Surgical and micro-invasive treatment of pancreatic duct stones: an analysis of 42 patients / 中华肝胆外科杂志

Pancreatic duct stone is a sequel of chronic pancreatitis and may be found in the main ducts,side branches or parenchyma.These stones obstruct the pancreatic ducts and produce ductal hypertension,which leads to pain,the cardinal feature of CP.Surgical operation has been the preferred treatment of pancreatic duct stones in many domestic and external pancreatic medical centers.Lithotomy by longitudinal pancreatic duct incision and Roux-en-Y anastomosis of pancreatic duct to jejunum is the main and effective surgical procedure,while micro-surgery was also rational for the treatment of pancreatic duct stones.However,further studies with a larger sample size and longer follow-up duration are needed to improve the surgical technique and verify our initial results.

Hepatic eosinophilic granuloma misdiagnosed as liver metastases / 中华消化外科杂志

Hepatic eosinophilic granuloma (HEG) is a rare benign liver disease,which belongs to histocytosis.Preoperative diagnosis of HEG was difficult because its clinical manifestation was not characteristic.In this article,the clinical data of 1 patient with HEG who was treated at the Jinhua Municipal Central Hospital of Zhejiang Province in September 2012 were retrospectively analyzed,and the diagnosis,differential diagnosis and treatment for HEG were investigated.

The use of the hepatoduodenal ligament tension-reduced operation in iatrogenic bile duct injury / 中华肝胆外科杂志

ObjectiveTo investigate the feasibility and efficacy of using the hepatoduodenal ligament tension-reduced operation (tension-reduced operation in short) for iatrogenic bile duct injury where the bile duct was severely defective. MethodsBetween March 2006 and May 2009, the authors treated 6 patients with iatrogenic bile duct injury (Bismuth type Ⅱ : 5 patients and type Ⅲ : 1 patient). A no. 7 black silk thread was used to hold the hilar plate tissues and the seromuscular layer of the bulbous part of the duodenum closer together and knots were tied. This method brought the porta hepatis and the duodenal bulb closer together and the hepatoduodenal ligament was shortened. An end to end anastomosis could then be made between the two broken ends of the defective bile duct without tension. ResultsSix patients suffered from bile duct injury and they recovered fully after the tensionreduced operation. There was no complication on follow-up. ConclusionsThe tension-reduced operation was efficacious in the treatment of iatrogenic bile duct injury. This technique should be popularized and more widely used.

Surgical management of pancreatic duct stones / 中华普通外科杂志

Objective To evaluate surgical management of pancreatic duct stones.Methods From 1997 to 2007, 24 cases of pancreatic duct stones underwent surgical treatment, the clinical data were retrospectively analyzed. Results In this study, 17 cases underwent lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosis(side-to-side) of pancreatic duct to jejunum, extra drainageof the main pancreatic duct was done in two cases, hepaticojejunostomy in three cases, pancreaticcystojejunostomy in one case. One case suffered from postoperative bleeding at pancreatic ojejunostomy, one from stress ulcer, and both were cured by conservative treatment. Three cases underwent pancreaticeduodenectomy, anastomosis bleeding occurred in one patient, and was cured by conservative method. One case underwent duodenum-preserving resection of the head of the pancreas, 2 cases underwent distal pancreatectomy, one case underwent lithotomy by pancreatic duct incision and primary closure, no postoperative complications occurred among those patients. 21 cases were followed up, results were excellentin 17 patients. Conclusions Lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosisof pancreatic duct to jejunum is the main and effective surgical procedure, while duodenum preserving pancreatic head resection and lithotomy by pancreatic duct incision and primary closure are also rational for the treatment of pancreatic duct stones.

Primary common bile duct closure after choledochotomy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi.</p><p><b>METHODS</b>From January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotomy. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups.</p><p><b>RESULTS</b>Postoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P > 0.05), and no reoperations were necessary. After surgery, the average time and volume of transfusion was 4.9 days and 9.1 liters in group A, versus 7.3 days and 12.8 liters in group B (P < 0.01). The patients in group B had a longer postoperative hospital stay than the those in group A (average 17.6:10.0 days, P < 0.01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B, and 3 patients required repeated surgery.</p><p><b>CONCLUSIONS</b>Primary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.</p>

Chronic pancreatitis complicated with pancreatolithiasis:a report of 11 cases / 中国普通外科杂志

Objective To sum up the experience in the diagnosis and treatment of pancreatic duct stone developed as a result of long-term chronic pancreatitis. Methods The clinical data of 11 patients with pancreatolithiasis treated in our hospital from 1996 to 2002 were retrospectively analyzed. Results The main clinical manifestations included abdominal pain, back pain as well as exocrine and endocrine functional disturbance. The disease can be diagnosed by B-mode ultrasonography, CT and ERCP. Nine of 11 cases were treated by pancreaticojejunostomy, 1 case suffering from concurrent carcinoma of the head of the pancreas received pancreaticodudenectomy and 1 case underwent distal pancreatetomy. Ten patients who were followed up were free of pain . Conclusions B-mode ultrasonography is the best choice for the diagnosis of panceatolithiasis, and pancreaticojejunostomy should always be attempted for cases with duct dilatation .

Diagnosis and treatment of multiple severe injuries / 中国普通外科杂志

Objective To investigate the clinical features and surgical management of patients with blunt multiple severe injuries. Methods 165 patients whth the injury severity score (ISS) over 16 were reviewed between 1988 and 1998. Results 47 cases (28.5%) had 3 or more injury sites, and 63 cases had multiple intraabdominal organ trauma. Abdominal trauma was evaluated by abdominocentesis in 143 cases, by US in 65 and CT in 47. All had positive values over 90%. Missed diagnosis of intraabdominal injury occurred in 21 cases (12 7%). The total mortality rate was 17 6% (29 cases). The average ISS for the died was 41 6 and 24 8 for the survivors ( t =15 21, P

Complications of small bowel tumors / 中国普通外科杂志

Objective To study the complications of small bowel tumors (SBT) and their diagnosis and treatment. Methods A retrospective study was carried out among 47 SBT patients suffering from complications of SBT during the last two decades. Results Thirty-three cases (70%) were of malignant tumors. Complications included bleeding in 17 cases, perforation in 8, intussusception in 11, bowel obstruction in 8, volvulus, internal hernia and volvulus plus intussusception in one each. Abdominal pain was the most common presenting sign and symptom (40 cases). The mean interval from the onset of signs and symptoms to exploration was 4.7 months for those with malignant SBT and 3.1 months for benign ones. Roentgenography was the mainstay for diagnosis. Ultrasound, CT and MRI were also helpful. Benign tumors were treated with segmental resection of the affected bowel. Out of 33 malignant SBT patients, curative resection was performed in 26 and palliative resection in 7. Two patients died postoperatively.Conclusions Most patients with SBT were not correctly diagnosed until complications popped up. Surgery remains as the therapy of choice. [