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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 effect of minielctrocholecystectomy(MEC) for gallbladder stone. Methods The clinical data of 4,200 cases(1991-2000) undergoing MEC were analysed restrospectively; the results of different operotors for the MEC were compared. Results All 4,200 cases were cured. Of them, 41 cases(0.98%) had serious complications, including intraoperative bleeding in 4 cases(0.09%), biliary tract injury in 18(0.43%); stress ulcer in 8(0.19%), and residual stones of biliary tract in 11(0.26%). Conclusions MEC has the following advantages: less trauma, short operation time, fast postoperative recovery and lower expense. The different operotors on MEC have distinguish difference in the results. It is important to preven the complications of MEC.
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Objective To explore a new way of treating refractory residual gallstones by endoscopy. Methods Choledochfiberscope(CHF) combined with air pressure ballistic lithoclast(APBL) under ureterscopy were used on 28 cases of large or impacted residual gallstones. Results All refractory stones were crushed and extracted completely in 1-3 times, including sufficient once in 16, twice in 10 and thrice in 2. No severe complications were occurred in this series. Conclusions This procedure is a safe, effective, simplicity, less complication and no heat injury methods. It is proved to be a new way of treating refractory residual gallstones, especially for large or impacted lithiasis. It is worthy for clinical application widely in the future.
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Objective To study the causes of mis diagnosis and the experience of diagnosis and management for cholelithiasis complicated with abdominal tumors.Methods Clinical data of 36 cases of cholelithiasis complicated with abdominal tumors were analyzed retrospectively.Among them,24 were male,12 female.The age ranged from 48 to 82 year old.Each case was diagnosis as cholelithiasis and admitted to our hospital.Results In 36 patients,18 was diagnosed as complecated with abdominal tumors preoperatively;12 was diagnosed intraoperatively,while in 6 cases the tumor was misdiagmosed for 5 days to 3 months,finally the tumor was comfirmed by reoperation and pathology.Among the 36 cases,the tumors cluding 5 of carcinoma of gallbladder(13.9%),4 of cholangiocarcinoma(11.1%),3 of hepatoma(8.3%),6 of pancreatic carcinoma(16.7%),6 of gastric carcinoma(16.7%),7 of colon carcinoma(19.4%),2 of rectal carcinoma(5.5%).Of them,2 cases refused operation,2 cases underwent intervention operation,the others reseived operation.During primary operation,radical resection of the tumor and cholecystectomy and/or common bile duct(CBD) exploration was performed in 18 patients,palliation resection and cholecystectomy and/or CBD exploration performed in 4 patients,exploratory laparotomy performed in 4 patients,and only LC and/or CBD exploration performed in 6 patients.Of the latters,reoperation was performed 5 days to 3 months after primary operation.4 patients had tumor radical resection,1 had palliation resection,and 1 had interventional therapy.Conclusions Cholelithiasis may complicated with abdominal tumor,especially with digestive tract tumor.For cholelithiasis patient the history-taking need to be done carefully before operation.For the senile patient and the patient without typical symptoms or physical signs,the systems checking shoud be done carefully preoperatively,and abdominal cavity should be checked carefully intraoperatvely to find the tumor,which may exist in abdominal cavity.the patient with syndrome of post-cholecystectomy shoud be carefully followed up to avoid the mis diagnosis and mistreatment of the tumor.
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Objective To study the therapeutic effects of combined use of laparoscopic cholecystetomy and endoscopic sphincterotomy for cholecystolithiasis with secondary choledocholithiasis.Methods Thirty-five patients were diagnosed as cholecystolithiasis with secondary choledocholithiasis by B-ultrasonography and magnetic resonance cholangiopancreatography.Of them,in 28 cases,laparoscopic cholecystetomy was performed first,and ERCP and endoscopic sphincterotomy were done one week later;in 7 cases,endoscopic sphincterotomy were performed before laparoscopic cholecystectomy.Results The outcome of all the thirty-five cases was satisfactory without severe complications or conversion into open procedure.Conclusions The method of combined laparoscopic cholecystomy and endoscopic sphincterotomy,for cholecystolithiasis with secondy choledocholithiasis,especially for cases in whom the diameter of the common bile duct stone is ≤1cm,can give good therapeutic results and has advantages of minimal invasiveness,few complications and quick recovery.
