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Objective To evaluate laparoscopic right hepatectomy through the right incisura or the right groove for hepatic benign disease.Methods This study enrolled 32 patients of hepatic benign lesions within the right lobe of the liver including hepatic hemangioma (n =7),hepatic focal nodular hyperplasia (n =2),right intra-hepatic bile duct stones (n =23) with concomitant extra-hepatic bile duct stones in 19 cases.Results Laparoscopic procedures were successful in 28 patients,while 4 patients were converted to laparotomy.Time of operation was 235 to 405 min,time for right hemihepatectomy was (305 ±41) min on average.Time for right hemihepatectomy and biliary tract exploration and removal of stones was (326 ± 48)min on average.The intraoperative blood loss was (573 ±219) ml on average.On postoperative follow-up,patients with hepatic hemangioma and focal nodular hyperplasia had no residual lesions.2 cases suffered calculus residue,residual stones were removed by repeat choledochoscopy with primary stones clearence rate of 91.3％ (21/23).Bile leakage occurred in 3 cases and pleural effusion in 7 cases.The gastrointestinal function recovered (2.8 ± 0.71) days after surgery.The hospital stay was (11.5 ± 2.98) days.28 patients were followed up for (32 ± 8) months.Conclusion The laparoscopic anatomical right hemihepatectomy through the right incisura or the right groove is a satisfactory surgical procedure.
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Objective To evaluate left liver anatomical resection via left vertical groove by laparoscope.Method Among 103 patients with left intrahepatic biliary calculi,39 cases underwent left lateral hepatectomy,20 cases did left liver anatomical resection via left vertical groove by laparoscope,29 cases underwent left lateral hepatectomy via left liver diaphragmatic surface,15 cases did left liver anatomical resection via the first porta.Result In the 103 cases of laparoscopic left liver anatomical resection,101 cases were successful and two cases were conversed to open surgery.In the success group,total laparoscopic anatomical left lateral lobectomy was performed (Ⅱ,Ⅲ section) in 68 cases.Compared with the approach via left liver falciform ligament diaphragmatic surface,the operatve time via left vertical groove was significantly shorter(t =-2.723,P =0.008,intraoperative blood loss was significantly smaller (t =-5.399,P =0.000),while the differences in postoperative hospital stay (t =-0.168,P =0.867) and postoperative complications (x2 =0.664,P =0.415) were of no statistical significance between the 2 groups.In the 33 cases of left hemihepatectomy (Ⅱ,Ⅲ,Ⅳ section),those performed via left vertical groove compared with through the first porta hepatic,used shorter operation time(t =-3.144,P =0.004),while blood loss was similar(t =-1.049,P =0.302),as well as the length of hospital stay(t =0.784,P =0.439).There was no postoperative bleeding and intractable bile leakage,nor postoperative air embolism.Flatus on an average of (2.5 ± 1.2) days.Patients were discharged from hospital 5-17 (9.98 ±2.98) days post-op.96 cases were followed up in the 101 cases undergoing successful total laparoscopic left hemihepatectomy.The followed-up time were 3-52 (32.6 ± 5.7) months.Postoperative review found no residue stone.One case in first porta hepatis group,caudate lobe atrophy was found by postoperative CT.Conclusions Left liver anatomical resection via left vertical groove by laparoscope is less traumatic,quick recovery with satisfactory clinical curative effect for the treatment of left hepatolithiasis.
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Objective To study the feasibility and efficacy of intraoperative choledoscopy combined with laparoscopic left liver resection to treat intrahepatic lithiasis.Method In 49 patients with biliary stone,laparoscopic left lateral sectionectomy/left medial sectionectomy/left hepatectomy combined with intraoperative choledochoscopy and stone retrieval were carried out.Results Laparoscopic left lateral sectionectomy was carried out in 29 patients,left medial sectionectomy in 2 patients and left hepatectomy in 18 patients.In all the patients,combined choledoscopy and stone retrieval were carried out.A concomitant laparoscopic cholecystectomy (LC) was carried out in 11 patients.The average operative time was 226 min.When LC was carried out,the mean operative time was 243 min.The mean intraoperative blood loss was 378 ml.There was no bile leak or postoperative bleeding.Flatus was passed 1-3 days after surgery.The patients were discharged home 7-10 days after surgery.Postoperative MRI/MRCP did not reveal any residual stone.On a mean follow up of 16 months for 47 patients,the patients did well and there was no recurrent stone.Conclusion Choledochoscopy combined with laparoscopic left liver resection for bile duct stone resulted in minimal trauma to the patient.The recovery was quick and there was a high stone clearance rate.The treatment was safe,efficacious,and it is a viable minimally invasive treatment option.
