Objective To discuss the effect and prognosis of the Da Vinci surgical system assisted surgical treatment for complex hepatolithiasis. Methods The clinical data of 15 patients with complex calculus of intraheoatic duct who accepted surgical therapy at General Hospital of the Second Artillery Corps of PLA from January 2009 to August 2011 were analyzed retrospectively. Results All operations of 15 patients were performed successfully, no case of converting to laparotomy， no injury of the important blood vessels and organs in surgical procedures. Postoperative complications occurred in 4 cases （26.7%）. Among them, there were 1 case （6.7%） of hemobilia, 1 case （6.7%） of lung infection, 2 cases （13.3%） of liver surface bleeding, and no case of death and liver failure occurred during the perioperative period. All patients （100%） had follow-up visited with a median time of 11 months （ranging from 3 months to 2 years）, 12 cases （80.0%） acquired good curative effect, 3 cases （20.0%） of residual stones were found, 1 case （6.7%） of recurrence stones were found. Conclusion There are enormous potential for Da Vinci surgical system assisted surgical treatment of complex hepatolithiasis, which can be used in elderly patients，and patients with multiple surgical history, poor liver function, acute cholangitis, and so on.
Objective To investigate the influence of diammonium glycyrrhizinate (DG) on the expression of NF-κB and neuron apoptosis after spinal cord ischemia-reperfusion injury in rats. Methods Fourty-eight healthy SD male rats, weighing 220-270 g, were randomly divided into the experimental group and the control group, with 24 rats in each group. A model of spinal cord ischemia-reperfusion injury was completed by intercepting the rats’ abdominal aorta between right and left renal arteries for 30 minunts. In the experimental group, each rat was injected 20 mg/kg DG via subl ingual vein 10 minutes before ischemia occurred. Equal qual ities of physiological sal ine were injected into the rats in the control group. The two groups were observed at 3, 24, 72 and 168 hours after ischemia-reperfusion, respectively. Lumbar myeloid tissues were prepared at the different times, respectively. The expression of NF-κB p65 in lumbar myeloidtissues was analyzed by immunohistochemistry and the apoptosis of neurons was examined by TUNEL reaction. Meanwhile, histological changes of spinal cord were observed by HE staining. Then the correlation between NF-κB and neuron apoptosis was analyzed. Results HE staining showed obvious histological changes of spinal cord of the two groups. In the control group, myeloid tissue edema and normal neurons were observed at 3 hours; there were more histological changes at 24 hours and 72 hours; vacuolus in gray matters and some survived neurons were seen at 168 hours. The histological changes at each time in the experimental group were fewer than those in the control group. The immunohistochemical staining showed that the expression of NF-κB p65 was observed. After ischemia-reperfusion, the expression strengthened at 3 hours, reached the peak at 24 hours and then weakened slowly. At 3, 24, 72 and 168 hours after ischemia-reperfusion, the absorbency (A) value of NF-κB p65 in the experimental group was 0.306 0 ± 0.024 4, 0.396 4 ± 0.022 7, 0.296 6 ± 0.021 1 and 0.267 9 ± 0.015 3, respectively, and that in the control group was 0.361 1 ± 0.017 7, 0.496 6 ± 0.020 1, 0.356 3 ± 0.021 0 and 0.301 4 ± 0.018 1, respectively. There were significant differences between the two groups (P lt; 0.05). The inhabitation ratio of NF- κB p65 expression by DG was 15.40%, 20.17%, 19.28% and 11.11% at 3, 24, 72 and 168 hours after ischemia-reperfusion, respectively. Neuron apoptosis was observed, which strengthened at 3 hours and was the most serious at 24 and 168 hours after ischemia-reperfusion. At 3, 24, 72 and 168 hours after ischemia-reperfusion, the A value of neuron apoptosis in the experimental group was 0.171 0 ± 0.029 1, 0.175 5 ± 0.031 1, 0.175 1 ± 0.027 9 and 0.183 2 ± 0.023 7, respectively, and that in the control group was 0.236 8 ± 0.063 6, 0.241 2 ± 0.042 6, 0.201 5 ± 0.049 8 and 0.250 1 ± 0.048 4, respectively. There were significant differences between the two groups (P lt; 0.05). The inhabitation ratio of neuron apoptosis by DG was 27.79%, 27.23%, 13.08% and 26.74% at 3, 24, 72 and 168 hours after ischemia-reperfusion, respectively. The expression of NF-κB in myeloid tissues was positively correlated with neurons apoptosis in the two groups (r = 0.838, P lt; 0.01). Conclusion Spinal cord ischemia-reperfusion injury may cause a marked expression of NF-κB and notable evidence of neurons apoptosis. DGcan reduce neurons apoptosis by inhibiting the expression of NF-κB.
