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Objective@#To summarize our clinical experience and management of an anomalous proximal bile duct joining the cystic duct in laparoscopic cholecystectomy (LC).@*Methods@#A retrospective study was conducted on 8 patients who had an anomalous right anterior bile duct joining the cystic duct who were treated at the Hunan Provincial People's Hospital from March 2003 to January 2019.@*Results@#All the 8 patients were diagnosed to have gallstones cholecystitis on preoperative CT, MRI and abdominal ultrasound. There were no suggestions of an anomalous bile duct. A total of 6 patients underwent reoperation after LC due to abdominal pain and biliary peritonitis. These 6 patients were treated with drainage and T-tube insertion. In the other 2 patients, the anomalous bile duct opening which joined the cystic duct were detected during LC. There was one patient converted to open laparotomy with preservation of the cystic duct and underwent common bile duct T-tube drainage. The other patients continued with laparoscopic surgery. The cystic duct was partially resected with removal of gallbladder, followed by common bile duct drainage. The average follow-up period was 3.4 years and the results were satisfactory.@*Conclusions@#Biliary duct anomaly is the main cause of iatrogenic proximal bile duct injury during laparoscopic cholecystectomy. It is not uncommon to have the anomaly of insertion of right anterior segmental bile duct to the cystic duct. To avoid iatrogenic biliary tract injury, careful preoperative study of X-ray films, accurate identification of the intraoperative gallbladder triangle anatomical structures. Strict adherence to carry out the three-word procedure of " discrimination, cut, identify" will help to reduce the incidence of biliary tract complications in laparoscopic cholecystectomy.
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Objective@#To summarized the experience in laparoscopic duodenum-preserving pancreatic head resection (LDPPHR).@*Methods@#The clinical data of four patients who underwent LDPPHR from February 2017 to June 2018 in Hunan Provincial People’s Hospital were retrospectively analyzed. The Clinical characteristics, operation time, intraoperative blood loss, biliary fistula rate, pancreatic fistula rate and follow-up data were analyzed.@*Results@#The four patients included one patient with a solid pseudopapillary tumor and three patients with a serous cystadenoma. Two patients underwent duodenum-preserving total pancreatic head resection, and two patients underwent duodenum-preserving subtotal pancreatic head resection. The operation time of the four patients was (525.8±121.8) minutes, and the blood loss (250.0±191.5) ml. Biliary duct drainage was carried out in 2 patients: one patient developed biochemical bile leakage, while another had no postoperative complication. The two patients without biliary drainage developed grade B pancreatic leakage, delayed bile leakage, abdominal bleeding and infection. All the three patients who developed postoperative complications were treated conservatively and they recovered well.@*Conclusions@#LDPPHR was designed to better preserve the integrity and function of digestive tract. However, the perioperative complications were high. This operation should only be carried out in large pancreatic centers. Routine biliary drainage is recommended to surgeons with little experience in this operation.
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Objective To summarized the experience in laparoscopic duodenum-preserving pancreatic head resection ( LDPPHR ) . Methods The clinical data of four patients who underwent LDPPHR from February 2017 to June 2018 in Hunan Provincial People' s Hospital were retrospectively analyzed. The Clinical characteristics, operation time, intraoperative blood loss, biliary fistula rate, pancreatic fistula rate and follow-up data were analyzed. Results The four patients included one patient with a solid pseudopapillary tumor and three patients with a serous cystadenoma. Two patients underwent duodenum-preserving total pancreatic head resection, and two patients underwent duodenum-preserving subtotal pancreatic head resection. The operation time of the four patients was (525. 8 ± 121. 8) minutes, and the blood loss (250. 0 ± 191. 5) ml. Biliary duct drainage was carried out in 2 patients: one patient developed biochemical bile leakage, while another had no postoperative complication. The two patients without biliary drainage developed grade B pancreatic leakage, delayed bile leakage, abdominal bleeding and infection. All the three patients who developed postoperative complications were treated conservatively and they recovered well. Conclusions LDPPHR was designed to better preserve the integrity and function of digestive tract. However, the perioperative complications were high. This operation should only be carried out in large pancreatic centers. Routine biliary drainage is recommended to surgeons with little experience in this operation.
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Objective To understand the medical college students' knowledge,attitude and behavior of AIDS,and provide the basis for health education programmes.Methods 2 130 school students were recruited by cluster sampling method in one medical college,including 717 freshman,533 sophomore and 880 junior.Questionnaire was used to investigate AIDS-related knowledge,attitudes and behaviors to all of the 2 130 students.Results The correct answer rate was 80.72%,which was positively correlated with the grade,but the knowledge of non-AIDS transmission and detection techniques was still not very clear,such as mosquito bites,sharing towels and clothing with AIDS patients could spread the AIDS or not,the correct answer rate was just 36.7% and 54.3%.There was a certain attitude of discrimination in medical students on AIDS,79.9% of medical students were unwilling to shopping at the place of AIDS patients,and 76.4% were unwilling to have dinner with AIDS patients.Compared with the freshmen,high-grade students have higher knowledge level on HIV/AIDS,but their attitude to AIDS patients was poor.Conclusions Presently,medical students' recognizing on HIV/AIDS still have a long distance from the professional requirements,suggesting that AIDS health education in medical college students is necessary.
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Sixty cases of simple obesity of stomach-intestine excessive heat type were randomly divided into acupuncture-Tuina groupand single acupuncture group, 30 cases in each group, and were given acupuncture-Tuina and single acupuncture respectively. The clinical effects of two groups were analyzed and compared by obesity and fat indexes before and after treatment. The total effective rates in acupuncture-Tuina and simple acupuncture group were 90.0% and 73.3% respectively. The effect of acupuncture-Tuina in treating simple obesity with stomach-intestine excessive heat type was satisfactory, and better than that of acupuncture(P<0.05).