Gallstone Disease and Bacterial Metabolic Performance of Gut Microbiota in Middle-Aged and Older Patients.

Background: Gallstone disease (GSD) is more commonly presented in aged people. Purpose: The purpose of the study was to explore the insights of metabolic performance of bacterial species from gut microbiota as well as the clinical background in middle-aged and elderly patients with GSD. Patients and Methods: This is an observational study concerning 120 research participants. Of those, 90 patients with symptomatic GSD addressed for cholecystectomy, average age 59.83 ± 15.32 years: 45 with cholesterol rich gallstones (CGSs), 45 with pigment gallstones (PGSs) and 30 healthy controls joined this observational study. Clinical examination, lab work-ups, upper and lower digestive video-endoscopies, abdominal ultrasound/CT and gallbladder motility assessment by Dodd's method were performed. Overall stool dysbiosis (DB) was assessed as 1 = minor, 2 = mild, 3 = severe, species being identified by matrix-assisted laser desorption ionization method. Stool samples from dysbiotic patients were analyzed by a next generation sequencing method with operational taxonomic unit identification. Results: Patients with GSD presented with a significant high range of overall gut DB (p < 0.0001) when compared with controls. Those with CGSs compared with those having PGSs displayed significant clinical differences related to elderly age, lifestyle and diet particularities, obesity, dyslipidemia, nonalcoholic fatty liver disease, hypertension, type 2 diabetes mellitus or impaired glucose tolerance, as well as motility disturbances of gallbladder with a decrease of the ejection fraction. Significant increase of overall DB range and alterations of several functional bacterial species with a decrease of butyrate, lactate, acetate/propionate and methane producers, mucin degrading bacteria, biodiversity index of microbiota, as well as an increase of lipopolysaccharide positive bacteria were significantly present in patients with CGSs. Conclusion: Middle-aged and elderly patients with GSD and a clinical background characterized by particular lifestyle, metabolic and gallbladder motility issues displayed significant modifications of biodiversity, overall gut DB and alterations of several functional bacterial species, with a decrease of their metabolic performance.

Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation / 器官移植

Objective To preliminarily evaluate the application value of SpyGlass direct visualization system in the diagnosis and treatment of biliary stricture after liver transplantation. Methods Clinical data of 4 patients presenting with biliary stricture after liver transplantation who underwent SpyGlass direct visualization system examination were collected. The examination, treatment and prognosis of biliary stricture were analyzed. Results The examination results of color Doppler ultrasound, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in 4 patients suggested biliary anastomotic stricture with intrahepatic biliary dilatation, and 2 of them were complicated with intrahepatic biliary calculi. Repeated placement of biliary stent under ERCP yielded poor effect in 3 cases. SpyGlass direct visualization system examination hinted biliary anastomotic stricture in 4 patients, 3 cases of intrahepatic biliary dilatation, 3 cases of intrahepatic biliary calculi, 2 cases of purulent bile and 3 cases of floccules within the biliary tract, 1 case of congestion and edema of biliary tract wall and 2 cases of local epithelial necrosis and stiffness changes of intrahepatic biliary tract wall. The wire could not be inserted in 1 patient due to severe biliary anastomotic stricture. Four patients were treated with biliary stricture resection + biliary stone removal + biliary end-to-end anastomosis, biliary stricture resection + biliary-intestinal anastomosis, ERCP lithotomy + biliary metal stent implantation, and biliary metal stent implantation + percutaneous transhepatic bile duct lithotomy, respectively. Relevant symptoms were relieved without evident complications. All patients survived during the follow-up until the submission date. Conclusions Compared with traditional imaging examination, SpyGlass direct visualization system may more directly display the morphological characteristics of biliary tract wall and structural changes within biliary tract cavity, which is an effective examination tool for biliary stricture after liver transplantation. In addition, individualized treatment methods may be adopted for different biliary tract diseases, which is expected to improve clinical prognosis of patients.

The role of periampullary diverticulum on the incidence of pancreaticobiliary diseases and the outcome of endoscopic retrograde cholangiopancreatography.

