的全面采集，坚持正规的体格检查程序，严密观察病情，正确的临床逻辑思维，恰当的辅助检查，是早期诊断和成功治疗该病的关键。     

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目的 探讨联合血管重建胰十二指肠切除术的适应证和方法。方法 回顾自1994年4月至2001年3月多家协作医院42例联合血管重建胰十二指肠切除术的经验。42例行胰十二指肠切除，其中1例胰头癌累及结肠肝曲合并右半结肠切除。全组均联合肠系膜上静脉门静脉（SMVPV）切除，其中合并肠系膜上动脉（SMA）和肝动脉（HA）切除重建者分别为4例和2例。1例胰头癌因与下腔静脉前壁粘连紧密不能分开则合并下腔静脉前壁部分切除修复。结果 围手术期死亡3例（7.1%）。无胆胰瘘及人工血管感染并发症，病理检查结果：胰腺神经内分泌恶性肿瘤1例，其余均为腺癌，切除血管内膜和胰腺切缘均无肿瘤浸润。失访2例。随访时间3－87个月，7例死于术后7个月至3年，其中6例为合并SMA、HA切除重建者，存活超过3年19例，超过5年6例。其余病例尚在随访中。结论 在选择适宜的病例中施行联合切除血管的胰头癌根治术可提高其切除订，延长病人存活时间。     

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??Transient rise of postoperative bilirubin for hilar cholangiocarcinoma: A report of 175 cases GAN Wei*??YU Wen-long??QIAO Liang??et al. *1st Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital??the Second Military Medical University, Shanghai 200438??China
Corresponding author??ZHANG Yong-jie??E-mail??yjoy005@sina.com
Abstract Objective To explore the change rule of postoperative bilirubin for hilar cholangiocarcinoma??and analysis the influence factors of postoperative serum bilirubin elevation. Methods The clinical data of 175 cases of hilar cholangiocarcinoma admitted from January 2009 to December 2012 in Eastern Hepatobiliary Surgery Hospictal were analyzed retropectively. All the cases were divided into groupA (105 cases of bilirubin declined gradually) and group B (70 cases of bilirubin rising trasiently). The influence factors of postoperative serum bilirubin elevation were analyzed by t-test chi-square test Fisher exact probability test and Keplan-Meier method. Results The postoperative serum bilirubin gradually declined to the normal range in 2 weeks in group A??whereas it reached a peak at the first 4-5 days then declined gradually in group B and still can not return to normal range in two weeks. According to the single factor analysis, blood transfusion, hepatectomy, hepatic liver cirrhosis or not, CA19-9, ALP, preoperative biliary drainage and GGT had statistical differences between two groups??P<0.05??. Multivariate Logistic analysis showed that ALP??OR=0.996??95%CI 0.993-0.998??, CA19-9??OR=2.434??95%CI 1.177-5.037??, blood transfusion (OR=2.274, 95%CI 1.088-4.753), hepatectomy(OR=5.842??95%CI 1.473-23.171?? and hepatic liver cirrhosis??OR=2.690??95%CI 1.192-6.070??were the independent risk factors for the changes of postoperative bilirubin. The hospital stays [(25.1±1.2)d vs. (38.7±2.0)d??t=-5.820] and postoperative complications incidence??9.5% vs. 38.0%, χ2=22.948??had statistical differences??P<0.05??. There was no statistical difference in the prognosis between two groups (median survival time:30 months vs. 26 months, χ2=0.562??P=0.453). Conclusion ALP, CA19-9, the blood transfusion, hepatectomy and liver cirrhosis were the independent influence factors for the transient rise of postoperative bilirubin. The transient rise of post operative bilirubin may increase the risk of postoperative complications,extend hospital stays??but not shorter the life expectancy.     

