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Objective:To compare the laparoscopic and open surgery in the treatment of Mirizzi syndrome (MS).Methods:The clinical data of 125 patients with MS undergoing surgery in Tianjin Nankai Hospital from May 2013 to April 2020 were retrospectively analyzed, including 59 males and 66 females, aged (57.7±13.6) years old. Patients were divided into the laparoscopic group ( n=84) and open group ( n=41). General data, operation time, intraoperative blood loss, postoperative complications, postoperative and total hospital were compared between the groups. Patients were followed up and screened for biliary stone recurrence or biliary stenosis by phone or Wechat. Results:The postoperative hospital stay [8.00(5.25, 12.00) d vs. 13.00(10.00, 17.50) d, P<0.001] and total hospital stay [15.00 (10.25, 22.75) d vs. 22.00 (16.00, 27.50) d, P<0.001] were shorter in laparoscopic group. The conversion rate of laparoscopic group was 15.5% (13/84). No perioperative death occurred in either group. The incidence of postoperative complications were comparable between the groups [9.5%(8/84) vs. 7.3%(3/41), P>0.05]. In laparoscopic group, 64 patients were followed up [76.2% (64/84)]. During follow-up, there were two deaths, five cases of bile duct stones recurrence and one case of bile duct stenosis. In open group, 37 patients were followed up [90.2% (37/41)]. During follow-up, there were four deaths, four cases of bile duct stones recurrence. All deaths during follow-ups were non-MS-related. Conclusion:Compared to open surgery, laparoscopic surgery could shorten the total/postoperative hospital stay while does not increase the morbidity and mortality, which could be safe and feasible in the treatment of MS.
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Bilioenterostomy with a wide variety of techniques is a common surgical operation in digestive surgery.Each of these surgeries has its own advantages and disadvantages.At present,Roux-en-Y choledochojejunostomy seems to be the dominant surgery,while other operations are used in some particular circumstances.Furthermore,some modified surgeries for bilioenterostomy have been conducted with the deepening understanding of the complications.Additionally,different kinds of new facilities and techniques have been applied to bilioenterostomy.Despite the controversy on specific issues,reasonable choice of bilioenterostomy should follow thc principles of specific purpose,correct choice and reliable effect.In other words,whether or not using bilioenterostomy should be considered correctly from the whole system,and then surgical methods should be accurately chose for patients,and finally avoiding the technical errors and guaranteeing the surgical effects.
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Objective To explore the effective therapeutic methods for hepatolithiasis.Methods We retrospectively analyzed the clinical material of 89 hepatolithiasis patients who underwent surgical therapy.Among the 89 patients,53 patients were treated with T-tube drainage(including 3 patients with left hepatic lobe or quadrate lobe resection),and 36 patients were treated with bile duct-intestinal anastomosis(including 6 patients with left hepatic lobe or quadrate lobe resection).Results Recurrence rate of postoperative angiocholitis in the two groups was 50.0% and 22.2% respectively,and the reoperation rate was 28.0% and 8.3% respectively.Conclusion The key to prevent recurrent angiocholitis and reduce the reoperation rate is to relieve biliary tract stricture,remove the focus of infection and provide unobstructed bile duct drainage.
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Objective To study the influence of the surgical glue on anastomosis scar formation after bilioenterostomy Methods Seventy-two hybrid canines were randomly assigned into group A (OB glue plus persistent T tube stent ), group B (OB glue plus T tube drawn out at different postoperative time), group C ( FG plus persistent T tube stent ) and group D (FG plus T tube drawn out at different postoperative time). The surgical glue (OB glue or FG) was used instead of silk thread in biliointestinal Roux-en-Y anastomosis, and T tube was placed as indwelling stent. The collagen content (BCC) of anastomotic specimen was measured in 3 weeks and 3 , 6 , 9 ,12 months after the operation. Results Three months after the operation, BCC in group B was significantly higher than that in group A (P0.05). Conclusions The surgical glue can promote anastomosis healing with less scar formation, and accelerate scar softening and maturation, which suggests that surgical glue should be effective in the prevention of anastomotic stricture.