INTRODUCTION: Periampullary diverticulum (PAD), although commonly discovered in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), remains controversial regarding its role in pancreaticobiliary diseases and the failure rate of cannulation. The aim of this study was to evaluate the association of PAD with pancreaticobiliary diseases and its impact on the outcome of ERCP. MATERIAL AND METHODS: A retrospective analysis was carried out on 1455 patients who underwent an ERCP. Patients were divided into a PAD group and a control group without PAD, and propensity score matching was performed to adjust for clinical differences. The comparison was focused on pancreaticobiliary diseases, technical success, and complications of ERCP. RESULTS: The occurrence of PAD is associated significantly with increasing age (p < 0.001). Incidences of acute pancreatitis (AP), suppurative cholangitis, and pancreatic head cancer were significantly higher in the PAD group (p < 0.05). After propensity score matching, the PAD group exhibited a higher rate of post-ERCP complications including haemorrhage, post-ERCP pancreatitis (PEP), and hyperamylasaemia (p < 0.05). However, the prevalence of perforation and the success rate of ERCP did not differ between groups (p > 0.05). CONCLUSIONS: Periampullary diverticulum develops with aging and seems to be associated with an increase in pancreaticobiliary diseases and post-ERCP complications except for perforation. Additionally, the presence of PAD does not affect the technical success of ERCP.

Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study.

BACKGROUND: Recurrence of common bile duct stone (CBDS) is not common after laparoscopic common bile duct exploration (LCBDE). This study aimed to investigate the risk factors of recurrence of CBDS after LCBDE. METHODS: Patients who underwent LCBDE between January 2001 and December 2018 in four teaching hospitals of The Catholic University of Korea were included. The operation, fluoroscopy, and endoscopic retrograde cholangiopancreatography records were investigated retrospectively. The primary outcome of this study was the independent risk factors for recurrence of CBDS. RESULTS: A total of 230 patients were included in this study. Thirty-one patients had recurrence of CBDS. In univariate analysis, CBDS size (>9 mm) (P = 0.003), multiple stones (≥2) (P = 0.031), stone size (≥1.5 cm) (P = 0.041), CBD diameter (≥12 mm) (P = 0.005), CBD dilatation (≥10 mm) (P = 0.02), prior history of laparoscopic cholecystectomy (P = 0.002) were associated with recurrence. After multivariable logistic regression, CBDS size (>9 mm) (OR 4.67, 95% CI 1.35-16.18, P = 0.011), CBD dilatation (≥10 mm) (OR 5.66, 95% CI 1.47-21.82, P = 0.012), and prior history of laparoscopic cholecystectomy (AOR 3. 90, 95% CI 1.34-11.37, P = 0.013) were associated with recurrence. CONCLUSIONS: Stone size >9 mm, CBD diameter ≥10 mm, and prior history of laparoscopic cholecystectomy were risk factors for recurrence of CBDS after LCBDE.

Percutaneous transhepatic Laser lithotripsy for intrahepatic cholelithiasis.

PURPOSE: To report the technical success, complications and long-term outcomes of patients with intrahepatic cholelithiasis not amenable to endoscopic retrograde cholangiopancreatography (ERCP) who were treated with percutaneous transhepatic biliary Laser lithotripsy (PTBLL). PATIENTS AND METHODS: A retrospective review of 12 patients who underwent PTBLL for intrahepatic cholelithiasis was performed. There were 5 men and 7 women with a mean age of 46±18 (SD) years (range: 23-75 years). PTBLL was performed when stone clearance using ERCP had previously failed or was not appropriate due to unfavourable anatomy or the presence of multiple stones or a large stone. Percutaneous biliary access into intrahepatic ducts was obtained if not already present and lithotripsy was performed using a HolmiumYAG 2100nM Laser. Patients files were analyzed to determine the technical success, complications and long-term outcomes. RESULTS: Eleven patients (11/12; 92%) had a history of previous hepatobiliary surgery and nine (9/12; 75%) had multiple stones confirmed on preprocedure imaging. A 100% success rate in fragmenting the target stone(s) was achieved and 11/12 patients (92%) had successful first pass extraction of target stone fragments. Two patients (2/12; 17%) required repeat lithotripsy. One patient (1/12; 8%) experienced a major complication in the form of cholangitis. Of patients with long-term follow-up, 4/10 (40%) had recurrence of intrahepatic calculi with a mean time interval of 31 months (range 3-84 months). CONCLUSION: For patients with intrahepatic biliary calculi not amenable to ERCP, PTBLL provides an effective and safe alternate treatment.

