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Objective@#To study laparoscopic ultrasound assisted hepatectomy in treatment of intrahepatic and extrahepatic bile duct stones.@*Methods@#The data of 52 patients with hepatolithiasis who underwent laparoscopic hepatectomy from May 2014 to January 2019 at the Fuyang District First People's Hospital in Hangzhou were analyzed retrospectively. There were 28 men and 24 women. The median age was 56 years. Operative laparoscopic ultrasonography was used to detect the location, size, distribution of stones and their relations to blood vessels. A total of 43 patients underwent anatomic hepatectomy, while 38 patients underwent choledochoscopic stone extraction. A " T" tube was used according to intraoperative conditions.@*Results@#Laparoscopic surgery was successfully carried out in 50 patients, while conversion to open surgery was required in 2 patients because of adhesions and bleeding. Laparoscopic ultrasonography revealed intrahepatic calcifications in 5 patients and choledochoscopy in 2 patients. Postoperative complications included 5 patients who devleoped abdominal abscesses. The operation time was (289.0±132.0) minutes. The intraoperative blood loss was (451.0±256.0) ml. The hospitalization after operation was (12.0±3.0) days. In 52 patients, 4 patients had residual stones and the residual rate was 7.7%. All of them were completely removed by T-tube sinus 8 weeks after operation.@*Conclusions@#Laparoscopic ultrasound helped to detect relevant bile ducts containing stones, reduced chance of bleeding in surgery, helped to clarify location and distribution of stones, improved accuracy of diagnosis, and reduced unnecessary hepatectomy by clearly defining intrahepatic bile duct stones intraoperatively. The residual intrahepatic and intrahepatic bile duct stones rates were reduced, and the safety and accuracy of the operations were improved.
ABSTRACT
Objective To study laparoscopic ultrasound assisted hepatectomy in treatment of intrahepatic and extrahepatic bile duct stones.Methods The data of 52 patients with hepatolithiasis who underwent laparoscopic hepatectomy from May 2014 to January 2019 at the Fuyang District First People's Hospital in Hangzhou were analyzed retrospectively.There were 28 men and 24 women.The median age was 56years.Operative laparoscopic ultrasonography was used to detect the location,size,distribution of stones and their relations to blood vessels.A total of 43 patients underwent anatomic hepatectomy,while 38 patients underwent choledochoscopic stone extraction.A "T" tube was used according to intraoperative conditions.Results Laparoscopic surgery was successfully carried out in 50 patients,while conversion to open surgery was required in 2 patients because of adhesions and bleeding.Laparoscopic ultrasonography revealed intrahepatic calcifications in 5 patients and choledochoscopy in 2 patients.Postoperative complications included 5 patients who devleoped abdominal abscesses.The operation time was (289.0 ± 132.0) minutes.The intraoperative blood loss was (451.0 ±256.0) ml.The hospitalization after operation was (12.0 ±3.0)days.In 52 patients,4 patients had residual stones and the residual rate was 7.7％.All of them were completely removed by T-tube sinus 8 weeks after operation.Conclusions Laparoscopic ultrasound helped to detect relevant bile ducts containing stones,reduced chance of bleeding in surgery,helped to clarify location and distribution of stones,improved accuracy of diagnosis,and reduced unnecessary hepatectomy by clearly defining intrahepatic bile duct stones intraoperatively.The residual intrahepatic and intrahepatic bile duct stones rates were reduced,and the safety and accuracy of the operations were improved.
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Objective To study the safety,efficacy and advantages of enhanced recovery after surgery (ERAS) combined with clinical pathway management in laparoscopic common bile duct exploration and lithotomy (Laparoscopic common bile duct exploration,LCBDE).Methods 78 patients who underwent LCBDE in the Department of Hepatobiliary and Pancreatic Surgery in the First Hospital of Fuyang District in Hangzhou were selected as the non-ERAS group (the control group).76 patients who underwent LCBDE treated with fast track surgery and ERAS clinical pathway management were selected as the ERAS group.The data between the two groups which included the postoperative insulin resistance index,changes in C-reactive protein,duration of postoperative analgesic use and analgesia,timing of first passage of postoperative flatus,postoperative abdominal tube removal,postoperative bile leakage,recurrence of biliary stones,intestinal ileus and other complications.Results All the two groups were discharged home successfully.On preoperative 7 day,the differences on the postoperative insulin resistance index and the levels of C reactive protein were significantly different (P＜0.05).The time to first get out of bed after operation,the postoperative analgesic use,the time to first passage of flatus,the time to postoperative abdominal drainage tube removal,and the time to clamping of the T tube after operation were significantly different (all P＜0.05).The postoperative complications of pulmonary infection,abdominal infection and the incidence of prolonged intestinal ileus were significantly different (all P＜0.05).Conclusions ERAS combined with clinical pathway management reduced postoperative stress reaction and complication rate.The treatment accelerated recovery and shortened hospital stay for patients who underwent LCBDE,which led to good social and economic benefits.
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Objective: To observe the therapeutic action of earth enteral nutrition after jejunum interposition in patients with carcinoma of gastric cardia.Methods: Sixty-two patients after jejunum interposition were divided into early enteral nutrition group(n=33) and parenteral alimentation group(n=29).The clinical observation index and nutrition index were compared between the two groups.Results: The enteral nutrition group had more advantages than the parenteral alimentation group in the aspects of clinical observation index postoperative complication and nutrition index.Conclusion: Early enteral nutrition could improve gastrointestinal function and nutritional state and decrease the incidence rate of postoperative complication.