ABSTRACT
Objective To evaluate the clinical efficacy and outcomes of percutaneous cholecystostomy(PC) under type-B ultrasonic guide as an alternative treatment option for critically ill patients of acute cholecystitis.Methods The clinical data of 53 high-risk patients of acute cholecystitis were retrospectively analyzed,who received PC from January 1999 to August 2005.Results All cases were successfully punctured and intubated,and 4 received reoperation because of blocked tube or fall-off.Fifty-two(97.3%) gained bile drainage effectively.No complications occurred due to the procedures in the cholecystostomy and intubation.One patient required emergency cholecystectomy on day 1 after the procedures because of deteriorating conditions.Forty-one accepted selective cholecystectomy in 2 weeks to 3 months after cholecystostomy.The follow-up period was 6 months to 3 years.Conclusion PC is an effective,convenient and safe method in managing acute cholecystitis in high-risk patients,with high achievement ratio and less complications.
ABSTRACT
Objective To evaluate the effect of surgical treatment for primary hepatocellular carcinoma(HCC) with bile duct thrombi(BDT).Methods Eleven cases were diagnosed as HCC with BDT by B ultrasound,CT,MRCP or ERCP.Hepatectomy and choledochotomy were performed,resecting the primary tumor and cleaning the BDT completely,followed with TACE.Results No patients died during operation.The survival time of 9 patients who received hepatectomy and BDT clearance ranged from 3 to 38(average 18.5) months,and that of the other two patients received TACE and BDT clearance survived 6 and 11 months respectively.Conclusion Accurate diagnosis and radical hepatectomy with complete BDT clearance are effective treatment for HCC with BDT.
ABSTRACT
Objective To investigate the cause and therapeutic principle of bile leakage after cholecystectomy.Method Materials of 12 cases of bile leakage in 1516 cases of cholecystectomy have been summarized and analyzed from January 1992 to December 1999.Results The incidence for bile leakage was 0.79%(12/1516).Causes of bile leakage included injury of bile duct in 2 cases,injury of liver tissue that the gallbladder was embedded in 7 ,leakage of stump of cystic duct, pentrating injury of common bile duct,and remain of gallbladder mucose in one each.10 cases underwent conservative therapy, 2 cases received reoperation, all were cured. Conclusions Bile leakage is related to anatomy, pathology and operation, malpractice was main cause for bile leakage.Therapeutic plan would be selected according to cause and amount of bile leakage.