ABSTRACT
Objective To investigate the diagnosis and surgical treatment of chronic acalculous cholecystitis characterized by absence of gallbladder wall contractability. Methods The clinical data of 42 patients with chronic acalculous cholecystitis in our hospital from January 2006 to December 2008were analysed. The patients were grouped into two groups: laparoscopic cholecystectomy (LC) group in 20 and non-surgical group in 22. The patients' symptoms on follow-up in the two groups were compared. Results The 42 patients with chronic acalculous cholecystitis were diagnosed by symptoms,ultrasound, fatty meal gallbladder contractability studies under ultrasound, fiber optic gastroscopy and magnetic resonance cholangiopancreatography (MRCP). In all patients, there was a complete absence of gallbladder wall contractability. In the LC groups, 20 patients received LC. 18 patients were followed up, and there were no symptoms. Two patients were lost to follow up. In the non-surgical group, 22 patients received non-surgical treatment. In 21 patients who were followed up, 19 patients had symptoms. One patient was lost to follow up. There was a significant difference between the LC group and the non-surgical group (P＜0.05). Conclusions Chronic acalculous cholecystitis characterized by absence of gallbladder wall contractability could be diagnosed by symptoms, ultrasound, fatty meal gallbladder contractability studies under untrasound, and MRCP. The optimal treatment of chronic acalculous cholecystitis characterized by absence of gallbladder wall contractability is LC.
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Objective To study the etiology and the management of postcholecystectomy syndrome (PCS). Methods A review of 148 cases of PCS was made. Results Positive signs existed in 111 cases. Seventy-eight cases underwent operations with complete cure in 74 cases and improvement in 4 cases, whereas the other 70 cases received conservative therapies with complete cure in 9 cases, improvement in 48 cases and no change in the remaining 13 cases. Conclusions PCS is a series of symptoms with complicated reasons. Prevention should be put first.
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ObjectiveTo study the significance of the change of serum nitric oxide(NO) level in the obstructive jaundice(OJ) patients complicated with renal dysfunction. MethodsWe studied the level of NO,BUN.Cr inserum and the activity of NOS in 25 OJ patients with renal dysfunction and 26 healthy adults (control group). ResultsThe patients' serum NO level and the activity of NOS were significantly lower than those in control group( P
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Objective To observe the outcome and consequential treatment during recovery of patients with severe acute pancreatitis (SAP) after non operative treatment.Methods The data of the follow up for 1 to 12 years in 41 cases of SAP with pseudocyst of pancreas, recurrent pancreatitis, chronic abdominal pain and gallbladder stones examined with CT, ERCP, laparotomy or pancreatic tissue biopsy from 3 months to 2 years were retrospectively analyzed. Results Pseudocyst of pancreas was the main complication of SAP after non operative treatment. The absorption of necrotic tissues of pancreas and proliferation of fibrotic tissue took a slow course of 3 to 6 months. The long term excellent curative rate was 73.2% and the rate of abdominal pain or maldigestion was 24 4%. One patient died of recurrent pancreatitis (2 4%). Conclusions More attention should be paid to treating pseudocyst of pancreas, resecting the gallbladder stones in time and preventing or treating recurrent pancreatitis after the recovery from SAP.
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Objective To explore a new surgical approach to intrahepatic segmental bile ducts.MethodSurgical anatomic relationships between intrahepatic bile ducts and blood vessels in 30 adult liver specimens were studied.Results Left and right hepatic bile duct lie to the superior anterior board of the left and right trunk of the portal vein; left medial and right anterior segmental duct lie to the anterior medial edge of corresponding portal vein branches. Right posterior segmental duct lies on the visceral side of right anterior portal branches in 73%(22/30). and on the visceral side of posterior right branches in 80%(24/30). Left lateral segmental duct lies in the deep visceral side of sagittal portion of left portal vein in 93%(28/30).A new combined operational routes getting to segmental ducts from both visceral and diaphragmatic faces were designed to treat 38 patients with multiple intrahepatic calculis.Conclusion Combined operational routes from both visceral and diaphragmatic facies can easily expose and cut open intra and extra hepatic ducts and the strictures, removing calculi.
ABSTRACT
11 cases of biliary-intestinal fistula were reported, among which there were 8 cases of cholecyotoduodeno-fistula. 2 casses of choledocho-duodenofistula and 1 case of choledocho-duodeno-papillary-fistula.The diagnosis of the disease depends mainly on X-ray photography of liver barium meal, duodenum endoscope and ERCP. Operation is the chief method for treatment. Cholecytoduodeno-fistula can be treated by resecting gallbladder and repairing duodenum fistula cavity. Choledocho-duodeno-fistula can be treated by enlarging the cavity or performing biliary tract-jejunum" Roux-cn-Y" anastomosis, the results are satisfactory.