Use of combined laboratory and ultrasonography results to select patients for biliary tract imaging or intervention: a retrospective cohort study.

AIM: To determine whether combined laboratory and ultrasonography results can be used to select patients for biliary tract imaging (BTI) or intervention. BACKGROUND: Despite ongoing research, selection of patients with suspected CBD stone (CBDS) for BTI or direct intervention without imaging is still a subject of debate. METHODS: Patients aged≥18 with symptomatic gallstone disease (SGD) who underwent MRCP over 3 years (2014-2017) were divided into the following cohorts: Group A: Normal liver enzymes with normal CBD diameter; Group B: Normal liver enzymes with dilated CBD; Group C: Isolated rise of liver enzymes with normal CBD diameter; Group D: Isolated rise of liver enzymes with dilated CBD; Group E: Hyperbilirubinemia with normal CBD diameter; Group F: Hyperbilirubinemia with dilated CBD. Binary logistic regression models were constructed for analyses. RESULTS: Overall, 1022 patients were included. The frequency of CBDS was 7.2% in Group A; 3.8% in Group B; 6.3% in Group C; 22% in Group D; 24.2% in Group E; 47.4% in Group F. Hyperbilirubinemia with normal CBD (OR:1.52,P=0.010) and hyperbilirubinemia with dilated CBD (OR:5.12,P<0.001) independently predicted CBDS. Normal or isolated rise of liver enzymes with or without dilated CBD did not predict CBDS. Combined laboratory and ultrasonography had positive predictive value and negative predictive value of up to 47.37% and 100%, respectively. CONCLUSION: Patients with isolated rise of liver enzymes or hyperbilirubinemia with or without dilated CBD should undergo BTI prior to ERCP. Direct ERCP could be preserved for patients with high suspicion of CBDS where clinical features do not allow waiting for BTI.

Percutaneous transhepatic cholangioscopy and lithotripsy in treating difficult biliary ductal stones: Two case reports.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is preferred for managing biliary obstruction in patients with bilio-enteric anastomotic strictures (BEAS) and calculi. In patients whose duodenal anatomy is altered following upper gastrointestinal (UGI) tract surgery, ERCP is technically challenging because the biliary tree becomes difficult to access by per-oral endoscopy. Advanced endoscopic therapies like balloon-enteroscopy or rendevous-ERCP may be considered but are not always feasible. Biliary sepsis and comorbidities may also make these patients poor candidates for surgical management of their biliary obstruction. CASE SUMMARY: We present two 70-year-old caucasian patients admitted as emergencies with obstructive cholangitis. Both patients had BEAS associated with calculi that were predominantly extrahepatic in Patient 1 and intrahepatic in Patient 2. Both patients were unsuitable for conventional ERCP due to surgically-altered UGl anatomy. Emergency biliary drainage was by percutaneous transhepatic cholangiography (PTC) in both cases and after 6-weeks' maturation, PTC tracts were dilated to perform percutaneous transhepatic cholangioscopy and lithotripsy (PTCSL) for duct clearance. BEAS were firstly dilated fluoroscopically, and then biliary stones were flushed into the small bowel or basket-retrieved under visualization provided by the percutaneously-inserted video cholangioscope. Lithotripsy was used to fragment impacted calculi, also under visualization by video cholangioscopy. Satisfactory duct clearance was achieved in Patient 1 after one PTCSL procedure, but Patient 2 required a further procedure to clear persisting intrahepatic calculi. Ultimately both patients had successful stone clearance confirmed by check cholangiograms. CONCLUSION: PTCSL offers a pragmatic, feasible and safe method for biliary tract clearance when neither ERCP nor surgical exploration is suitable.

Safety and efficacy of SpyGlass cholangiopancreatoscopy in routine clinical practice in a regional Singapore hospital.

