Concurrent percutaneous transhepatic papillary balloon dilatation combined with laparoscopic cholecystectomy for gallstones and common bile duct stones / 中华普通外科杂志

Objective To evaluate the clinical effectiveness and safety of percutaneous transhepatic papillary balloon dilatation (PTBD) combined with laparoscopic cholecystectomy (LC) for concurrent gallstones and common bile duct stones.Methods From Sep 2010 to Dec 2016,23 patients undergoing PTBD + LC were retrospectively compared with 34 cases recieving laparascopic common bile duct exploration (LCBDE) + LC.Parameters included surgical success rate,postoperative complications,residual stone rate,operation time,postoperative anal exhaust time,postoperative hospital stay,and hospitalization expenses.Results In this study 23 patients received PTBD + LC,34 patients received LCBDE + LC.In PTBD + LC group:the operation success rate was 91.3％,postoperative complications (2 cases of pancreatitis,3 cases of pulmonary infection,1 case of incisional infection),and the postoperative residual stone rate was 4.3％.In LCBDE + LC group:surgery success rate was 88.2％,postoperative complications (bile leakage 2 cases,lung infection 2 cases,incisional infection 1 case),postoperative residual stone found in 2.9％;The success rate,postoperative complications and postoperative residual stone rate between the two groups were not statistically different (P ＞ 0.05),nor in operation time,postoperative anal exhaust time,and hospitalization cost (P ＞ 0.05).PTBD + LC group had shorter hospital stay (P ＜ 0.05).Conclusions PTBD combined with LC is effective and safe procedure for the treatment of gallstones and bile duct stones.

Laparoscopic assisted small incision biliary tract exploration in treatment of recurrent extrahepatic bile duct stones / 中华肝胆外科杂志

Objective To compare the clinical results between laparoscopic assisted small incision biliary duct exploration with traditional biliary exploration for patients with recurrent extrahepatic bile duct stones who had undergone biliary surgery for ≥2 times.Methods The clinical data of patients with recurrent extrahepatic bile duct stones who had undergone biliary surgery for ≥2 times,and underwent laparoscopic assisted small incision biliary duct exploration or traditional biliary exploration from September 2011 to June 2016 were retrospectively studied.Results 23 patients underwent laparoscopic assisted small incision biliary duct exploration (Group A),and 24 patients underwent traditional biliary exploration (Group B).The time spent on abdominal adhesion separation in group A and group B was (74.7 ± 20.5) min and (90.8 ± 20.3) min (P ＜ 0.05),respectively.The amount of intraoperative blood loss were (67.4 ± 35.6)ml and (107.4±31.5) ml (P ＜0.05).The number of patients with intestinal injury were 0 and 4.The postoperative time to first pass flatus was (26.9 ± 3.8) h and (35.5 ± 6.5) h (P ＜ 0.05).The durations of postoperative hospital stay were (8.1 ± 1.4) d and (12.8 ± 2.9) d,respectively,(P ＜ 0.05).The numbers of patients who required postoperative analgesics were 10 and 19 cases (P ＜ 0.05).The number of patients with postoperative incisional wound infection were 1 and 6.There was no significant difference in the time spent on biliary exploration,incidences of biliary leakage,pulmonary infection rate,hospitalization cost and liver function status between the two groups of patients (P ＞ 0.05).Conclusions Laparoscopic assisted small incision biliary duct exploration was safe and effective for patients with recurrent extrahepatic bile duct stones who had undergone biliary surgery for ≥2 times.This operation can be used as a preferred procedure.

Severe kyphosis in thoracolumbar fracture patients with injured intervertebral disc after posterior fixation / 中国组织工程研究

