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Vascular injury is a severe complication when combined with biliary injuries in laparoscopic cholecystectomy. The most frequent injury is damage to the right branch of the hepatic artery. The incidence ranges between 6. 7% and 61.1%. When bile duct transection is combined with vascular injury, the clinical course is complicated by liver ischaemia or necrosis, biliary stricture, and liver lobar atrophy which sometimes necessitating liver resection or even transplantation. Reconstruction of vascular injury is helpful when the injury is identified early.
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To investigate the cause of donor death in living donor liver transplantation(LDLT), we reviewed all published articles in English on LDLT from the Foreign Medical Journal Full-Text Service (FMJS) and searched the literature for donor deaths before 2008. We identified 12 donor deaths. The rate of donor death is 0.2%. Any donor death would be a catastrophe for the donor's family and for the medical team. It is imperative to avoid donor death in LDLT.
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Objective To explore the effects of CO2 pneumoperitoneum on pancreatic function in diabetic rabbits. Methods Forty-eight rabbits were divided into 4 groups: control group (the group of N0, n=4), the group of T0 (n=4), the group of T10 (n=20), and the group of T15 (n=20). The animal used in the groups of T0, T10 and T15 was diabetic rabbit, and the pressures of pneumoperitoneum of the three groups were 0 mm Hg, 10 mm Hg and 15 mm Hg respectively.The model of diabetic rabbits were made through intrvenous administration of Allxon. Arterial blood samples were collected before the onset of CO2 pneumoperitoneum, 0, 2, 6, 12 hours after deflation for measuring blood glucose, amylase, insulin and C-peptid. Then the rabbits were sacrificed and their pancreases were removed for measuring SOD activity and MDA content. Results After abdominal deflation, the blood glucose, amylase, insulin, C-peptid, MDA content were significantly increased (P
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0.05).Conclusion Under atherosclerosis conditions,CO_2 pneumoperitoneum has an adverse influence on the blood flow of the common carotid arteries which may be associated with increased intra-bdominal pressure,absorbed CO_2 gas.
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Objective To investigate the influence of CO_2 pneumoperitoneum on intestinal mucosa permeability in rats with liver cirrhosis.Methods Fifty rats were randomly divided into following groups: control group(n=5),cirrhosis group(n=5) and pneumoperitoneum group(n=40);the pneumoperitoneum group was further divided into 8 mm Hg group(n=20) and 13 mm Hg group(n=20).Four time points were chosen,including 0.5,2,6,and 12 hours after the end of pneumoperitoneum.After rat models with cirrhosis were established successfully,the abdominal cavity was insufflated with CO_2 and maintained under the pressures of 8 mm Hg and 13 mm Hg respectively for two hours.The portal venous blood was collected and the levels of D-lactic acid and endotoxin were measured.Results The levels of endotoxin and D-lactic acid in cirrhosis group were much higher than those of control group(P0.05).Conclusion The intestinal mucosa permeability is increased in rats with liver cirrhosis.It can be further increased under CO_2 pneumoperitoneum with certain pressure and time and in a pressure-dependent manner.The permeability can decrease after removal of pneumoperitoneum.
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<p><b>OBJECTIVE</b>To evaluate the role of laparoscopic ultrasonography(LUS) in prevention of bile duct injury(BDI) and residual common bile duct (CBD) calculi during complicated laparoscopic cholecystectomy (LC).</p><p><b>METHODS</b>One hundred and four cases of LC were defined complicated because of anatomic aberrance of the extrahepatic biliary system, unconfirmed exposed cystic duct, suspected CBD calculi or BDI, adhesion or inflammation in the Calot's triangle, acute cholecystitis, and atrophic gallbladder. LUS was performed to scan the extrahepatic bile duct. LC was carried out with assistance of the LUS.</p><p><b>RESULTS</b>Assisted with the LUS demonstrated anatomic relationship between the extrahepatic bile duct and cystic infundibulum or cystic duct, 85 cases of LC were accomplished successfully. 19 were converted to open cholecystectomy because of LUS-indicated potential risk of BDI, CBD calculi, and suspected BDI.</p><p><b>CONCLUSIONS</b>With the extrahepatic bile duct visualized by LUS and contrast of the cystic infundibulum and cystic duct, operators can precisely identify the anatomic relationships between the cystic infundibulum, cystic duct and extrahepatic bile duct. Preoperatively unpredicted choledocholithiasis may be recognized.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bile Ducts, Extrahepatic , Diagnostic Imaging , Cholecystectomy, Laparoscopic , Methods , Cystic Duct , Diagnostic Imaging , Postoperative Complications , UltrasonographyABSTRACT
Objective To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods CEPP experiences of 1046 patients in 6600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results Of the 1046 patients, 1028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.
