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Biliary stent has been widely used in the treatment of biliary stricture and obstruction, it can relieve the pain of patients effectively, but bacterial infection and stent obstruction are still troublesome after surgery. We introduce the mechanism of infection and stent blockage caused by bacterial invasion after biliary stent implantation, and expound the formation mechanism of bacterial biofilm and bile sludge in this review. Antibacterial biliary stent is an effective way to inhibit biliary tract infection, the literatures on antibacterial modification of biliary stent with different antibacterial methods in domestic and abroad are reviewed, and the research prospect of antibacterial biliary stent is summarized and prospected.
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Humanos , Antibacterianos/farmacología , Bilis , Sistema Biliar , Colestasis , StentsRESUMEN
ObjectiveTo compare orthotopic liver transplantation (OLT)and combined liverkidney transplantation (CLKT) in the treatment of severe hepatitis B.MethodsIn this study 52 patients of severe hepatitis B were allocated to OLT (40 cases) or CLKT( 12 cases) at our department from Jan.2001 to Sep.2005.The perioperative complications and the result of follow-up were analyzed.ResultsThe preoperative renal functions in CLKT cases were severer than that in OLT cases.Postoperative severe infection was more common in CLKT cases than that in OLT cases.In OLT group 28 patients (70％)suffered from early posttransplant renal dysfunction,among them 11 patients needed dialysis,whilst there were 2 (16.7％ ) patients who needed dialysis in CLKT group (P ＜0.01 ).The posttransplant mortality in OLT group was 40％ ( n =16),significantly higher than that in CLKT ( 16.7％,n =2) ( P ＜ 0.01 ).In OLT group,9 cases developed severe renal failure and died.No one died of renal failure in CLKT group.ConclusionsThe prognosis is more favorable to perform CLKT in patients who suffered from severe hepatitis B with chronic renal dysfunction before transplantation.
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Objective To investigate the indications and results of combined liver-kidney transplantation.Methods From Jan. 2001 to Dec. 2003, 15 patients were subjected to combined liver-kidney transplantation in our department. The underlying diseases included hepatitis B viral cirrhosis complicated by HRS ( n= 8), hepatitis B viral cirrhosis complicated by uremia ( n =2), hepatitis B viral cirrhosis complicated by diabetic nephropathy ( n =1), polycystic liver and kidney disease ( n =2), Caroli's disease and polycystic kidney ( n =1), alcoholic liver cirrhosis complicated by uremia ( n =1). The surgical procedure, perioperative complications, acute and chronic rejection, the recurrence of hepatic viral B hepatitis, and the result of follow-up were analyzed.Results The graft function in 15 cases of combined liver-kidney transplantation was restored well after operation. The 6-month and one-year survival rate was 100%. One patient was supported by respiration machine for 48 days. The complications occurred in 3 patients after operation, including one case of gastroenternal bleeding repeatedly and one case of postoperative wound bleeding subject to non-surgical treatment, and one case of stenosis of biliary anastomosis subject to ERCP. Only one patient experienced a rejection episode of the liver. No acute rejection of the kidney graft occurred. One patient was died from liver graft function failure by recurrence of hepatitis B after 30 months.Conclusions Combined liver-kidney transplantation is only radical treatment method for patients with end-stage liver disease with chronic renal dysfunction or chronic renal failure. In the patients with hepatitis B,lamividine and hepatitis B immunoglobin can prevent the recurrence of hepatitis B.
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Objective To evaluate the clinical effect of Ho:YAG laser with flexible ureteroscope on the treatment of renal calculi. Methods Fifty one cases of renal stone burdens were treated with Versa Pulse Select Ho:YAG lithotriptor through flexible ureteroscope. Results The successful rate of stone fragmentation after single session was 90%(45/51).Mean operation duration was 45 min (30～78 min).Mean duration of post operation in hospital was 2.4 days (1～6 days).Stone free time was 3～6 weeks,with a mean of 4 weeks.No ureteral perforations or pyonephrosis occurred. Conclusions Ho:YAG laser lithotripsy through flexible ureteroscope is a safe, effective treatment for renal calculi.