ABSTRACT
Objective To determine the methods and effects of common bile duct(CBD) exploration and primary suture by laparoscopic procedure after laparoscopic cholecystectomy (LC) . Methods After LC, 35 patients' CBD were explored.After hte CBD stone was removed by choledochofiberscopy completely and CBD stenosis was excluded, the CBD was sutured primarily. Results 32 cases of CBD gallstone were removed ,and 3 exploration were negative.All the 35 CBD were sutured primarily . Two patients occurred bile leakage 1～3 day after the operation ,which were cured by conservative therapy.29 patients were followed-up for 3～24 months,no residual stone or bile duct stricture was found. Conclusions Primary suture CBD is safe and effective in laparoscopic CBD exploration,if the patient selected correctly.
ABSTRACT
Objective To evaluate the value of bile duct drainage using ureter catheter through cystic duct remnant with primary closure of the common bile duct(CBD) incision after CBD exploration.Methods (Retrospective) analysis of the clinical data of 218 cases using this method. Results All cases were operated on successfully.There were no complications such as bile leakage,bile duct stricture in this series.The (catheter) were removed 5-7 days after operation in 215 cases,10 days after operation in 3.None of the 218 cases had complications after removal of the catheter.The rate of stone clearance was 99.7%(217/218).Average hospitalization time after operation was(6.5?3.0)days.All the 218 cases were followed up for 1-5 years.On ultrosounography no bile duct stricture was found in the followed up cases.Conclusions (Using) ureteral catheter through cystic duct remnant for drainage of bile duct after CBD exploration with primary closure of the CBD is an effctive,reliable and safe method in preventing postoperative bile leakage,bile duct stricture and diagnosis of the postoperative retention of bile duct stones.
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Objective To study the causes and management of the reoperation after cholangiointestiostomy(CIS). Methods A retrospective analysis was made on the clinical data of 28 cases of reoperation after CIS from June 1995 to June 1999. Results Among the 28 cases, 26 cases(92%) had CIS anastomotic stenosis. Of the 26 cases, 9 cases accompanied with left hepatobiliary duct stenosis, 3 cases with right hepatobiliary duct stenosis, 5 cases with left and right hepatobiliary ducts stenosis. 9 cases with biliary reflux comfirmed by barium meal radiography, all of the 9 cases were subjected to a choleduodenostomy. Of the 28 patients, 3 underwent reanastomose after excision the primary anstomosis, 8 operated with hilar bile duct reform and left lateral hepatolobectomy, 2 with left hepatic duct jejunostomy and hilar bile duct jejunostomy. 15 cases with intrahepatic bile duct jejunal Roux-en-Y anastomosis, after resolved the intrahepatic bile duct stenosis. Conclusions The basic cause of reoperation after CIS is anastomotic stenosis, the other causes are as follows: the selected operation is unsuitable, the intrahepatic bile duct stenosis is not resolved, and the stonedoes not clean out completly. When reoperation is performed on these cases, the following principles must be abided by: romoving all the stones, resolving the stenosis, making a clear drainage; and performing hepatic lobectomy, anastomotic sustaining and drainage, and cholefibroscopic management must be done if needed.
ABSTRACT
Objective To study the optimal laparoscopic procedure and its indication for remove of common bile duct stone. Methods Analysis was made on the clmical data of 124 cases of laparoscopic choledocholithotomy and T tube drainage in our center.Results 82 patients underwent the improved laparoscopic procedure, alternation to open operation in 4 cases (4.9%),and the mean operating time was (80?30) min. While 42 patients were operated with traditional laparoscopic method,changing to open operation in 6 cases (14.3%),and the mean operating time was (170?40) min . The improved method could shorten the operation time and reduce the open operation rate significantly than traditional method did (P