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Objective To investigate the effects of CO 2 pneumoperitoneum during laparoscopic cholecystectomy (LC) on pulmonary functions in chronic pulmonary failure rabbits and their mechanisms. Methods A total of 50 healthy male rabbits ( oryctolagus cuniculus ) were randomly divided into 4 groups: normal control group (N 0: n=5, no pneumoperitoneum), experimental control group (T 0: n=5, no pneumoperitoneum), 10 mmHg experimental group (T 10 : n=20, 10 mmHg pneumoperitoneum) and 15 mmHg experimental group (T 15 : n=20, 15 mmHg pneumoperitoneum). After the successful establishment of emphysema rabbit models, CO 2 pneumoperitoneum was conducted and maintained for 2 hours at the pressure of 10 mmHg (1.33 kPa) and 15 mmHg (2.00 kPa), respectively. Pulmonary functions (total respiratory resistance, central resistance and total airway resistance) of the 4 groups were measured by pulse oscillation technique before and after the pneumoperitoneum, respectively. Results Total respiratory resistance, central resistance and total airway resistance increased after the establishment of emphysema models. And they decreased at the end of pneumoperitoneum compared with those before pneumoperitoneum ( q=17.824, P
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ObjectiveTo compare the hospital charges incu rred for laparoscopic cholecystectomy (LC) and open cholecystectomy (OC).MethodsT he authors selected 100 cases of LC and 100 cases of OC of 1991 (initial per iod of LC) and 2000 (mature period of LC), respectively. Comparisons on hospital charges be tween the two procedures of both periods were made. ResultsT hat total charges of LC (2575 86?261 61)yuan were significantly higher than those of OC (1240 61?382 67)yuan ( t =28 805, P
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Objective To investigate the reasons for the changes of serum ALT, AST after laparoscopic cholecystectomy. Methods 69 patients admitted in Oct, 1999 were randomly divided into two groups. The gallbladder was resected with monopolar cautery laparoscopically and cystic bed was routinely coagulated in 35 patients, group a. The gallbladder was removed with microscissors and the cystic artery was clipped with titanium clip in 34 patients, group B. Hepatic tissue in bulk of 1cm X 1cm and close to the gallbladder bed was sampled for histological study for all patients in the two groups. The serum ALT and AST levels were measured on the 1st, 5th ,postoperative day. Results Comparing with group B, the serum ALT and AST levels in group A were significantly higher on the 1th postoperative day ( P
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Purpose: To explore the autocrinism of vascular endothelial growth factor ( VEGF) in human hepatocellular carcinoma cell and its significance. Methods: The expression of VEGF receptors was analyzed by reverse transcription-polymerase chain reaction (RT-PCR) in human hepatocellular carcinoma cell lines SMMC7721, HHCC and HepG2 in vitro. The expression of VEGF in human hepatocellular carcinoma cells was inhibited by synthetic antisense oligodeoxynucleotide (ODN). Phenotypic alterations in human hepatocellular carcinoma cells by antisense reduction of VEGF expression were observed. And the alterations for expression of VEGF receptors in human hepatocellular carcinoma cell membranes were analyzed by flow cytometry. Results: Flt-1 was expressed faintly in SMMC-7721 cell whereas KDR was expressed in HHCC cell and HepG2 cell in vitro. Compared to control, antisense ODN against VEGF inhibited HHCC cell proliferation in vitro in a dose-dependent manner and had no effects on SMMC-7721 cell and L929 cell. When the concentration of antisense ODN was 2.5 ?mol/L,5 ?mol/L and 10 ?mol/L, the proliferation of HHCC cell was inhibited by 26%, 41 % , and 50% respectively. Compared with control, flow cytometry analysis showed a decrease in cell number in S phase and a pre-apoptosis peak in HHCC cell treated by antisense ODN. There was no alteration of cell cycle in SMMC-7721 cell. The positive rate of KDR expression in HHCC cell membrane was 19. 2%, 29. 8% and 31. 2% in the antisense ODN, sense ODN and control groups, respectively. The expression of KDR in HHCC cell membrane was markedly inhibited by antisense ODN against VEGF compared with the control group, as measured by flow cytometry. There was no alteration for expression of Flt-1 in SMMC-7721 cell membrane. Conclusions: VEGF produced by human hepatocellular carcinoma cells acts directly upon human hepatocellular carcinoma in an autocrinal manner and may promote the proliferation and differentiation of human hepatocellular carcinoma cells via the activation of the KDR-dependent signaling pathway.