BACKGROUND:Thoracolumbar fracture often accompanies with the injury of adjacent intervertebral disc. Traditional posterior short-segment fixation does not deal with the injured intervertebral disc, which may be the main reason for kyphosis in patients after surgery. OBJECTIVE:To investigate the effect of injured intervertebral disc on kyphosis angle in patients with single vertebral thoracolumbar fracture after treated with posterior short-segment fixation alone. METHODS:From January 2009 to June 2014, 40 cases of thoracolumbar fractures were treated in Jinan Central Hospital. They were folowed-up at preoperation, 2 and 12 months after operation and 6 months after internal fixation removal. Data were obtained from X-ray and MRI scanning. According to the preoperative MRI images, cases were assigned to observation group (17 cases) and control group (23 cases) according to injury and non-injury intervertebral disc. Data of vertebral wedge angle, sagittal plane kyphosis, proximal intervertebral disc angle, sagittal index and degeneration classification of proximal intervertebral disc angle from two different groups were analyzed at each folow-up time point (18-30 months, averagely 23.6 months). RESULTS AND CONCLUSION:(1) Imaging parameters: sagittal plane kyphosis was significantly severer at 6 months than that at 2 months in both groups (P < 0.05). Sagittal plane kyphosis, proximal intervertebral disc angle and sagittal index were greater in the observation group than in the control group at 12 months after surgery and 6 months after fixator removal (P < 0.05). (2) Degeneration classification of proximal intervertebral disc angle: Pearce degeneration grade of proximal intervertebral disc was significantly higher in the observation group than in the control group at 2 months after surgery and 6 months after internal fixation removal (P < 0.05). (3) Results suggested that kyphosis may appear in the patients with thoracolumbar fracture after a posterior short-segment fixation alone, and the injured disc may lead to more severe kyphosis.

Pulmonary embolism following laparoscopic bileduct exploration / 中华普通外科杂志

Objective To analyze the risk factors of pulmonary embolism complications following laparoscopic bile duct exploration.Methods The data of 201 cases undergoing laparoscopic bile duct exploration from June 2002 to December 2014 were retrospectively analyzed.Fourteen risk factors of pulmonary cmbolism complications were evaluated by univariate analysis using no conditional binary Logistic regression.Results 23 patients developed pulmonary embolism complications (11.4％).Age (≥60y),Diabetes mellitus,coronary heart disease,history of cerebral infarction,preoperative shock,time of operation,ambulation after operation (≥3 d) were significant risk factors of pulmonary embolism complications (P ＜0.05).Multivariate Logistic regression analysis identified diabetes mellitus,coronary heart disease,history of cerebral infarction,time of operation,ambulation after operation (≥ 3 d) as independent risk factors of pulmonary embolism complications (P ＜ 0.05).Conclusions Diabetes mellitus,coronary heart disease,history of cerebral infarction,time of operation,ambulation after operation (≥ 3 d) are independent risk factors for pulmonary embolism complications following laparoscopic bile duct exploration.

Laparoscopic cholecystectomy and laparoscopic common bile duct exploration in treatment of cholecvstolithiasis and choledocholithiasis / 中华肝胆外科杂志

Objective To study the use of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in patients with cholecystocholedocholithiasis.Methods From July 2006 to June 2010,127 patients with cholecystocholedocholithiasis were treated either by LC+LCBDE (n=78) or LC+endoscopic sphincterotomy (EST,n=49).The treatment success rate,complications,retained bile duct stones rate,recovery of gastrointestinal function and hospital-stay were retrospectively analyzed.Results The LCBDE+ LC group:The operative success rate was 94.87 ％.The incidence of postoperative complications was 5.41 ％.The EST+ LC group:Complete removal of bile duct stones was achieved in 46 of 48 patients (95.92％).The incidence of postoperative complications was 12.77％.There was a significant difference in the incidences of postoperative complications between the EST+ LC group and the LCBDE+ LC group (P＜0.05).The operative time and the cost for hospital stay between the two groups were significantly different (P＜0.05).After a follow-up of 3.2 years (mean,range 1-5 years),there was no significant difference in long-term complications such as bile duct recurrent stones,duodenal papilla stenosis and cholangitis between the two groups (P＜0.05).ConclusionsLCBDE was a safe,efficacious and feasible minimal invasiveness treatment for cholecystocholedocholithiasis.Primary closure of common bile duct in selected cases brought additional benefits to the minimal invasive technique.

The comparative study of life quality in patients after laparoscopic appendectomy and open appendectomy / 中国基层医药

Objective To evaluate the life quality in patients who underwent laparoscopic appendectomy resection and open appendectomy resection for choledocholithiasis.Methods A survey was made on 30 patients who underwent laparoscopic appendectomy resection and 30 patients who underwent open appendectomy resection.The quality of life was measured with the Gastrointestinal quality of life index (GIQLI) preoperation and 2,5,10,16 weeks after the operation.Results There were no significant difference in the GIQLI scores.The GIQLI scores were 121,115,126,131,and 133 respectively in preoperation and 2,5,10,and 16 weeks after laparoscopic appendectomy resection.The scores of GIQLI were 122,109,120,127,and 129 respectively in preoperation and 2,5,10,and 16 weeks after open appendectomy resection.Conclusion The GIQLI scores from laparoscopic appendectomy resection group is better than that from the open appendectomy resection group.