ABSTRACT
Objective To study the protective effect and mechanism of lactulose on the renal function in acute cholelithiasis with obstructive jaundice. Methods Fifty five cases of acute cholelithotic obstruction were randomly assigned into lactulose group (group L, n=28) and control group (group C, n=27), and 50% lactulose (group L)or 10% glucose (group C ) was administered orally for 3 days before the operation , respectively. The systemic and portal blood endotoxin (ET), blood urea nitrogen (BUN) and endogenous creatinine clearance rate (Ccr) were measured periodically. Results (1) In group L, the level of systemic vein ET and BUN were significantly lower than that in group C (P0.05); and the systemic vein ET and Ccr decreased significantly on 9d (P
ABSTRACT
Objective To investigate a rational treatment for severe gallstone pancreatitis(SGP) and evaluate therapeutic effect.Methods A retrospective study was made on the clinical data of 97 cases with SGP.(Results) Among 97 SGP patients,54 cases were in severe grade I, 43 cases were Grade II;77(79.4%) cases were cured and 20(20.6%)died.The morbidity rates of endoscopic therapy(EST),delayed surgery and early surgery were 24.1%,25.0% and 65.5% respecticely,while the mortality rates in the 3 groups were 10.3%,13.9% and 37.5% respectively.The morbidity and morality rates in the first 2 groups were significanty lower than the early surgery group(P
ABSTRACT
Objective To study the diagnosis, treatment and prognosis of hepatolithiasis combined with cholangiocarcinoma. Methods The clinical, pathological and follow-up data of 17 cases of hepatolithiasis combined with cholangiocarcinoma were retrospectively analysed. Results The results showed that the incidence of cholangiocarcinoma in hepatolithiasis was 5% in this series. 17.6% of the patients were diagnosed as cholangiocarcinoma preoperatively. Tumor occurring in intrahepatic ducts was 88.2% and in hepatic porta ducts 11.8%. Nine cases were well-differentiated adenocarcinomas. Only 7(41.2%) cases were radically resected and their average survival time was 26.0 months. Eight(47.1%) patients underwent internal drainage with average survival time 12.4 months. 2(11.7%) cases subject to external drainage with survival time 3.6 months. Conclusions If patients with hepatolithiasis have a long history of recurrent cholangitis, weight-loss in a short period, progressive jaundice or intractable abdominal pain, the possiblility of combined with cholangiocarcinoma should be considered. Resection of the tumor has a better prognosis than that of tumor unresected; and the prognosis of internal drainage is better than that of external drainage.
ABSTRACT
Objective To investigate the risk factors of gallbladder stone changing to gallbladder carcinoma. Methods The clinical data of 200 patients with gallbladder stone undergoing operation were retrospective analysed. Results (1) In the 200 resected gallbladder specimens, gallbladder mucosa hyperplasia was found in 144 specimens(72%), atypical hyperplasia(AHP) in 38(19%), infiltrative cancer in 7(3.5%). All the paracancer mucosa had midder or severe AHP. The incidence of atypical hyperplasia and canceration had increased with patients' age and the history lenth of cyst stone. (2) The content of DNA, the porpotion of euplpoid cells, the AgNOR content in tissues as follows: hyperplasia<mild AHP<midder AHP<severe AHP<canceration. Conclusions The results of this study indicate that the canceration of gallbladder from cyst stone may be a chronic process which from hyperplasia→AHP→canceration. So the risk factors of canceration including age≥50 years; long term history of cyst stone, espically in women; that for cases of cyst stone with age≥50 years, more long term history, especially in women, therefore periodical examinations should be done, and preventive cholecystectomy should be performed if necessary.
ABSTRACT
Objective To observe the effect of laparoscopic surgery for patients with acute gallstone pancreatitis(AGP). Methods The clinical data of 134 patients suffered from AGP treated with laparoscopy surgery since 2000 in our hospital were analyzed retrospectively.Results All the patients were treated with laparoscopic surgery successfully. Among them, 21 cases were treated with laparoscopic cholecystectomy (LC);113 cases with LC and exploration of common bile duct,induding 75 cases received opening the pancreatic capsule and placement of irregation tubes for postoperative washing the abdominal cavity during the same operation. One hundred and tweent-six cases(94.0%) cured, 6 cases(4.5%) died, 2 cases( 1.5%) discharged themself. Conclusions Laparoscopic surgery in the treatment of early stage of AGP can get good results and improve the prognosis remarkably.It is worth to be used widely.
ABSTRACT
Objective To evaluate the curative methods of periampullary diverticula(PAD) complicated with biliopancreatic disease.Methods The clinical data of 32 cases of PAD complicated with biliopancreatic disease treated by surgical or endoscopic measures were retrospectively analyzed.Results Of the 32 cases,16 cases were treated with gastroectomy and Roux-en-Y gastrojejunostomy,and 8 with gastroectomy and Billroth Ⅱ gastrojejunostomy,8 with endoscopic sphincterotomy (EST).Postoperative complication occured in 4 cases,but no operative death.Twenty-seven cases were followed up for 5 months-8 years, and the results were excellent in 20 cases, good in 7 cases.Conclusions Gastroectomy and Roux-en-Y gastrojejunostomy is a better surgical method for PAD complicated with biliopancreatic disease.EST has become a new effective measure to deal with the diseases;It will be safe to use the first method for patients with intradiverticular papilla if it treated by EST.
ABSTRACT
Objective To study the perioperative treatment of intra-and extra-hepatic cholelithinsis in patients with liver cirrhosis . Methods The clinical data of intra-and extra-hepatic cholelithinsis in patients with liver cirrhosis in our hospital in resent 10 years was retrospectively analyzed. Results According to the preoperative examation, improving hepatic function(turn child class C to A or B), correcting the coagulation disturbance,decreasing portal vein pressure preoperatively,and proforming operation carefully to reduce bleeding,and giving support treatment and liver care treatment to improve the liver function further postoperatively etc were made.Fifteen cases remained stones, 5 cases appearred chronic liver failure,2 cases appearred kidney failure ,the other 69 cases recovered well. Conclusions If optimizing perioperative treatment is given, favorable effect might be obtained in intra-and extra-hepatic cholelithinsis in patients with liver cirrhosis.