INTRODUCTION: This study examined the efficacy and safety of cholangiopancreatoscopy via the SpyGlass™ system in routine clinical practice. METHODS: The clinical data of endoscopic retrograde cholangiopancreatography (ERCP) performed in a regional hospital from January 2013 to November 2016 was retrieved from an electronic database and reviewed. All patients who had undergone SpyGlass cholangiopancreatoscopy were enrolled. Patient demographics, procedure indication, technical success rates, clinical success rates and complication rates were analysed. A subanalysis of clinical outcomes was performed comparing the SpyGlass legacy (fibreoptic) and digital systems. RESULTS: Out of 2,050 ERCP procedures performed, 47 patients underwent 50 cholangiopancreatoscopy procedures. Clinical indications were difficult common bile duct (CBD) stones (59.6%, n = 28), indeterminate CBD stricture (36.2%, n = 17), indeterminate pancreatic duct stricture (2.1%, n = 1) and proximally migrated CBD stent (2.1%, n = 1). Complete stone extraction was achieved in 26 (92.9%) out of 28 patients. Among patients with strictures, a correct diagnosis of malignancy based on image visualisation was achieved in all 11 cases. The sensitivity and specificity for SpyBite™ biopsies were 81.8% (95% confidence interval [CI] 48.2%-97.7%) and 100.0% (95% CI 15.8%-100.0%), respectively. The proximally migrated CBD stent was successfully extracted. Complications included pancreatitis (2.1%, n = 1), suspected sealed perforation after laser lithotripsy treated conservatively (2.1%, n = 1) and cholangitis (10.6%, n = 5). There was no difference in clinical outcomes between the SpyGlass legacy (n = 20) and digital (n = 30) systems. CONCLUSION: SpyGlass cholangiopancreatoscopy is a safe and effective tool in routine clinical practice.

Safety and efficacy of SpyGlass cholangiopancreatoscopy in routine clinical practice in a regional Singapore hospital

INTRODUCTION@#This study examined the efficacy and safety of cholangiopancreatoscopy via the SpyGlass™ system in routine clinical practice.@*METHODS@#The clinical data of endoscopic retrograde cholangiopancreatography (ERCP) performed in a regional hospital from January 2013 to November 2016 was retrieved from an electronic database and reviewed. All patients who had undergone SpyGlass cholangiopancreatoscopy were enrolled. Patient demographics, procedure indication, technical success rates, clinical success rates and complication rates were analysed. A subanalysis of clinical outcomes was performed comparing the SpyGlass legacy (fibreoptic) and digital systems.@*RESULTS@#Out of 2,050 ERCP procedures performed, 47 patients underwent 50 cholangiopancreatoscopy procedures. Clinical indications were difficult common bile duct (CBD) stones (59.6%, n = 28), indeterminate CBD stricture (36.2%, n = 17), indeterminate pancreatic duct stricture (2.1%, n = 1) and proximally migrated CBD stent (2.1%, n = 1). Complete stone extraction was achieved in 26 (92.9%) out of 28 patients. Among patients with strictures, a correct diagnosis of malignancy based on image visualisation was achieved in all 11 cases. The sensitivity and specificity for SpyBite™ biopsies were 81.8% (95% confidence interval [CI] 48.2%-97.7%) and 100.0% (95% CI 15.8%-100.0%), respectively. The proximally migrated CBD stent was successfully extracted. Complications included pancreatitis (2.1%, n = 1), suspected sealed perforation after laser lithotripsy treated conservatively (2.1%, n = 1) and cholangitis (10.6%, n = 5). There was no difference in clinical outcomes between the SpyGlass legacy (n = 20) and digital (n = 30) systems.@*CONCLUSION@#SpyGlass cholangiopancreatoscopy is a safe and effective tool in routine clinical practice.

Laparoscopic choledochoduodenostomy as a reliable rescue procedure for complicated bile duct stones.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction is generally accepted as first line management for common bile duct (CBD) stones. CBD exploration, either by open or laparoscopic approach nowadays, is usually reserved for ERCP failures, complicated stone locations, along with altered anatomical situations. The aim of this study was to highlight the increasing role of laparoscopic choledochoduodenostomy which is not only a reliable but also as a rescue procedure for those failed ERCP cases due to complicated bile duct stones. MATERIALS AND METHODS: It is a retrospective review of the database, from a tertiary care teaching institution from India, from Jan 2012 up to December 2016. RESULTS: Out of total 30 patients who underwent laparoscopic choledochoduodenostomy, 28 had failed ERC stone clearance while two patients were directly offered drainage in view of unfavorable anatomy. The major reasons for failed ERC stone clearance were as follows-multiple large calculi (42.8%), recurrent stones (21.4%), and associated stricture (21.4%). Mean operating time was 130 (± 27) minutes with mean blood loss of 60 (± 19) ml. Stone extraction was successful, primarily by milking in 13 (43.33%) patients, rest required augmentation by Dormia basket/balloon. Two patients (6.66%) developed controlled bile leak which resolved with conservative treatment. The median length of hospital stay was 5 days (IQR 3-9). Mean duration of follow-up was 17 (± 3.2) months. CONCLUSION: Laparoscopic common bile duct exploration with choledochoduodenostomy has been shown to be a safe, reliable, and efficient method for treating complex CBDS, especially after failed ERCP procedures.