Objective To summarize the clinical experience of da Vinci surgical system in treatment for senile patients with severe obstructive jaundice．Methods From January 2009 to May 2011, 209 patients with hepatopancreatobiliary （HPB） diseases underwent robotic surgeries by using da Vinci surgical system. Forty-seven senile patients with severe obstructive jaundice were selected for robotic surgery （robot group） and 44 for open surgery（open group）.The distribution of disease, pro-, intra-, and post-operative data in the two groups were analyzed. Results Baseline of two groups was same. A total of 46 patients had underwent total robotic surgeries （97.87%，46/47） and 1 patient converted to hand-assisted procedure （2.13%，1/47）. Surgeries included all HPB difficult surgical procedures, also including 1 case of hilar cholangiocarcinoma patient who had high level serum bilirubin （375μmol/L）and underwent emergency resection for hilar cholangiocarcinoma and portal-jejunal Roux-en-Y anastomosis． Postoperative complications occurred in 7 cases （14.89%, 7/47） and 1 case died （2.13%, 1/47） . Three-month survival rate was 78.15%. Fifteen-day and 3-month after surgery, physical strength score was 42.87±18.61 and 58.51±23.86, respectively. The total length of abdominal incision was （6.30±1.70） cm. All the patients in the open group completed surgery, including emergency operation in 4 cases. Postoperative complications occurred in 13 cases （29.55%, 13/44） and 2 cases died （4.55%, 2/44）.Three-month survival rate was 72.36%. Fifteen-day and 3-month after surgery, physical strength score was 37.15±13.64 and 45.27±18.96, respectively. The total length of abdominal incision was （26.73±3.07） cm. There were significant differences of postoperative complications, postoperative 15-day and 3-month physical strength score, and incision length between two groups（P＜0.05）. Conclusions da Vinci surgical system is safe and effective in treatment for senile patients with severe obstructive jaundice.
Objective To investigate the effects of lycium barbarum polysaccharide (LBP) on the formation of traumatic neuroma and pain after transection of sciatic nerve in rats. Methods Forty Sprague-Dawley (SD) rats, weighing 200-220 g, half male and half female, were allocated into 2 groups randomly: LBP group and control group (n=20 per group). The right sciatic nerves were transected and 2 cm sciatic nerve were removed in all rats of the 2 groups. LBP were intraperitoneally injected in a volum of 10 mg/(kg·d) in the LBP group, while the same volum normal sal ine (NS) in the control group for 28 days. The deficiency of toenail and toe were observed to estimate the autophagy of the operated l imb. Light microscope and transmission electron microscope were used to observe the formation of traumatic neuroma aftertransection of sciatic nerve. Results Autophagy was observed in 5 rats (25%) of LBP group and in 12 rats (60%) of controlgroup at 4 weeks, showing significant difference (P lt; 0.05). Neuroma formed in 8 rats (40%) of LBP group and in 16 rats(80%) of control group, showing significant difference (P lt; 0.05). The observation of l ight microscope showed that there were unorganized growth cells in the neuroma, infiltrated muscle cells, the regeneration of axons and ensheathing cells to form small patch and funicular structure in the control group, while in the LBP group there were less prol iferation of nerve fibers with a regular arrangement. Transmission electron microscope showed that there were lots of axons in nerve tumour, more fusoid fibroblasts, more collagen fiber, and hyperplasia and degenerated myel in sheath in the control group, while in the LBP group there were less myel in sheath in the proximal end of injuring nerves, less Schwann cells and fibroblasts, and sparsed collagen fibers. Conclusion LBP can inhibit autophagy and the formation of traumatic neuroma after transection of sciatic nerve in rats.