An retrospective analysis of 112 cases with localized left hepatolithiasis (LLH) treated in our center in recent two decades was made. The results showed: ①Coexisting involvements of both left external hepatic duct (LEHD) and left medial hepatic duct (LMHD) were the most common pathological pattern (83.08%), came next the only LEHD involvement (12.31%). There was no localized LMHD caculi in this group. ②The rate of concomitant LHD stricture was 59.82% and that of LMHD or LEHD were 84.85% and 84.00% respectively, in which severe degrees dominate. ③Lateral segmentectomy was the most common clinical practice for LLH (58.93%), and left lebectomy was much less frequently used (12.50%), although the latter led to a significantly smaller rate of residual (7.14% vs 21.21%) and had a satification follow-up rate of 85.71% being superior to lateral segmentectomy (46.97%), or cholangiojejunostomy (40.00%), bile duct exploration and drainage (0). ④The most common prognostic factors were residual or recurrent stones of LMHD (62.50%) and residual LHD stricture (37.50%). ⑤There was no significant difference between left lobectomy and lateral segmentectomy in length of operation, intraoperative bleeding, and postoperative complications. The results indicate that too much dependence on lateral segmentectomy in the management of LLH is one of the most important factors affecting the longterm results, for which left lobectomy is an applicable and safe therapy of choice.
ObjectiveTo summarize clinical experiences of combination of laparoscope,choledochoscope,and balloon nasobiliary exploration (LCBNE) in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter (0.3-0.8 cm) of common bile duct (CBD).
MethodsFrom April 2010 to May 2015,there were 43 cases of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD underwent LCBNE,involving choledochotomy,choledochoscopic exploration,electrohydralic lithothipsy,balloon nasobiliary dilatation for removing cholelith,nasobiliary drainage,and the primary closure of incision.
ResultsThe procedure was successful in 27 cases of removing the bile duct residual stones through the choledochoscopic procedure,9 cases through the balloon nasobiliary procedure,and 7 cases were converted to endoscopic sphincterotomy for choledocholithasis.No case was converted to open CBD exploration.No case had residual stone.Bile leakage occurred in 1 case,which was cured by peritoneal drainage and nasobiliary drainage.One patient had a slight pancreatitis after operation.One patient had the stenosis of primary suture of CBD incision.Total postoperative complications rate was 7.0%(3/43).No case had perforations of intestine and bile duct,bleeding,severe pancreatitis,and death after operation.
ConclusionFrom preliminary results of limited cases in this study,if patients are indicated,combination of LCBNE in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD is safe and effective.
Objective To assess the benefits and harms of routine primary suture (LBEPS) versus T-tube drainage (LCHTD) following laparoscopic common bile duct stone exploration. Methods The randomized controlled trials (RCTs) or quasi-RCTs were electronically searched from the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2010), PubMed (1978 to 2010), EMbase (1966 to 2010), CBMdisc (1978 to 2010), and CNKI (1979 to 2010); and the relevant published and unpublished data and their references were also searched by hand. The data were extracted and the quality was evaluated by two reviewers independently, and the RevMan 5.0 software was used for data analysis. Results Four studies including 3 RCTs and 1 quasi-RCT involving 274 patients were included. The meta-analysis showed that compared with LCHTD, LBEPS was better in shortening operation time (WMD= –17.11, 95%CI –25.86 to –8.36), abdominal drainage time (WMD= –0.74, 95%CI –1.39 to –0.10) and post-operative hospitalization time (WMD= –3.30, 95%CI –3.67 to –2.92), in lowering hospital expenses (WMD= –2 998.75, 95%CI –4 396.24 to –1 601.26) and in reducing the complications due to T-tube such as tube detaching, bile leakage after tube drawing, and choleperitonitis (RR=0.56, 95%CI 0.29 to 1.09). Conclusion LBEPS is superior to LCHTD in total effectiveness for common bile duct stone with the precondition of strictly abiding by operation indication. Due to the low quality of the included studies which decreases the reliability of this conclusion, more reasonably-designed and strictly-performed multi-centered RCTs with large scale and longer follow up time are required to further assess and verify the efficacy and safety of this treatment.
ObjectiveTo compare the effectiveness and safety of laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with LC plus endoscopic retrograde cholangiopancreatography (ERCP) for patients with concomitant cholelithiasis and choledocholithiasis by using meta-analysis.MethodsWe searched PubMed, Cochrane Library、EMBASE, Chinese Biomedical Literature Database, Chinese Science and Technology Academic Journal, Chinese Journal Full-text Database and Wanfang database to identify relevant articles from their inception to 31 October 2018. A meta-analysis was carried out using the RevMan 5.3 software.ResultsA total of 13 RCTs were included in this meta-analysis, 747 cases received LC+LCBDE and 761 cases underwent LC+ERCP. The meta-analysis results showed that no significant difference between the LC+LCBDE group and the LC+ERCP group in terms of common bile duct (CBD) stone clearance rate [RR=0.99, 95%CI (0.95, 1.02), P=0.87] and overall complications [RR=0.94, 95%CI (0.72, 1.22), P=0.64]. The LC+LCBDE group had higher rate of postoperative bile leakage rate [RR=3.87, 95%CI (2.01, 7.42), P<0.000 1] than that LC+ERCP group. However, the LC+LCBDE group had lower rate of postoperative pancreatitis [RR=0.28, 95%CI (0.14, 0.55), P=0.002] than that LC+ERCP group.ConclusionsBoth LC+LCBDE and LC+ERCP are equivalent in CBD stone clearance rate and overall complications, LC+LCBDE is associated with a higher postoperative bile leakage rate and lower rate of postoperative pancreatitis, appropriate treatment should be selected according to the individual patient’s condition.