Percutaneous management of residual bile duct stones through T-tube tract after cholecystectomy: A retrospective analysis of 89 patients.

PURPOSE: The purpose of this study was to analyze the outcome of percutaneous management of residual common bile duct (CBD) stones in patients with surgically inserted T-tube in CBD after cholecystectomy. MATERIAL AND METHODS: Between April 2001 and August 2015, 89 patients (52 women, 37 men) with a mean age of 55.7 years±18 (SD) (range, 22-88 years) underwent percutaneous sphincteroplasty and stone expulsion into the duodenum with a Fogarty balloon catheter through the T-tube tract for residual CBD stones. All patients had previously undergone open cholecystectomy with CBD exploration and T-tube insertion 7 to 60 days (mean, 14.4 days) before the procedure. Results of the procedure and complications were evaluated by a review of clinical notes, imaging and laboratory findings. RESULTS: The procedure was successful in 87/89 patients (97.7%). Complete CBD clearance was achieved in a first session in 86 patients (96.6%). One patient (1.1%) needed a second session. The procedure was unsuccessful in 2 patients (2.2%) due to inappropriate position of T-tube and stone impaction into the cystic duct remnant. Two complications (2.2%) including intra-abdominal bile collection and distal CBD stricture were observed after the procedure. CONCLUSION: Percutaneous CBD expulsion into the duodenum through the T-tube tract is a non-traumatic, effective and safe method for the treatment of residual CBD stones in patients who had cholecystectomy and T-tube insertion.

The value of post processing technique of MSCT in the diagnosis of bile duct stones / 实用放射学杂志

Objective To investigate the value of post processing technique of MSCT in the diagnosis of bile duct stones.Methods 89 cases with high density bile stones were collected.All of the images were reconstructed by using surface reconstruction(CPR),multiplanar reconstruction(MPR),volume reconstruction(VR), to clearly show the location, size, number and shape of bile duct stones, and provide accurate image information for clinic.Results 396 cases of bile duct stones were detected in all of the 89 patients,after treatment,the reconstructed image of could accurately show the location,size,number and shape of stones.Conclusion Post-processing technique of MSCT can provide accurate image information for the diagnosis of the the biliary stone,and improve the effectiveness and safety of the operation.

Laparoscopic Transcystic Treatment Biliary Calculi by Laser Lithotripsy.

BACKGROUND AND OBJECTIVES: Laparoscopic transcystic common bile duct exploration (LTCBDE) is a complex procedure requiring expertise in laparoscopic and choledochoscopic skills. The purpose of this study was to investigate the safety and feasibility of treating biliary calculi through laparoscopic transcystic exploration of the CBD via an ultrathin choledochoscope combined with dual-frequency laser lithotripsy. METHODS: From August 2011 through September 2014, 89 patients at our hospital were treated for cholecystolithiasis with biliary calculi. Patients underwent laparoscopic cholecystectomy and exploration of the CBD via the cystic duct and the choledochoscope instrument channel. A dual-band, dual-pulse laser lithotripsy system was used to destroy the calculi. Two intermittent laser emissions (intensity, 0.12 J; pulse width 1.2 µs; and pulse frequency, 10 Hz) were applied during each contact with the calculi. The stones were washed out by water injection or removed by a stone-retrieval basket. RESULTS: Biliary calculi were removed in 1 treatment in all 89 patients. No biliary tract injury or bile leakage was observed. Follow-up examination with type-B ultrasonography or magnetic resonance cholangiopancreatography 3 months after surgery revealed no instances of retained-calculi-related biliary tract stenosis. CONCLUSION: The combined use of laparoscopic transcystic CBD exploration by ultrathin choledochoscopy and dual-frequency laser lithotripsy offers an accurate, convenient, safe, effective method of treating biliary calculi.

