RESUMEN
Introduction. The principal therapy for gallstones was open cholecystectomy. Recently, however, with remarkable advances in laparoscopic surgery on the biliary tract in particular, laparoscopic cholecystectomy has become preferred treatment for symptomatic cholelithiasis. To assess our experience in surgical treatment for gallstones and determine the best method to reduce postoperative discomfort, cases of cholecystectomy performed in our institution were reviewed.<BR>Patients.-During the past 14 years, 524 patients were treated for cholelithiasis (cholecystolithiasisin 412, choledocho-cholecystolithiasis in 75, choledocholithiasis in 36, intrahepatic stones in 1). The ratio of men to women was 1: 1.7 and the average age was 61 years. Results.-Only cholecystectomy was performed on 86% of the patients with cholecystolithiasis and 91% had accompaning open surgery with laparoscopic cholecystectomy in latest years. Open cholecystectomy by inserting a T tube was done on 61% of choledochocholecystolithiasis cases. In some cases papilloplasty and/or choledochoduodeno or choledochojejunostomy followed. Almost all patients with choledocholithiasis had open cholecystectomy with T-tube insertion and additional procedures to remove stones in thebiliary tract in earlier years. In these years, no more addidional procedures except for choledochotomy with T-tube insertion had been performed in any cholelithiasis cases.<BR>Conclusions.-Laparoscopic cholencystetomy is a safe and effective procedure and should be preferred for symptomatic cholelithiasis except for cases with acute cholecystitis, common bile duct stones, gallbladder cancer and other severe complications.
RESUMEN
During the 13-year period from 1979 Jan. to 1992 Apr., 93 patients with carcinomas of the biliary tract including the ampulla of Vater and the pancreas were surgically treated at Kumiai General Hospital in the northern Hida district of Gifu Prefecture. In these 93 patients, 31 were diagnosed as suffering from carcinomas of the extrahepatic bile duct; 19, gallbladder carcinomas; 5, carcinomas of the ampulla of Vater and 38, pancreatic carcinomas. But the majority of these patients were classified into the far-advanced stages in accordance with the Japanese stage classification. Resectability was 58.1% in carcinoma of the extrahepatic bile duct, 42.1% in gallbladder carcinoma, 100% in periampullary carcinoma and 31.5% in pancreatic carcinoma and their survival rates were discouragingly low. To improve the postoperative results, it should be advocated that early diagnosis and treatment are most important for biliary tract carcinoma of m and fm in pathological depth, gallbladder carcinoma of m and pm in depth and small pancreatic carcinoma smaller than 2 cm.