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Objective To investigate the selection of the types of anastomosis of bilioenterostomy and evaluate the therapeutic effects.Methods From 1990 to 2000,536 patients with obstructive jaundice underwent bilioenterostomy in our hospital.The patients included 279 cases(52%) of hilar strictures with hepatolithiasis,108 cases(20%) of end stage periampullary tumors,96 cases(17%) of proximal cholangiocarcinoma and 53 cases(12%) of congenital choledochus cyst.The types of anastomosis included extra or hilar hepatic bilioenterostomy in 302 cases(56%),intra hepatic duct anastomosis with different type of hepatectomy in 222 cases(42%),of which 44 cases(8%) were anastomosed by roud ligament approch,27 cases(5%) through gallbladder fossa.Results The short term and 1～9 years long term follow up indicated that the jaundice of different patients can be completed relieved by suitable type of bilioenterostomy.Conclusions The good therapeutic effects of bilioenterostomy come from the correct selection of the anastomosis methods.
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Objective To explore the effective therapeutic methods for hepatolithiasis.Methods We retrospectively analyzed the clinical material of 178 hepatolithiasis patients who underwent surgical therapy.Among the 178 patients,107 patients were treated with T-tube drainage(including 7 patients with left hepatic lobe or quadlrate lobe resection),and 71 patients were treated with bile duct-intestinal anastomosis(including 11 patients with left hepatic lobe or quadrate lobe resection).Results Recurrence rate of postoperative angiocholitis in the two groups was 49.5 % and 24 % respectively,and the reoperation rate was 28.7 % and 8 % respectively.Conclusions The key to prevent recurrent angiocholitis and reduce the reoperation rate is to relieve biliary tract stricture,remove the focus of infection and provide unobstructed bile duct drainage.
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Objective To explore the therapeutic effect of choledochojejunostomy with a subcutaneous blind loop of interposed jejunum for treating postoperative residual biliary stones.Methods The clinical data of 72 cases of choledochojejunostomy with subcutataneous blind loop of interposed jejunum were retrospectively analysed.Results After exploration of distal common bole duct,and when a No.8-10 bougie could pass through the sphincter of Oddi,a 10-15 cm segment of jejunum with its vascular pedicle was mobilized,and an end to-side choledochojejunal anastomosis was performed at the proximal side of the jejunal segment and its distal end was converted to a blind loop and fixed subcutaneously to relevant abdominal wall.A T-tube for external drainage was inserted across the choledochojejunal anastomosis and exited through the blind jejunal loop.Seventy-two patients were cured without any complication or mortality.Conclusions The procedure is simple and minimally invasive,so that it could be carried out very easily and quickly by general surgeons with basic choledochojejunostomy skill.
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Objective To explore an effective treatment for inflammatory hilar bile duct stricture. Methods The clinical data with patients of intra hepatic cholelithiasis complicated with hilar bile duct stricture that received plastic repair of hilar bile duct stricture(PHBDS) with pedicled cholecystic graft or Roux en Y cholangio jejunostomy (RYCJ) in our hospital during recent 10 years were retrospectively analyzed. The peri operative conditions, postoperative morbidity of cholangitis and recurrence of hepaticolithiasis were observed . Results The peri operative morbidity of biliary fistula and inflammatory ileus were not significantly different between the two groups. The postoperative morbidity rate of cholangitis was 5.66% and 21.88%,(P=0.010) and recurrence rate of hepaticolithiasis was 3.77% and 16.67%,(P=0.021) in PHBDS group and RYCJ group respectively . Conclusions PHBDS is an easy and safe operation. RHBDS can preserve the physiologic function of Oddi′s spincter, so the reflux of intestinal contents to bile duct is avoided , and the results are better than the RVCJ.