Treatment strategies of complicated extrahepatic bileduct stones / 中华消化外科杂志

Complicated extrahepatic bile duct stone is defined as not easy to achieve the treatment standard of total stone clearance,stricture removal,unobstructed drainage and recurrence preventing in a single operation or combined with other liver diseases,which include hepatic hilar bile duct stones incarceration,distal bile duct stone incarceration,Mirizzi syndrome,residual cystic duct stones,recurrent extrahepatic bile duct stones,and combined with portal hypertension or intrahepatic bile duct stones.Through comprehensive and meticulous preoperative evaluation,we can clarify the cause of extrahepatic bile duct stones,the location of stones and bile duct stenosis,the variability of bile duct,the anatomy of the hepatoduodenal ligament,the condition of liver function and biliary tract infection,and make the proper surgery plan.During the surgery,we apply the perihilar surgical techniques,pancreatic hilar plate reduction techniques,Oddi sphincter incision and shaping,and choledochoscopic lithotripsy and lithotomy comprehensively to achieve the goal of reducing residual stone rate and recurrence rate.It is important that reasonably select endoscopic retrograde cholangiopancreatography indications,correctly hold indications of bilioenteric anastomosis,and prevent iatrogenic injury of extrahepatic bile ducts on the premise of clearing stones.

Treatment strategies of complicated extrahepatic bileduct stones / 中华消化外科杂志

Complicated extrahepatic bile duct stone is defined as not easy to achieve the treatment standard of total stone clearance, stricture removal, unobstructed drainage and recurrence preventing in a single operation or combined with other liver diseases, which include hepatic hilar bile duct stones incarceration, distal bile duct stone incarceration, Mirizzi syndrome, residual cystic duct stones, recurrent extrahepatic bile duct stones, and combined with portal hypertension or intrahepatic bile duct stones. Through comprehensive and meticulous preoperative evaluation, we can clarify the cause of extrahepatic bile duct stones, the location of stones and bile duct stenosis, the variability of bile duct, the anatomy of the hepatoduodenal ligament, the condition of liver function and biliary tract infection, and make the proper surgery plan. During the surgery, we apply the perihilar surgical techniques, pancreatic hilar plate reduction techniques, Oddi sphincter incision and shaping, and choledochoscopic lithotripsy and lithotomy comprehensively to achieve the goal of reducing residual stone rate and recurrence rate. It is important that reasonably select endoscopic retrograde cholangiopancreatography indications, correctly hold indications of bilioenteric anastomosis, and prevent iatrogenic injury of extrahepatic bile ducts on the premise of clearing stones.

Application of perihilar surgical techniques in perihilar biliary tract tumours / 中华外科杂志

Perihilar biliary tract tumours include hilar cholangiocarcinoma, gallbladder cancer invading the hepatic hilum and intrahepatic cholangiocarcioma invading the hepatic hilum.The tumours have the special characteristics such as strong invasion capability, the anatomic variant, the pathophysiological complexity, the biological behavior diversity and the difficulty of preoperative evaluation which result in low R0 resection rate, more postoperative complications, more mortality and poor prognosis.The perihilar surgical techniques system aims to set a reasonable and individual operation procedure on the principle of precision surgery by taking the key technique of hilar dissection and exposing, evaluting the hilar anatomy by the means of three-dimensional digital medical image evaluation system, evaluting the relationship between the tumour and hepatic artery and portal vein under the condition of hepatic hilum complete exposure by combining anterograde and retrograde route from intra and extra-hepatic direction to hepatic hilum.The perihilar surgical techniques system is applied to improve the accuracy of resectable evaluation, the R0 radical resection rate, the safety of operation and the accuracy of cholangiojejunostomy through the accurate preoperative evaluation, the detailed operation plan, the accurate intraoperative reassessment, the perfect operative procedure and the excellent postoperative management, eventually for the purpose of reducing the postoperative complications rate and perioperative mortality and improving the prognosis of perihilar biliary tract tumours.