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Objective To explore the effect and the mechanism of glycynhizin in the prevention of colonic cancer (after) cholecystectomy. Methods Sixty mice were randomly divided into 3 groups: Sham group(S group),group of model of colonic cancer after cholecystectomy(C group) and glycynhizin treatment group(GL group). The incidence of colonic cancer, expressions of p53 mRNA,p21 mRNA and bcl-2mRNA and the activity of NF-?B were tested. Results The incidence of colonic cancer in C group was significantly higher than that in GL group (P
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Objective To study the experience in prevention and treatment of iatrogenic bile duct trauma(IBDT). Methods A retrospective study was made on the clinical data of 118 patients with iatrogenic bile duct trauma admitted to the Hunan Provincial People's Hospital from March 1990 to September 2000. Results 50.8% (60/118) of patients with IBDT resulted from the wrong identification of the anatomy of the Calot' Triangle during cholecystectomy. The clinical diagnosis of IBDT depended on the clinical findings, diagnostic abdominocentesis and image examination. The diagnostic rate of ultrasonography for IBDT was 93.2%(110/118). According to the injury site of bile duct, IBDT could be divided into 6 types, the most common type of IBDT was resection of partical hepatic duct and part common bile duct(type Ⅲ) which occurred in 83.9% (99/118) of the patients. The cure rate of IBCT was 100%(118/118) in this series due to the choice of operation according to the trauma type. Conclusions The key of prevention to IBDT lies in abiding by the princible of “identifying-cut-recognazing” during cholecystectomy. The choice for surgical operative procedure should agree with the trauma type.
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Objective To investigate the endoscopic diagnosis and therapy for patient with relapsing pancreatitis after cholecystectomy. Methods The clinical data of 21 patients with relapsing pancreatitis after cholecystectomy underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) were analyzed. Results Nineteen out of 21 patients were diagnosed as sphincter of Oddi dysfunction (SOD), and remaining 2 patients as choledocholith iasis. The treatment outcome of EST for the 21 patients in short-term after EST was satisfactory, and there was no complication of EST. Conclusions ERCP has a great value in the diagnosis of the cause of relapsing pancreatitis after cholecystectomy.The treatment of EST for patients with relapsing pancreatitis after cholecystectomy is safe and effective.
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Objective To study the prevention and management of early post-cholecystectomy jaundice.Methods The dinical data of 43 cases of jaundice occurring within one week after simple open cholecystectomy in 11 226 cases were retrospectively analyzed.Results The incidence of jaundice at one week after operation was 0.38% in simple open cholecystectomy,among them,medical jaundice accounted for 18 cases,and surgical jaundice for 25cases.Ultrasound,ERCP,MRCP,liver enzyme profile and reoperation confirmed the folowing: Extra-hepatic bile duct or the right hepatic duct was ligated in 9 cases,common bile duct residual stone in 6,partial gallbladder or gallbladder duct stone in 4,biliary leak in 4,cholangitic hepatitis in 4,hepatitis B or posthepatitis cirrhosis in 5,icterus after blood transfusion in 2,hemobilia in 2,ligation of right branch of hepatic artery in 2,and icterus of unknown causes in 5 cases.Reoperation was done in 8 cases,with one mortality.Conclusions Detailed case history,adequate examination before operation,and careful operative technique are the essential prerequisites to prevent early post-cholecystectomy jaundice.Early post-cholecystectomy jaundice should be treated according to the different causes.
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Objective To investigate the causes of and prophylactic measure for complications of minilaparotomy cholecystectomy (MC).Methods The clinical data of 10 200 patients receiving MC from Apri1 1991 to March 2006 were analyzed.Results MC was successful in 9 835 cases(96.4%), and in 365 cases(3.6%) the incision was lengthened. Serious complications were 12 cases(0.12%)of bi1e duct injury, 4 cases(0.04%)of colon injury, 8 cases(0.08%)of massive haemorrhage, and 25 cases (0.25%)of bile leakage. Four 4 cases(0.04%) died. Conclusions The key to prevention of complications is a strict selection of MC indications,careful identification of the anatomical structures of Calot's triangle,use of suture ligation of the mesentery of gallbladder triangle and the technique of deep knot-tying and the timely use of extension of the incision.
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Objective To explore the reasons,diagnosis and treatment of residual cholecystitis(RCC) with gallstones. Methods The clinical data of 36 RCC patients with gallstones identified by operation were retrospectively analyzed. Results All the 36 patients were cured by reoperation. Residual cholecystectomy was performed on 8 patients, and residual cholecystecomy plus common bile duct exploration and T tube drainage on 28 patients. Thirty one patients were followed up for 3 months to 12 years,93.55% of the patients had good results. Conclusions The main reason of residual cholecystitis with gallstones was not followed the principle of "identify cut identify" during cholecystectomy .The clinical presentation of RCC is similar to that of cholecystitis with gallstones .The accurate rate of auxiliary examinations is low,so the results of these exammations should be analyzed comprehensivly in the diagnosis. The principle of "identify cut identify" should be followed during the reoperation. The common bile duct and common hepatic duct should be opened first and then the residual gall be resected.