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The pneumoperitoneum may reduce the renal blood flow which was demonstrated both in experimental and clinical research. Greater change could be seen as the pressure of pneumoperitoneum increased,which may induce lower GFR, decrease urine output ,increase the level of plasma Scr?BUN and so on.All these changes were related to the variety of hemodynamics?nerval-endocrine factors releasing?body position and sorts of insufflated gas.Ischemia-reperfusion injury also is an ignorable factor. Pneumoperitoneum may influence the kidney function , which is reversible under certain pressure and operating time,and were concerned with multiple mechanism. More obvious damage to the dysfunctional kidney could occur under high pressure of pneumoperitoneum.
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Objective To investigate the feasibility and ways of closed establishment of pneumoperitoneum for laparoscopic procedures in patients with a history of abdominal surgery. [WT5”HZ]Methods[WT5”BZ] Between September 1991 and December 1998, 963 patients with a history of abdominal surgery received closed establishment of pneumoperitoneum. The difficulties with closed establishment were classified as false and real types. Veress needle penetrating into falciform ligament, mesentery, great omentum or retroperitoneal fat tissue caused false difficulty, while the difficulty due to Veress needle penetrating into abdominal viscera or because of extensive adhesion was known as real difficulty.[WT5”HZ] Results[WT5”BZ] 18 cases for false and real difficulty were transfered to open surgery.Two cases suffered visceral injuries for laparoscopic cholecystectomy, including jejunum and ileum injuries in one each case. The occurrence rate of visceral injuries accounted for 0 2% in this group.[WT5”HZ] Conclusion[WT5”BZ] This result demonstrates that closed establishment of pneumoperitoneum is safe and feasible in most patients with abdominal operative history. Abiding by the rule of closed establishment pneumoperitoneum and conversion to laparotomy in time in real difficulty is important to avoid visceral injuries.
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Objective To report a randomized trial in comparing the clinical outcomes of three-port LC versus standard four-port LC. Methods From March 2001 to August 2004, four hundred consecutive patients who underwent elective LC were randomized to receive either the three-port or the four-port technique. All patients were blinded to the type of operation they underwent. Postoperative overall pain and incisional pain at different sites were assessed on the first day after surgery using the Prince-Henry scale. Other outcome measures included length and success of the operation, analgesia requirements, postoperative complications, postoperative stay, and the cosmetic results. Results There was no difference between the two groups in age, sex, weight or other diseases. In terms of outcome, patients in the three-port group had less pain at individual subcostal port sites and better cosmetic results. Success rate, mean operative time, complications, subxiphoid port and overall pain score, analgesia requirements, and postoperative hospital stay were similar between these two groups. Conclusion Three-port LC resulted in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port LC. The three-port technique is as safe as the standard four-port procedure for LC. Thus, it can be recommended as a routine procedure in elective LC.
