ABSTRACT
Objective To compare and discuss the clinical application effect of the end-to-end anastomosis of pancreatic and intestinal anastomosis,binding type of pancreatic and intestinal anastomosis,end-to side pancreatic duct anastomosis and modified pancreatic duct jejunum anastomosis.Methods Collected pancreatoduodenectomy in 95 cases,the end-to-end pancreatico duodenal sleeve type anastomosis in 23 cases,binding type pancreatic enteric anastomosis in 18 cases,end to side pancreaticojejunostomy anastomosis in 28 cases,improvement of the pancreatic duct jejunum end to side anastomosis in 26 cases,compared with four groups of patients with pancreatic enteric anastomosis time and postoperative complications.Results Anastomosis time:A group (34.0 ± 4.6) min,B group (31.0±5.8) min,C group (32.0 ±6.3) min,D group (14.0 ±4.2) min(P=0.037,P＜0.05).And the incidence rate of postoperative pancreatic fistula,bile leakage,abdominal cavity or digestive tract bleeding had no significant difference (P ＞ 0.05).Improvement of the pancreatic tube jejunum end to side coincident with a low incidence of pancreatic fistula,but different pancreatic enteric anastomosis way pancreatic fistula rate difference was not statistically significant,improvement of the pancreatic duct and jejunum mucosa end side group pancreatic enteric anastomosis anastomosis time significantly shorter in the three groups,the difference was statistically significant (P ＜ 0.05).Conclusion Improvement of pancreatic duct jejunum end to side anastomosis with short operation time,low incidence of pancreatic fistula,and the operation is simple and practical,safe.
ABSTRACT
Objective To evaluate the therapeutic effect and application value of laparoscopy combined with holmium laser in the treatment of intrahepatic and extrahepatic bile duct stones.Methods Retrospectively analyzed the clinical data of 22 cases with intrahepatic and extrahepatic bile duct stones who treated with laparoscopy choledo-choscopy combined with holmium laser lithotripsy(the observation group),and 21 cases who treated with laparoscopy combined with choledochoscopic lithotomy(the control group).The clinical curative effect was compared between the two groups.Results In the observation group,the residual stones completely removed in 21 cases(95.4%),the mean operation time was (130 ±13)min,the intraoperative bleeding volume was (85 ±20)mL,the average hospitali-zation time was (8.3 ±2.0)days,without conversion to open surgery,no incision infection,1 case had residual stones after operation,through T tube sinus tract choledochoscopy took a stone again.In the control group,took net calculi in 13 cases(61.9%),the average operation time was (135 ±20)min,the intraoperative hemorrhage volume was (70 ± 15)mL,the average hospitalization time was (14.5 ±2)days,6 cases converted to laparotomy,incision infection in 2 cases,8 cases had residual stones after operation,through T tube sinus combined with choledochoscopy again take stone,which 2 secondary mirror lithotomy in 6 cases,3 cases of 2 stones.The differences of the two groups in stone from the net rate,conversion rate,average hospitalization time were statistically significant(χ2 =2.203,2.897,t =4.293,P =0.033,0.006,0.017).The differences of mean operation time,intraoperative hemorrhage had were not statistically significant(t =1.176,1.629,P =0.246,0.111).Conclusion It is safe,effective and minimally invasive for the treatment of intrahepatic and extrahepatic bile duct stones with holmium laser combined with endoscopic holmi-um laser.