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Objective To explore the effect of hepatectomy or cholangiolithotomy on patients with hepatocholangic stones. Methods The clinical data of surgical treatment of 316 patients with hepatocholangic stones combined with bile duct stricture was retrospectively analyzed. The patients were divided into two groups:172 patients chiefly underwent hepatectomy,and the other 144 patients chiefly underwent cholangiolithotomy. Results The ratio of residual stones and reoperation in the hepatectomy group was significantly lower than those in the cholangiolithotomy group (P
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Objective To assess the therapeutic effect and opportune time of surgical treatment of hepaticolithiasis . Methods The clinical data of 92 patients with hepaticolithiasis who underwent surgical treatment were analyzed retrospectively. Results (1) The incidence of postoperative complications was 14.1% (13/92 cases), in choledochoscopy group it was 9.3%(4/43 cases) and in the non choledochoscopy group 18.4%(9/49 cases) ; in the emergency operation group it was 36%(9/25 cases) and in selective operation group 5.97%(4/67 cases) . (2) The incidence of residual stones was 22.9%(21/92 cases); in choledochoscopy group it was 13.9%(6/43 cases) and the non choledochoscopy group 30.6%(15/49 cases); in emergency surgery group it was 36%(9/25 cases) and in selective operation group 17.9%(12/67 cases).(3)One pationt died from ACST two days after operation . All of the patients were followed up for 4-10 years; there were 80 cases (86.9%) who had a good therapeutic outcome. Conclusions Logical surgical procedure associated with choledochoscopy and appropriate timing of surgical intervention can markedly improve the effect of surgical treatment of hepaticolithiasis and reduce the incidence of postoperative complications.
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Objective To study the therapeutic methods of cholecystic duct stones. Methods A retrospective analysis of the clinical data of 158 cases of cholecystic duct stones treated in the recent 6 years was made. Results 97 of the 158 cases of cholecystic duct stones were removed by open surgical operation and 61 cases by laparoscopic cholecystectomy(LC).In 49 of the 61 cases treated with LC,the cholecystic duct stones were removed together with removal of the gallbladder, and 12 by duodenoscopy after LC. Conclusions One should strive to extract the cholecystic duct stones while removing the gallbladder. If the stones or stone fragments escape into the common bile duct, they could be removed through a choledochotomy at the time of the open operation ,or by postoparative duodenoscopy in cases undergoing LC. The latter method of treatment is associated with minor trauma, quick recovery and definite therapeutic results.
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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.
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Objective To explore a new way of treating refractory residual gallstones by endoscopy. Methods Choledochfiberscope(CHF) combined with air pressure ballistic lithoclast(APBL) under ureterscopy were used on 28 cases of large or impacted residual gallstones. Results All refractory stones were crushed and extracted completely in 1 3 times, including sufficient once in 16, twice in 10 and thrice in 2. No severe complications were occurred in this series. Conclusions This procedure is a safe, effective, simplicity, less complication and no heat injury methods. It is proved to be a new way of treating refractory residual gallstones, especially for large or impacted lithiasis. It is worthy for clinical application widely in the future.
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Objective To study the effect of minielctrocholecystectomy(MEC) for gallbladder stone. Methods The clinical data of 4,200 cases(1991-2000) undergoing MEC were analysed restrospectively; the results of different operotors for the MEC were compared. Results All 4,200 cases were cured. Of them, 41 cases(0.98%) had serious complications, including intraoperative bleeding in 4 cases(0.09%), biliary tract injury in 18(0.43%); stress ulcer in 8(0.19%), and residual stones of biliary tract in 11(0.26%). Conclusions MEC has the following advantages: less trauma, short operation time, fast postoperative recovery and lower expense. The different operotors on MEC have distinguish difference in the results. It is important to preven the complications of MEC.