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Objective To introduce the techniques of scanning the common bile duct(CBD) in full length with laparoscopic ultrasonography through the sonic window dorsal to the first portion of the duodenum(FPD). Methods The lower segment of the CBD in 300 cases was scanned in full length through the sonic window dorsal to the FPD. Results In our series, 97.67% of the lower segment of the CBD can be visualized with simple techniques through sonic window dorsal to the FPD. Visualization in 25 cases were improved with injection of saline into the subhepatic space and extraction of gas from the stomach and duodenum. Conclusion Through the sonic window dorsal to the FPD and with simple techniques, the lower segment of the CBD in majority of our cases can be satisfactorily imaged in full length. Visualization can be improved in some individuals with injection of saline into the subhepatic space and extraction of gas from the stomach and duodenum.
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Objective The value of laparoscopic ultrasonographic scanning (LUS) in laparoscopic cholecystectomy (LC) and the way of scanning extrahepatic biliary system were reported. Methods 80 patients with gallstone receiving LC had real－ time color Doppler LUS of the extrahepatic biliary system. Results The sonic picture of major extrahepatic bile duct could be clearly visualized by LUS. While the image of the part posterior to duodenum could also be seen satisfactory with the method modified by the authors. But viewing the image of exact cystic duct needs further study.Conclusion LUS gives distinct intraoperative sonographic images of extrahepatic bile ducts , thereby the operator can precisely locate the ducts without injurying them. LUS can be considered as an important and safe supplement to LC.
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Objective To probe the prevention and management of complications after laparoscopic cholecystectomy (LC). Methods Retrospective study was performed on 13 000 patients, who underwent LCs from September 1991 to February 2005 at our department. Results The complication rate was 1. 66% (216 patients) including intraabdominal hemorrhage in 21 patients (0. 16%),bile duct injury in 11 (0. 08% ),gastrointestinal perforation in 7(0. 05% ) , bile leakage in 26(0. 20% ) , retained abdominal tumor in 10(0. 08% ) , retained common bile duct stones in 47(0. 36% ) , intraabdominal abscess in 4(0. 03% ) , upper gastrointestinal hemorrhage in 2(0. 02% ) , extensive subcutaneous emphysema in 32 (0. 25% ) , port wound infection in 46(0. 35% ) , incisional hernia in 1 (0. 01% ) and deep vein thrombosis in 9 (0.07%). Six patients died postoperatively. Conclusions LC is a safe technique when up-to-date equipment and meticulous dissection techniques are employed. With the routine procedure, LC can be performed more safely.
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Objective To investigate the cause of and management for bile leakage after laparoscopic cholecystectomy (LC). Method Thirty-four bile leakage cases out of 12 000 LC procedure performed in our department were retrospectively analyzed. Results Common bile duct (CBD) transection injury in 6 cases was retrieved by Roux-en -Y choledochojunostomy. Bile leakage caused by clip exfoliation in 3 cases necessitated a reexploration. Injury on CBD lateral wall or right hepatic duct in 7 cases was successfully treated by repair and T-tube stenting. Twenty-one cases of aberrant duct or accessory duct injury were cured by conservative therapy. Subdiaphragmetic abscess developed in 3 cases were cured by puncture and aspiration. Anastomotic stricture in one case after Roux-en-Y choledochojunostomy was cured by redoing Roux-en-Y choledochojunostomy. Conclusions Bile duct injury is the most common cause of bile leakage after LC. Patent drainage, bile duct repair and T tube stenting or choledochojejunostomy are the main method in treating bile leakage after LC.
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Objective To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods CEPP experiences of 1?046 patients in 6?600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO 2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results Of the 1?046 patients, 1?028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.
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The author studies dynamically the changes of the liver tissue reaction to various suture materials during the period 5-90 days in the 96 rats.From the result of comparative experimental sdudy of the effect on tissue reaction, we had found: All suture materials produce an intense inflammatory reaction for approximately five days after implantation, thereafter the liver tissue reaction to various suture materials makes a great difference. The least reaction suture is the nylon, the lagest reaction suture is the chromic catgut, dacron and silk are between them.The good "hand" of dacron, which ties like silk, and the slight inflammatory reaction produced this polyester do much to recommened its use in the liver.