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??Evaluation on outcomes and reliability of treatment options for splenic arterial steal syndrome after orthotopic liver transplantation:A report of 5 patients ZOU Wei-long*, ZHANG Wei, REN Xiu-yun, et al. *Department of Liver Transplant and Hepatopancreatobiliary Surgery, the General Hospital of Chinese People’s Armed Police Force, Beijing 100039, China
Corresponding author: SHEN Zhong-yang, E-mail: wlzouah@sina.com
Abstract Objective To evaluate the clinical outcomes and reliability of treatment options based on diagnostic timing for splenic artery steal syndrome (SASS) in recipients underwent orthotopic liver transplantation (OLT), and to compare splenic artery coil-embolization (SAE) with other options by efficacy and reliability. Methods The incidence and clinical manifestation of SASS in 191 consecutive patients performed OLT between January 2004 and December 2013 in the General Hospital of Chinese People’s Armed Police Force were analyzed retrospectively. Those patients were suffered from liver cirrhosis combined with splenomegaly, with the ratio of pre-OLT splenic artery (SA) diameter to common hepatic artery (SA/CHA) diameter ≥1.5, but intra-OLT peak systolic velocity (PSV)≥30 cm/s. SAE, re-anastomosis HA to aorta (HTA, SA or abdominal aorta), splenic artery ligation (SAL) or splenectomy (SPT) were performed to cope with SASS depending on occurring time and aftermath of SASS. SAE with other treatments were compared by clinical outcomes and reliability. Results A total of 17 cases out of 191 patients (8.90%) were identified as SASS, and the overwhelming majority of whom (16/17, 94.11%) were detected in 15d early after OLT. The sluggish and dim PSV of the patency hepatic artery increased immediately in the mean PSV from 16.55±2.97 cm/s to 39.34±7.67 cm/s (P??0.001), and resistivity index (RI) of HA rehabilitated to reasonable level(0.5~0.8) after SAE, without any related complication detected. A total of 12 patients with hepatic artery thrombosis secondary to SASS were performed embolectomy or thrombolysis followed by HTA (4 patients), SA ligation (SAL, 3 patients), or splenectomy (SPT, 5 patients), while 3 of them developed requiring re-OLT. All the patients obtained satisfactory results by the salvage strategies, except 2 out of 12 patients died from liver failure. Conclusion SASS is a severe complication after OLT. As an effective salvage intervention to prevent from devastating consequence, coil-emblization of SA shortly after early diagnosis is deserved to be introduced for satisfactory results and reasonable safety.     

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??Diagnosis and treatment of the pancreatitis as an initial manifestation of primary hyperparathyroidism?? A report of 6 cases HE Liang*, ZHANG Hao, ZHANG Ping, et al. *Department of General Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
Corresponding author: ZHANG Hao??E-mail: haozhang@mail.cmu.edu.cn
Abstract Objective To evaluate the clinical characteristics, diagnosis and treatment of the pancreatitis as an initial manifestation of primary hyperparathyroidism (PHPT). Methods The clinical data of 6 cases of the pancreatitis as an initial manifestation of PHPT admitted from February 2009 to March 2013 in Department of General Surgery, the First Hospital of China Medical University were reviewed retrospectively for the diagnosis and treatment strategies. Results Of 6 patients with PHPT, 4 patients complicated with acute pancreatitis and 2 patients complicated with chronic pancreatitis. Four patients with acute pancreatitis presented rapid progression. The serum calcium concentration was higher than 3.5mmol/L and the typical hypercalcemia crisis appeared in 4 patients. Resection of parathyroid adenoma was performed in 3 patients. Two patients were cured and 1 died of drug-induced liver failure. The other one without operation died of hypercalcemia crisis. Two chronic pancreatitis patients with pancreatolithiasis showed mild symptoms. Although the serum calcium concentration was higher than 3.5mmol/L, no hypercalcemia crisis appeared. They were cured after the resection of parathyroid adenoma. One of them presented recurrent pancreatitis during the follow-up period and one patient had no recurrence. Conclusion PHPT should be suspected highly when pancreatitis appeared without common causes, especially combined with normal or elevated serum calcium concentration. Surgery is considered as the most direct and effective way to treat PHPT and could alleviate the symptom of pancreatitis and improve survival rate.