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Objective To investigate the value of laparoscopy combined with choledochoscopy in treatment of cholecystolithiasis complicated with choledocholithiasis.Methods Clinical data of 168 patients with cholecystolithiasis and choledocholithiasis treated in our haspital from June 2005 to June 2009 were analysed.Ninety patients were randomly selected and treated by laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage (group A),the other 78 patients,as control group,underwent routine cholecystectomy and choledocholithotomy plus T-tube drainage by laparotomy (group B).Results The hospital stay and the mean time to passage of flatus in group A was much shorter than that in group B (P0.05).Conclusions Laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage for cholecystolithiasis and choledocholithiasis is a microtrauma management with advantages of quick recovery and shorter hospital stay,that makes it superior to the open operation.
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Objective To evaluate therapeutic effects of hepatectomy for hepatolithiasis.Methods Retrospective analysis of the clinical data,including stones distribution,operative modality,postoperative complications,and therapeutic effect of hepatectomy for hepatolithiasis in 107cases admitted in our hospital from June 2000-July 2007 was undertaken.Results Among the 107 patients,left lateral lobectomy was performed in 80 cases,left hepatectomy in 14 cases,right hepatectomy in one case and selective combined segmentectomy in 12 cases.The postoperative residual stone rate was 10.3% (11/107 cases),but the final residual stone rate was 3.7% (4 /107 cases) after stone extraction by subsequent T-tube route or endoscopic sphincterotomy (EST).Postoperative complication rate was 29.9%(32 /107 cases),while in left lateral lobectomy,left hepatectomy,right hepatectomy and selective combined segmentectomy complications were 23.7% (19/80 cases),42.8% (6/14 cases) and 53.8% (7/13 cases),respectively.The latter 2 procedures had a higher rate of complications than the former 2 procedures (P
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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 investigate the value of clinical use of laparoscopy combined with choledochoscopy in treatment of cholecystolithiasis complicated with choledocholithiasis.Methods Of 120 patients suffering from cholecystolithiasis combined with choledocholithiasis,56 patients underwent laparoscopic cholecystectomy together with choledocholithotomy and T-tube drainage(LCTD),and 64 patients received routine cholecystectomy and choledocholithotomy plus T-tube drainage by laparotomy.Postoperative administration of analgesics,wound infection,recovery of function of gastrointestinal tract(RFGI),and hospital stay were compared between the two groups.Results In both groups,there were no severe complications.Wound infection rate was 12.5 %,average hospital stay was(14.9?3.1) d,and RFGI was(26.1?8.6) h in routine operation group;while in LCTD group,there was no wound infection occurred,hospital stay was(5.8?1.4) d and RFGI was(10.6?3.4) h.There were significant difference in postoperative recovery conditions between the two groups(P
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Objective To study the methods and effect of the surgical treatment for intrahepaticolithiasis(IHL). Methods In recent 12 years, in our hospital,230 cases of IHL were treated by different operations companied with biliary fibrescopy to remove the residnal stones of biliary tract. Results (1) Hepatolobectomy combined with Y-type hepatocholangiojejunostomy was done in 103 cases,the success rate was 91.8%.(2)Y-type hepatocholangiojejunostomy was performed on 45 cases,the success rate was 81.2%.(3)Hepaticolithotomy combined with T-tube drainage was done in 72 cases,the success rate was 69.3%. Conclusions For intrahepaticolithiasis,combination of hepatolobectomy with other operation and with biliary fibrescopy during or after the operation shoul be done, which can effectively improve the curative effect.