Hepatobiliary and pancreatic ascariasis.

Hepatobiliary and pancreatic ascariasis (HPA) was described as a clinical entity from Kashmir, India in 1985. HPA is caused by invasion and migration of nematode, Ascaris lumbricoides, in to the biliary tract and pancreatic duct. Patients present with biliary colic, cholangitis, cholecystitis, hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly, get trapped and die, leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir, one such region, HPA is the etiological factor for 36.7%, 23%, 14.5% and 12.5% of all biliary diseases, acute pancreatitis, liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.

Monochromatic energy images from spectral CT in diagnosing X-ray negative biliary stones / 中华肝胆外科杂志

Objective To study the role of monochromatic energy images from spectral CT in diagnosing X-ray negative biliary stones.Methods 32 patients who were diagnosed to have X-ray negative biliary stones were retrospectively studied.They were examined by spectral CT scanning and the spectral CT data were loaded into a spectrum analysis software.The optimal contrast-to-noise ratio (CNR) of the monochromatic energy images were exposed and the contrast ratio between the X-ray negative stones and bile on the optimal monochromatic and hybrid energy CT images were compared,respectively.The monochromatic and hybrid energy CT images for diagnosing X-ray negative biliary stones were validated by two senior radiologists based on postoperative histology.Results The corresponding KeV of optimal CNR for X-ray negative stones were not quite consistent.They were 140KeV in 19 patients,40KeV in 8 patients,53KeV,57KeV,62KeV,64KeV and 73KeV in one patient each.The contrast between the negative stones and the adjacent bile were (6.4 ±5.6) HU on hybrid energy CT images and (50.4 ±24.4) HU on optimal monochromatic energy CT images.The Eff-Z of negative stones and bile were 6.6 ± 0.6 and 7.9 ± 0.2,respectively.In our study,the diagnostic accuracy of hybrid energy CT images was 34.38％ and that of optimal monochromatic energy CT images was 78.13％.Conclusion The optimal monochromatic energy CT images were more valuable in diagnosing X-ray negative bile duct stones,which were obviously better than the hybrid energy images from traditional CT.

The therapy experience of liver resection combined intraoperative choledochoscope for intrahepatic biliary calculi in 17 cases / 重庆医学

Objective To investigate the clinical efficacy of liver resection combined intraoperative choledochoscope for intra‐hepatic biliary calculi .Methods A retrospective analysis of clinical data in seventeen patients with intrahepatic biliary calculi ,who have been received liver resection combined intraoperative choledochoscope in the department of hepatobiliary surgery during 2005 to 2014 was conducted .According to the distribution of intrahepatic bile duct stones ,six cases located in left liver lobe ,five cases lo‐cated in left half liver ,three cases located in liver section Ⅵ ,one case located in liver section Ⅶ ,one case located in liver section Ⅷ , one case located in left liver lobe associated with right posterior lobe lower segment .Seventeen cases were treated with hepatolobec‐tomy or segmental liver resection (single clamp method combined first hilar occlusion) ,among which six cases received hepatic left lateral lobectomy ,five cases received left hemihepatectomy ,three cases received partial hepatic resection in paragraph Ⅶ ,one case received partial hepatic resection in paragraph Ⅶ and one in Ⅷ ,one case received the left lateral lobe combined right posterior lower segmental resection ,ten cases at the same time received choledocholithotomy and T tube drainage .Results All patients were cured without serious complications ,no long term stone recurrence .Conclusion Liver resection combined intraoperative choledochoscope is positive and effective treatment for intrahepatic biliary calculi patients .