ObjectiveTo explore the prognostic factors of malignant tumors in ampulla, lower bile duct, head of pancreas, uncinate process, and neck of pancreas after operation.MethodThe recent literatures on malignant tumors in this region at home and abroad were summarized.ResultsThe prognosis of five groups of malignant tumors in ampulla, lower bile duct, head of pancreas, uncinate process, and neck of pancreas was correlated with their origin, growth site, tumor diameter, nerve invasion, vascular invasion, lymphatic metastasis, pathological and histological classification, and cutting edge status. The different location and pathological classification of tumors made the different neurovascular invasion rate, lymphatic metastasis rate, and R0 resection rate.ConclusionsBy summarizing and analyzing the origin, growth site, diameter, nerve invasion, vascular invasion, lymphatic metastasis, pathological and histological classification, and cutting edge status of tumors, we can improve the clinical prediction of tumors in this region, select appropriate surgical methods before operation, and formulate more reasonable adjuvant treatment plan after operation, in order to improve the pertinence of the treatment of tumors in this region, improve the prediction, and finally better serve the clinical work.
Objective To evaluate the linkage between the proxmal as well as long term outcome and choice of therapeutical modality for benign hilar stricture of bile duct prospectively. Methods 25 patients have been catergorized into 4 groups according to different pathogen and the proxmal as well as long term outcome after pathogen based management have been studied prospectively. Results The hepatic portal cholangio-jejunostomy applied for iatrogenic hilar stricture of bile duct has been proved to be effective and the incidence of refulux cholangitis is only 10%(1/10). Hepatic hilar plasty procedures keep the physiological entitity of bile duct and the vital, sufficient autologous repair materials as well as reliable operation design are needed. Resection of atrophic right liver lobe bearing hepatolithiasis combined hepatic hilar plasty has reached both elimination of liver focus and maintaining the physiological entitity of bile duct. The ballon dilation for mild ring-like hilar stricture of bile duct is valide but not for hilar tubular stricture of secondary sclerosing cholangitis.Conclusion The strategy of individualized management (pathogen based management) for benign hilar stricture of bile duct has proved to be reliable and effective.
【Abstract】ObjectiveTo investigate the anatomic feature and special clinical manifestations of variant right intrahepatic bile duct draining into left hepatic bile duct near the umbilical portion. MethodsVariant right intrahepatic bile ducts joining into left hepatic bile ducts near the umbilical portions were identified through cholangiograms in 52 patients, who were included in this study. Their history, clinical process and operations were reviewed. ResultsThere were total 38 cases of intrahepatic gallstone in this group. High incidence of intrahepatic calculi was found in variant right intrahepatic bile ducts （23/38 cases, 60.52%） and left hepatic ducts （33/38 cases, 86.84%）. Most of these cases were accompanied with dilatation and stricture of bile ducts in these area. The gallstones in the variant right intrahepatic bile ducts were not detected in 8 cases (8/23) and the rate of residual gallstone was as high as 86.95%(20/23). Injury of variant right intrahepatic bile duct took place when left hepatectomy was performed in one case. ConclusionGallstone is very likely to be formed in the variant right intrahepatic bile duct due to derangement of bile hydrokinetics and compression of blood vessel. Special attention should be paid to the diagnosis and operation of this abnormity.
To evaluate the effects of different pressure and duration of autologous bile perfusion into dog’s pancreatic duct on the severity of induced acute pancreatitis. Thirty mongrel dogs were divided into five groups, with each group consisting of six dogs. Histological changes of pancreas were observed. Results: Histological changes of pancreas were correlated with the pressure and duration of autologous bile perfusion into pancreatic duct. It was easier to produce acute hemorrhagic necrotizing pancreatitis in the groups with a higher pressure and a longer duration of perfusion than in the groups with a lower pressure and a shorter duration. The results indicated that there was a significant effect of higher pressure and longer duration bile perfusion into pancreatic duct on the severity of induced acute pancreatitis.
From 1978 to Dec. 1991, 50 cases of dilatation of the extrahepatic biliary duct in children were treated. They were classified as: cystic dilatation in 34 cases, arid fusiform dilatation in 16 cases. Types of reconstruction of the extrahepatic biliary duct included: excision of cystic dilatation and Rorx-en-Y hepatoductojejunostomy in 25 cases, and interposition of jejunum and hepatoductoduodenostomy in 9 eases. for those cases having fusiform dilatation, interposition of jejunum and hepatoductoduodenostomy，cases and Rorx-en-Y-hepatoductojejunostmy 5 cases.The follow-up period averajed 6.5 years. Forty nine patients were recoverwd from the teatment and 1 patient died.
In order to improve the epilepsy management and treatment of Hebei province, improve the life quality of epilepsy patients. Hebei Association Against Epilepsy start a multicenter-clinical trial about the diagnosis, medicine treatment and effect of epilepsy through mobile phone APP. The data collected by health management APP shows that the diagnosis rate of epilepsy syndrome has enhanced from 21% to 39% within six months; also 80.4% of patients have got seizure-free within the first month of treatment. Therefore, the diagnosis and treatment of epilepsy in Hebei province has been improved. However, only 46% of adult patients have been hospitalized within the first 2 years of seizure onset. Therefore, patients need further education about epilepsy in the future. In this trial, the daily management of patients by doctors has come true through the use of mobile phone APP. Through the mobile phone APP, doctors achieved the real-time supervision of disease progress and adjustment of the treatment. This trial provide evidence for future treatment and daily management of epilepsy patients.