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Objective To investigate the effect of endoscope assisted microincision cholelithotomy(EMC) in the treatment of gallstone. Methods The clinical data of 86 patients with gallbladder stone treated by EMC were analyzed retrospectively.Of them, 63 cases were follwed-up and studied. Results All eighty-six patients were successfully operated on and discharged, no operative complications occurred. Among 63 patient being followed up for 1～3 years,the recurrence rate of gallbladder stones was 3.2%(2/63). No recurrence was noted in 46 patients with single gallstone. In the other seventeen patients with multiple stones, gallstone recurrence was found in 2 patients, the recurrence rate was 11.8%(2/17). Conclusions If selection of the operation idications are strict, endoscope assisted microincision cholelithotomy for treatment of gallstone is simple, safe, effective and less trauma, and can preserves the function of gallbladder, but it can not replace the cholecystectomy.
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Objective To explore the value of application of choledochofiberscopy in the diagnosis and treatment of the extrahepatic bile duct disease, and the effect on reducing the incidence of the postoperative residual stone in biliary ducts. Methods According to the case history and ultrasonography,if the common bile duct(CBD) diseases suspected,the CBD was explored by intraoperative choledochofiberscope(IOCF). During the procedure,a biliary passage mirror inducer apparatus and biliary tract probe which were manufactured by ourselves were used. Results During LC,IOCF was performed on 385 cases of the 10 396 LC cases,and possitive findings were dicovered in 102 cases(26.49%). Among those positive patients, 67 cases belonged to stricture of the lower biliary tract; 5 cases were Mirizzi syndrome; 2 cases were carcinoma of the periampulla; 1 case was primarily carcinoma of the bile duct; 1case was ascarisis of the biliary system. Conclusions IOCF is a good inspect technique with high success rate and clear image of bile duct, it can discover the common duct diseases which are difficult to be diagnosed through the routine examination.At the same time, it can provide the locative and qualitive diagnosis, determine reasonable methods of operation,and effectively provent postoperative complications.
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Objective To summarze our experience and evaluate the therapeutic effect of hepatectomy for intrahepatic bile duct stones. Methods The clinical data of 316 patients suffering from intrahepatic lithiasis who underwent hepatectomy from Feb. 1985 to Dec. 2004 were retrospectively analyzed. Stones distribution, operation modality, postoperative complications, and therapeutic effect were evaluated. Among the 316 patients, 192 cases(60.76%) were treated with left lateral hepatectomy, 58 cases(18.35%) with left hemihepatectomy, 12 cases(3.80%)with quadarate lobectomy, 54 cases(17.09%) with right hemihepatectomy or segmentectomy, and 14 cases(4.43%)with left and right segmentectomy. Additional biliary procedures including common bile duct exporation and cholangio-enterostomy were performed in 184 patients(58.23%). Results Postoperative complications occurred in 56(17.72%)cases, including biliary fistula, hemobilia, and subdiaphragmatic infections. Three patients(0.95%)died. The follow-up study conducted in 258 patients(81.65%)for an average of 10.3 years showed that excellent results were achieved in 90.31% of the patients. Conclusions Regular hepatic lobectomy/segmentectomy is the most effective treatment for intrahepatic lithiasis.
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Objective To evaluate the effect of surgical treatment for cholecystolithiasis with billiary-cardiac syndrome(BCS). Methods The clinical data of 149 cholecystolithiasis patients with BCS were retrospectively analysed. Results The incidence of BCS in cholecystolithiasis was 39.4%(149/378).All the 149 patients underwent cholecystectomy.No severe complications or death occurred in this series. Three months after operation, 123(82.6%) cases of BCS were followed up. Of them, ECG returned to normal and the symptoms disappeared in 102 cases(82.9%);ECG had no obvious change,but the symptoms improved in 15 cases(12.2%). Conclusions Cholecystectomy is the only effective method for treating cholecystolithiasis with BCS. For patients with asymtomatic cholecystolithiasis,if the patients cardiac function can tolerate operation,a cholecystectomy should also be done.