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[Objective] To investigate the therapeutic status of laparoscopic management for gallbladder stones and common bile duct stones. [Methods] A Retropective study were adopted to analysize the therapeutic scheme,effect for patients with gallbladder stones and common bile duct stones who were treated from January 1996 to September 2004. [Results] 68 cases were diagnosed, and most of them underwent single stage laparoscopic cholecystectomy (LC) and common bile duct exploration (LC BDE). A few of them were treated through endoscopic procedure in combination with LC, or open surgery when the minimal invasive surgery failed. [Conclusions] Both them indicated that patients by LC+LCBDE have shorter hospital stay, easier recovery and less complications. LC+LCBDE has obvious advantage over the other methods with appropriate operative time and high success rate. For choledochlithiasis patients, the single laparoscopic management should be a better, major option.
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Objective To discuss surgical techniques of laparoscopic treatment for intrahepatic stones.Methods A total of 57 cases of intrahepatic stones from March 2000 to March 2005 were studied. Under laparoscopic visualization,openings of left and right hepatic bile ducts were exposed through a longitudinal incision in the common hepatic duct to the bifurcation of left and right hepatic ducts.Stones in left and right hepatic bile ducts were evacuated with the use of a lithotomy forceps,a tiny basket,or pressure irrigation.Then openings of secondary hepatic ducts were exposed through the dilated primary ducts for the removal of stones in secondary hepatic ducts.Sometimes even openings of tertiary hepatic ducts could be seen for stone removal.When mud-or sand-like calculi were encountered,repeated irrigation of bile ducts was carried out.Results Conversions to open surgery were required in 3 cases(3/57,5.3%).The time of operation was 75～275 min(136?54 min).Residual stones were found in 49 cases(49/57,86.0%),which required postoperative choledochoscopy for 1~4 times to clear the intrahepatic stones.Complete clearance of all intrahepatic stones was achieved in 53 cases(53/57,93.0%).In 2 cases of calculi impacted in the lower common bile duct,laparoscopic electrohydraulic lithotripsy was performed for stone extraction.Postoperative bile leakage occurred in 5 cases(5/57,8.8%),and was cured with tube drainage.Follow-up observations for 0.5~5 years(2.3+1.5 years) in 43 cases showed excellent outcomes in 38 cases(88.4%),good outcomes in 3 cases(7.0%),and poor in 2(4.6%).Conclusions Intrahepatic stones can be removed laparoscopically through a longitudinal incision in the common hepatic duct to the bifurcation of left and right hepatic ducts for the exposure of primary and secondary hepatic ducts,or even tertiary hepatic ducts.
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Objective To explore the expression of heat shock protein 90?(HSP90?)in colon carcinoma tissues and HCT-8 cell line,and to investigate the relationship of HCT-8 cells to chemoresistance.Methods The expression of HSP90 ? in colon carcinoma tissues was detected by immunohistochemistry and the relationship of HSP90? expression with the Dukes stage and pathological grade was analyzed,The medium effective concentration(IC50)of vincristine(VCR)to colon cancer parent cells HCT-8 and drug resistance cells HCT-8/VCR was detected by MTT method.The expression difference of HSP90?mRNA in of HCT-8 cells and HCT-8/VCR cells was detected by RT-PCR to investigate its relationship to the chemoresistance.Results The positive expression rate of HSP90 ? was higher in colon carcinoma tissues(41.67%)than non-cancerous colon tissues(16.67%)(P0.05).The drug resistance of HCT-8/VCR cell line to VCR was significantly higher than that of HCT-8 cell line(P
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Objective To inverstigate the effect and safety of refractory intrahepatic and extrahepatic bile duct stones treated by choledochoscope holmium laser combined with electrohydraulic lithotripsy.Methods The cllnical data of 67 cases of postoperative intrahepatic and extrahepatic bile duct stones treated with combined endoscopic holmium laser and electrohydraulic lithotripsy were analysed retrospectively.Results After 1 to 7 times of biliary endoscopic holmium laser electrohydraulic lithotripsy treatment,65 patients had complete removal of all residual stones with the success rate of 97%,and without complications.Conclusions After holmium laser combined with electrohydraulic lithotripsy,the effect of choledochoscopic removal of intrahepatic and extrahepatic bile duct residual stones can be greatly improved It is a safe method for treatment of refractory intra-and extra-hepatic bile duct stones.