Therapeutic effect of the combined treatment of multiple segmental resection and choledochoscope lithotomy on complex intrahepatic biliary calculi / 中国基层医药

Objective To learn therapeutic effect of the combined treatment of multiple segmental resection and choledochoscope lithotomy on complex intrahepatic biliary calculi.To provide effective and reliable operation method for the treatment of disease.Methods 213 cases with complex intrahepatic biliary were randomly divided into observation group(117 cases)and control group(96 cases)by random number table method.The control group was treated with multiple segmental resection,the observation group was treated with multiple segmental resection com-bined choledochoscope lithotomy.The postoperative complications of the two groups were observed,and the patients of the two groups were followed up,and the effect of surgical treatment was evaluated.Results The hospitalization time of the observation group was (10.1 ±3.4)d,which was significantly shorter than (13.7 ±4.6)d of the control group (t =6.560,P <0.05).Postoperative 3 -6 weeks residual stone rate of the observation group was 7.69%(9 /117), which was lower than that of the control group,the difference was statistically significant (χ2 =4.099,P <0.05).In both two groups,the average duration of follow -up was (11.2 ±3.9)months.In the observation group,the excellent and good rate of surgery 89.74%(105 /117)was higher than the control group (χ2 =9.154,P <0.05).The postop-erative complication rate of the observation group 18.80%(22 /117)was lower than that of the control group,the difference was statistically significant (χ2 =14.467,P <0.05).Conclusion In the treatment of complex intrahepat-ic biliary calculi,the combined treatment of multiple segmental resection and choledochoscope lithotomy has better curative effect and low postoperative complication rate,with good clinical application value.

Diagnosis of biliary stone disease: T1-weighted magnetic resonance cholangiography with Gd-EOB-DTPA versus T2-weighted magnetic resonance cholangiography.

OBJECTIVE: We aimed to compare diagnostic performance of gadoxetic-acid-enhanced-T1-weighted-MR cholangiography (MRC) with that of conventional T2-weighted-MRC in diagnosing biliary stone disease. MATERIALS AND METHODS: Ninety patients who underwent MRC for evaluation of biliary disease were included. Presence of stones in extrahepatic duct, gallbladder and intrahepatic duct, and presence of acute cholecystitis were evaluated. Sensitivity, specificity, and accuracy of biliary stone disease diagnosis in each biliary duct location according to each image sets were measured. RESULTS: There was no significant difference in diagnostic performance between two sets of MRC in diagnosing biliary stone disease. CONCLUSIONS: Diagnostic performance of T1-MRC with gadoxetic-acid in diagnosing biliary stone disease is comparable to that of T2-MRC.

Long-term results of choledochoduodenostomy in benign biliary obstruction.

AIM: To determine the long-term results of choledochodudenostomy in patients with benign billiary obstruction. METHODS: This prospective study was conducted at Sheri Kashmir Institute of Medical Sciences Srinagar Kashmir, India over a period of 10 years from January 1997 to December 2007. The total number of patients who underwent choledochoduodenostomy during this period was 270. On the basis of etiology of biliary tract obstruction, patients were divided into a calculus group, an oriental cholangiohepatitis group, a benign biliary stricture group and others. Patients were followed for a variable period of 13 mo to 15 years. RESULTS: Choledochoduodenostomy (CDD) with duo-denotomy was performend in four patients. CDD with removal of T- tube, CDD with left hepatic lobectomy and CDD with removal of intra biliary ruptured hydatid was performed in three patients each. In the remaining patients only CDD was performed. Immediate post operative complications were seen in 63 (23%) patients, while long-term complications were seen in 28 (11%) patients, which were statistically significant. Three patients died during hospitalization while four patients died in the late post-operative period. CONCLUSION: Our conclusion is that CDD is safe and produces good long term results when a permanent biliary drainage procedure is required.

Clincal analysis of biliary duct reoperation in 71 patients / 中国综合临床

Objective To explore and analyse the causes of reoperation after biliary duct operation, so as to decrease the reoperation rate of biliary tract. Methods Clinical data of 71 patients who underwent reoperation of biliary duct diseases in our hospital between January 2005 to September 2010 were analysed,and the causes of biliary duct reoperation were summarized and analysed. Results The main cause of reoperation was recurrent or retained bile stone (76.1%,54/71), noncalculous stenosis of biliary tract ( 15.5 %, 11/71 ),biliary tract obstruction due to tumor (4.2%,3/71), and other factors (4.2%,3/71).Conclusion Recurrent or retained bile duct stone were the main cause for biliary reoperation, but noncalculous stenosis of biliary tract and biliary tract obstruction due to tumor could not be ignored. The initial rational operative method, approporiate operation time and the thoroughness of operation are the key factors to decrease bile duct reoperations.