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Objective:To explore the diagnosis, treatment and prevention of biliary hemorrhage after percutaneous transhepatic choledochoscopic lithotomy(PTCSL).Methods:Retrospective summary and analysis were made on 48 cases of PTCSL completed by the hepatobiliary surgery department of Hunan Provincial People′s Hospital (the First Affiliated Hospital of Hunan Normal University) from January 2016 to December 2020.Results:Biliary hemorrhage occurred in 3 cases after operation, of which 1 case was considered to have a small amount of biliary mucosa bleeding, and the bleeding was stopped after blood transfusion, hemostatic agents and appropriate fluid rehydration. In the other case, a small amount of blood oozing around the T-tube sinus canal was accompanied by a small amount of bloody fluid in the T-tube, which was considered to cause arterioles or venules accompanied by bile duct bleeding during sinus expansion during operation, and the bleeding stopped after compression. Another patient underwent a short time drainage of hemorrhagic fluid ≥100 ml in T tube 15 days after operation, and was prepared for interventional therapy while receiving blood transfusion products and conservative treatment. Celiac arteriography was performed, and pseudoaneurysm was found in the right anterior lobe of the liver. Embolization was performed later and the patient discharged 10 days after embolization.Conclusions:Biliary hemorrhage is one of the more common complications after PTCSL. Increasing the understanding of this complication provides a guarantee for the safety of surgery and has clinical significance for patients with accelerated postoperative recovery.
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Objective:To analysis the application value of rigid ureteroscope combined with holmium laser in diagnosis and treatment of complicated hepatolithiasis guided by three-dimensional visualization technology.Methods:50 patients with complex hepatolithiasis treated in Hunan People′s Hospital from October 2016 to March 2019 were selected as the study subjects. They were divided into observation group and control group by simple random method. 20 cases underwent rigid ureteroscope combined with holmium laser under the guidance of three-dimensional visualization technology were taken as observation group, 30 cases underwent rigid ureteroscope combined with holmium laser by traditional imaging diagnosis were taken as control group. The differences between the two groups in operation time, intraoperative bleeding volume, stone residual rate, postoperative hospital stay and postoperative complications were statistically analyzed.Results:The residual rate of calculi in observation group was 10% (2/20), while it was 40% (12/30) in control group; the amount of bleeding during operation in the observation group was (170.9±18.0)ml, and it was (371.6±37.0)ml in the control group; the operation time of observation group was (179.0±14.3)minutes, and it was (340.2±24.3)minutes in the control group; the postoperative hospital stay of observation group was (8.3±1.5)days, and it was (10.1±1.8)days in the control group; postoperative biliary hemorrhage occurred in 1 cases of the observation group, biliary tract leakage occurred in 2 cases, postoperative biliary hemorrhage occurred in 3 cases of the control group, biliary tract leakage occurred in 4 cases.Conclusions:Rigid ureteroscope combined with holmium laser guided by three-dimensional visualization technology can further improve the clinical efficacy in the diagnosis and treatment of complex hepatolithiasis. which is worthy of clinical application.
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ABSTRACT:In recent years ,there has been high prevalence of murine typhus in Yunnan Province ,People's Republic of China .A large outbreak of murine typhus occurred in Xishuangbanna Prefecture ,Yunnan Province in 2010 .However ,not all cases were confirmed by laboratory assays ;therefore ,field epidemiologic and laboratory investigations of murine typhus in Xishuangbanna Prefecture were conducted in 2011 .Blood samples were collected from clinical diagnostic cases at the acute and convalescence stages of murine typhus in Xishuangbanna Prefecture ,Yunnan Province ,from June to September of 2011 ,and blood and spleen samples were collected from mice sharing the same habitats as the patients .Immunofluorescence assays were used to test for the presence of IgM and IgG antibodies against Rickettsia typhi in sera from patients and mice .Real‐time PCR was used to detect the groEL gene of R .typhi in blood clots from patients at the acute stage and in spleen tissue from mice .A total of 1 157 clinically diagnosed murine typhus cases occurred in Xishuangbanna Prefecture ,Yunnan Province in 2011 ,with an incidence of 102 .10/100 000 .Of these cases ,80 were investigated by laboratory assays and 74 of 80 patients were confirmed to have murine typhus .The coincidence rate between the clinical diagnosis and laboratory detection was 92 .50% .The positivi‐ty rate for IgG antibodies against R .typhi was 14 .0% (14/100) for Rattus f lavipectus ,while the rate by PCR was 9 .0%(9/100) .That laboratory diagnoses confirmed that the severity of the murine typhus outbreak in Xishuangbanna cannot be ig‐nored .The distribution of host animals transmitting R .typhi underscores this conclusion .