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Objective To focus on the causes and management of complications after laparoscopic cholecystctomy (LC). Methods A retrospective analysis of clinical records of 13 278 patients undergoing LC in this hospital from March 1991 to July 2003 was made. Results Complications occurred in 110 patients (0.83%), involving 19 cases of bile duct injuries (0.14%), 37 cases of bile leakage (0.28%), 31 cases of residual calculi in common bile duct (0.23%), 4 cases of intraabdominal hemorrhage (0.03%), 5 cases of gastrointestinal injury (0.04%), 3 cases of intraabdominal abscess (0.02%), 6 cases of incisional infection or hernia (0.05%) and 5 cases of serious subcutaneous emphysema (0.04%), respectively. Five patients died (0.04%). Conclusions The major complications after LC include bile duct injury, bile leakage and residual calculus. Most of complications are preventable and curable.
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Objective To explore the effect of ulinastatin trypin inhibitor on inhibiting pancreatic secretion and preventing and curing pancreatic fistula in patients underwent pancreatodudenectomy.Methods 45 cases underwent pancreatodudenectomy were not given ulinastatin as control group postoperatively,32 patients underwent pancreatodudenectomy were intravenously driped by ulinastatin 100,000u solution in physiologic saline,every 12 hours (Bid) for 5～8days.Child's pancreatodudenectomy was adopted in all the cases. Results Pancreatic secretion at postoperative 120h in ulinastatin group (138 26?114 74)ml/d were significantly lower than those of control group (248 56?106 75)ml/d (P
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Objective To summarize the experience in prevention and treatment of bile duct injury during laparoscopic cholecysteclomy(LC). Methods Retrospective analysis on the clinical data of 31 cases of LC was carried out. Of them, 27 underwent one stage operative repair and 4 underwent palliative external drainage of the bile duct first. Results 16 cases succeeded and 11 failed in the one stage operative repairing.There were 15 cases underwent 2～4 operations in this series,and the re-operation rate was 48.4%. 29 patients was cured while 2 died. Conclusions During LC, the operative rule should always be strictly observed, and the key to preventing bile duct injury is to avoid clipping, cutting and coagulation blindly.
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Objective To investigate the risk factors leading to complications in patients undergoing laparoscopic cholecystectomy (LC). Methods Clinical data of 11?974 patients undergoing LC from Mar. 1991 to June 2003 were collected and analyzed retrospectively. Fifteen clinical factors were recruited for the study in relation to surgical complications. Data were analyzed by ?2 test and Logistic regression. Results The overall operative complication rate was 1.896%. The procedure was shifted to open surgery in 2.389% of all cases, Logistic regression analysis revealed that Calot triangle adhesion, stage, expertise of the team, gallbladder wall thickness, gallbladder and vicinity adhesion were important risk factors for complications. Conclusion LC complications can be prevented by good training, strictly following protocol, and timely shifting to open surgery.
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Objective To discuss the clinical value of combined antegrade and retrograde technique of laparoscopic cholecystectomy in prevention of bile duct injury.Methods Clinical data of 613 patients who underwent laparoscopic cholecystectomy with combined antegrade and retrograde technique from March 1991 to June 2006 were analyzed retrospectively.Results Cholecystolithiasis with atrophy of gallbladder was found in 121 cases,acute and subacute cholecystitis in 432 cases,cholecystolithiasis with chronic cholecystitis in 42 cases and polyps of cholecyst in 18 cases.Nine cases were converted to laparotomy(5 cases of cholecystolithiasis with atrophy of gallbladder and 4 cases of subacute cholecystitis).The average operation time was 43.5 minutes.Bile leakage occured in only 1 case after operation and fully recovered after 3 days of drainage,and all the other cases had smooth recovery with no bile duct injuries or serious complications such as haemorrhage,infection or death.The mean hospitalization time after operation was 5.5 days.Conclusions The application of combined antegrade and retrograde technique can increase the success rate of laparoscopic cholecystectomy,and reduce the incidence of injuries of bile duct,especially in those patients with inadequate exposure or anatomical variation of Calot′s triangle.
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Objective To evaluate the therapeutic effect of combination of sandostatin and growth hormone (GH) in the treatment of severe acute pancreatitis (SAP ). Methods Sixty patients with SAP were divided randomly into 3 groups:(1)Sandostatin treatment(ST) group (n=15);(2)combination of sandostatin with GH treatment(CT) group (n=30) ;(3)control group (n=15). The changes in serum IL-1, IL-6,TNF-? and albumin levels after treatment, and the incidence of complications, the duration of hospital stay and cost were compared among the 3 groups. Results The complications, mortality, duration of hospital stay in the CT group were significantly shorter than those in ST group and control group (all P