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Objective To investigate the methods for prevention and treatment of unexpected hemorrhage during operation of biliary tract.Methods The clinical data of 28 patients with intraoptrative hemorrhage from Jan.2006 to Dec.2016 in our hospital were retrospectively analyzed.Results The cause of introoperative hemorrhage included:iatrogenic biliary injuries in 14 cases (50％),cholelithasis complicated biliary infection in 9 cases (32.1％),bleeding in gall bladder bed in 3 patients (10.7％),and other causes in 2 cases (7.1％).The intraoperative blood loss was 600 to 3000 ml.According to the specific location of bleeding,the amount of blood loss,the cause of bleeding and other conditions,the individual treatment was given.26 were cured and 2 died of hemorrhagic shock and MODS.Conclusions The major causes of hemorrhage during operation of biliary tract comprise iatrogenic biliary injuries,biliary infection,and biliary lithiasis.The reasonable treatment of intraoperative hemorrhage should be based on the concrete bleeding etiologies.
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Objective To investigate the efficacy of sequential ERCP and laparoscopy for acute biliary pancreatitis (ABP).Methods A total of 80 patients with ABP were randomly divided into 2 groups to receive sequential ERCP and laparoscopy (observation group,n=40) or traditional surgery (control group,n=40).Clinical data including abdominal pain relief time,recovery time of white blood cell,blood amylase and liver function,hospital stay,complication rate and mortality were analyzed.Results ERCP failed in 1 patient in observation group,and the remaining 39 patients (97.5％) were recruited into the study.There were significant differences between 2 groups in regarding of abdominal pain relief time (7.7±2.7 d vs.11.4±3.7 d),recovery time of white blood cell ( 9.7±2.6 d vs.13.3±3.9 d ),blood amylase ( 8.2±2.1 d vs.12.5±3.3 d ),liver function ( 12.5±5.1 d vs.21.3±6.5 d ),hospital stay ( 16.1±5.1 d vs.23.3±7.6 d ) and rate of complication ( 12.8％ vs.30.0％ ).There was no significant difference in morbidity between 2 groups (5.1％ vs.7.5％).Conclusion Sequential ERCP and laparoscopy is effective for ABP.
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Objective To investigate the efficacy of laparoscopic cholecystectomy (LC) for the treatment of patients with cholelithiasis complicating liver cirrhosis. Methods The clinical data of 50 patients with cholelithiasis complicating liver cirrhosis were analyzed retrospectively, who received LC (LC group,23 cases) or open cholecysteetomy (OC group,27 cases). Summarized and compared with operation time, blood loss,length of stay and complications of two groups. Results Operation time,blood loss and length of stay in LC group [(43.2 ± 15.6) min, ( 78.3 ± 22.5 ) ml, (5.7 ± 2.5 ) d] were significantly less than those in control group [(77.4 ±21.2) min, (195.7 ±32.4) ml, (9.3 ±3.2) d.], the differences were statistically significant (P ＜ 0.05). The mainly post-operative complications were dehydration and urinary tract infection, but the incidence rate had no statistically significant difference between two groups (P ＞ 0.05 ).There was no other severe complications and death case occurred postoperation in two groups. Conclusion For patients with cholelithiasis complicating liver cirrhosis in Child-Pugh A and B class, LC is a safe and feasible minimally invasive surgery, it is worthy to be popularized.