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Objective@#To study the clinical outcomes of anatomical hepatectomy combined with intraoperative choledochoscopy in treatment of complicated hepatolithiasis.@*Methods@#The clinical data of 176 patients with complicated hepatolithiasis who underwent operation at the Department of General Surgery of No.960 Hospital of PLA from May 2005 to July 2015 were analyzed retrospectively. The data included general data, clinical manifestations, types of stones, operative methods, postoperative complications and follow-up.@*Results@#There was no perioperative death. The postoperative complications which occurred in 31 patients (17.6%) included lung infection, intra-abdominal infection, bile leakage, and liver failure. Eighteen patients (10.2%) were found to have residual stones. After a follow-up which ranged from 1 to 3 years, 152 patients (94.4%) had good clinical outcomes. Recurrent stones were found in 12 patients (7.5%).@*Conclusion@#Anatomical hepatectomy combined with intraoperative choledochoscopy improved operative outcomes in patients with complicated hepatolithiasis and decreased residual stone and recurrence rates.
ABSTRACT
Objective To study the clinical outcomes of anatomical hepatectomy combined withintraoperative choledochoscopy in treatment of complicated hepatolithiasis.Methods The clinical data of176 patients with complicated hepatolithiasis who underwent operation at the Department of General Surgeryof No.960 Hospital of PLA from May 2005 to July 2015 were analyzed retrospectively.The data includedgeneral data,clinical manifestations,types of stones,operative methods,postoperative complications andfollow-up.Results There was no perioperative death.The postoperative complications which occurred in 31patients (17.6％) included lung infection,intra-abdominal infection,bile leakage,and liver failure.Eighteen patients (10.2％) were found to have residual stones.After a follow-up which ranged from 1 to 3years,152 patients (94.4％) had good clinical outcomes.Recurrent stones were found in 12 patients(7.5％).Conclusion Anatomical hepatectomy combined with intraoperative choledochoscopy improvedoperative outcomes in patients with complicated hepatolithiasis and decreased residual stone and recurrencerates.
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Laparoscopic cholecystectomy is the gold standard for the treatment of gallstones and chronic cholecystitis.A patient with gallstone was admitted to the 88th Hospital of PLA in August 2012 and received laparoscopic cholecystectomy.She had bile leakage after operation,and had to accept reoperation.Pancreaticobiliary maljunction and aberrant duct upon gallbladder bed were found postoperatively by T-tube cholangiography and pancreatic amylase test in the bile,which led to a complicated treatment and a tortuous recovery.This article analyzed the treatment process for this disease and explore the proper diagnosis and treatment.
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Objective To explore the clinical characteristics of periampullary carcinoma in the prejaundice stage and improve early diagnosis rate and operative effects.Methods Clinical data of 27 cases with periampullary carcinoma in the prejaundice stage in our institute during the period of Jan 1998 to Dec 2005were analyzed retrospectively.Results The clinical symptom was mostly nonspecific, mainly included abdominal discomfort ( 92.6% ), abdominal pain ( 55.6% ), and irregular fever ( 29.6% ).The positive diagnosis rate with US, CT, MRCP, ERCP and EUS was 75.6%, 85.2%, 83.3%, 84.6%, and 88.9%,respectively, and they were helpful for early diagnosis.Among these 27 patients, 19 cases received regional pancreaticoduodenectomy, and 5 cases received pancreaticoduodenectomy in combination with vessel resection,3 cases received bile duct or gallbladder jejunal Roux-en-Y anastomosis, the overall resection rate was 88.9% with no operative mortality, and the post-operation complication rate was 7.4%.The 1,3, and 5 year survival rates were 100%, 70.8% and 41.7%, respectively.Conclusions The periampullary carcinoma in the prejaundice stage has its own clinical characteristics and abnormal image changes.If the diagnosis can be confirmed in the prejaundice stage, it is still an important method to improve the resection rate and prognosis.
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Objective To summarize the experience of surgical treatment of chronic pancreatitis (CP) and improve the operative efficiency Methods The clinical data of 138 CP patients under going surgical treatment in this hospital from March 1992 to May 2002 were analyzed retrospectively Results Relapsing upper abdominal pain was the major symptom of CP All patients were treated surgically, in which pancreatic fistula developed in three patients and anastomotic hemorrhage in two postoperatively The morbidity rate was 3 6% Pain was relieved in 97 8% patients One hundred and twenty four patients (89 9%) were followed up for 1～9 years (mean 4 9 years) Recurrence was seen in 13 patients (9 4%) Seven patients developed diabetes mellitus and five occurred fat diarrhea during the follow up Five patients died with two dying of CP complications Conclusion Timing of operation and selection of operation modality are of critical importance in modifying the course of the disease and improving life quality of patients
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Objective To summarize the experience of the diagnosis and treatment of mass-type chronic pancreatitis(MTCP) to improve the knowledge about MTCP. Methods The clinical data of tweent-five patients with MTCP undergoing operation in recent 8 years were analyzed retrospectively. The positive discovery rates with computed tomography(CT),ultrasonography(US),endoscopic retrograde cholangiopancreatography(ERCP),and endoscopic ultrasonography(EUS) were 95.7%,85.7%,83.3%,and 100%,respectively. All patients received operation,including pancreatoduodenectomy(15 cases),pancreatoduodenectomy with reservation of pylorus(2 cases),Beger′s procedure(1 case),Frey′s procedure(3 cases),and resection of pancreatic body and tail(4 cases). Results Upper quadrant abdominal pain is the main symptom of MTCP. Pancreatic masses were located in the head of pancreas in 21 cases(84.0%),in the body or tail in four cases(16.0%). 16 patients were diagnosed as MTCP and 9 diagnosed as pancreatic adenocarcinoma before operation. 22 patients were diagnosed as MTCP and 3 were diagnosed as chronic pancreatitis complicated with adenocarcinoma by pathology after operation.Preoperative misdiagnosis rate was 24.0%. Pain relieved immediately after operation in 92.0% of patients. One patients developed pancreatic leakage and two had anastomotic hemorrhage postoperatively,morbidity rate was 12.0%. 23 patients were followed-up for 1-5 years (mean 3.4 years). The therapeutic outcome was satisfactory in 82.6% of patients. Conclusions Operation should be performed as early as possible when the MTCP is diagnosed. It is effective to delay the progress of the disease.