Four hundred and eighty two paients suffering from intrahepatic bile duct stone undergoing lobectomy and segmental resection (from 1975 to 1994,9) has reported. 63% of the patient in this group underwent 1-5 operations, including different types of biliary-intestinal anastomosis (21.6%). 482 cases underwent different types of hepatectomy, including left lateral-lobetomy 321 cases (66.6%),left hemihepatectomy 80 cases(16.6%), right hemihepatectomy 19 cases (3.9%), and multiple segmental resections 39 cases (8.1%, including Ⅴ+Ⅷ 11 cases, Ⅵ+Ⅶ 28 cases). Other type hepatectomy combined with guadrate lobectomy 20 cases (4.1%). Postoperative complication rate was 10.2%, including diliary fistula. hemobilia and subdiaphragmatic and resectional surface infectioin, 85% of the patients were followed up with an excellent result of 88%. The authors emphsize that hepatic lobectomy nad segmental resection is the core of treatment and selection of operative methods depends on clinical-patholigic types of the disease.
Pancreolith with pancreatic carcinoma is a rare disease. It’s difficult to be diagnosed before operation. In this study we summerized 29 cases of pancreolith (including cases of pancreolith with pancreatic carcinoma) during Jan. 1989 to Oct. 1994 treated in our hospital. The clinical characteristics were the following more male patients encomtered; many had the history of chronic alcoholic pancreatitis and many accompanied with diabetes; the main symptoms were persistent upper abdominal pain, pain in the back anoxia, diarrhea, wasting, but rarely jaundice. Main points in diagnosis: ①When the symptoms of chronic pancreatitis are getting worse and the patients become wasting, the carcinoma should be considered. ②Mutiple investigations such as B-US, CT, and MRI, CA19-9, CEA should be taken. ③Exploretory laparotomy and freezy biopsy is performed If nesscessery. Two patients were diagnosed before operation in this study. 3 cases had pancreatoduodenectomy. One had biopsy and other had pancreatojejunostomy.
63 normal human gallbladders (non-stone group) and 47 inflammed cholesterol stone gallbladders(stone group) were assayed for the amount of macrophages(ΜΦ),the levels of tumor necro-sis factor (TNF) and interleukin 1(1L-1).It was found that in stone group,the amount of ΜΦ was significantly higher than in non-stone group(ΜΦ4101.90±295.72 vs 572.13±30.07AU,Plt;0.01).The levels of TNF and 1L-1 released mainly from the MΦ in stone group were also significantly increased in comparison with those in non-stone group(TNF 18.12±2.03 vs 4.45±0.39ng/mg,Plt;0.001;1L-1 102.42±7.84 vs 66.75±9.50u/mg protein,Plt;0.05).These results suggest that the activited ΜΦ and increases of TNF,1L-1 may be closely related to the inflammatory reaction in gallbladders and the formation of cholesterol gallstones.
目的 探索急性化脓性梗阻性胆管炎20世纪90年代后期与80年代以前的差异，探讨对本病治疗的方向。 方法 收集我院1996～2000年病例，并与我院1950～1981年资料进行比较。 结果 ①发病率显著降低，从46.08%降至15.62%； ②发病年龄延后10～20岁； ③入院时病情相对较轻，有休克者从51.39%降至22.80%； ④病死率明显下降，从25.78%降至3.50%； ⑤再手术患者显著增加，从12.12%增至55.20%。造成上述差异的原因与患者就诊早，及时的治疗，医务人员的水平提高，药品与医学的发展等有关。 结论 对急性梗阻性化脓性胆管炎患者，虽然发病率和死亡率已明显下降，仍需足够重视，因术后T管造影和B超检查发现肝内残石或胆管狭窄者，高达85.1%，复发再手术率达55.2%，远不能令人满意。为提高远期效果，应在急诊手术引流后，待患者病情平稳后，再进一步检查和彻底处理肝内病变。
目的：总结运用腹腔镜胆总管探查术的治疗经验。方法：回顾性分析1992年3月～2006年12月运用腹腔镜胆总管探查术对1221例患者进行治疗的经验。结果：即时缝合671例中634例和T管引流550例中501例治疗获得成功。中转开腹9例，胆漏46例，术后残余结石内镜未取净11例，死亡5例。结论：只要选择合适的病例，腹腔镜胆总管探查术对于有较高内镜和腹腔镜技术者是可行、有效和安全的。
Objective To introduce the current status of clinical research on endoscopic cholecystolithotomy with reservation of gallbladder. Methods Literatures related to the basis, advantage, indication, contraindication, operative method and current controversy were reviewed and summarized. Results The objective evidences were afforded by postoperative complications of cholecystectomy for endoscopic cholecystolithotomy with reservation of gallbladder. The progress of endoscopic technique made it possible for reservation of gallbladder. The controversy in endoscopic cholecystolithotomy with reservation of gallbladder was focused on the choice of indications and operative procedure. Incorrect patient selection and undue pursuit of cholecystolithotomy with reservation of gallbladder would be completely opposite to the treatment of gallstone. Conclusion It is feasible for endoscopic cholecystolithotomy with reservation of gallbladder to remove completely stone and reserve gallbladder function, but further investigation and long-term follow up are required to delineate gallstone recurrence after operation.
ObjectiveTo evaluate the feasibility and surgical techniques of laparoscopic subtotal cholecystectomy （LSC) in treatment for patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy. MethodsThe clinical data of 83 patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy admitted to this hospital between January 2006 and April 2010 were analyzed retrospectively. ResultsEighty-one patients were performed LSC, 2 patients were converted to laparotomy. In which 39 patients with the part of wall residual of the fundus and (or) body of the gallbladder, 26 patients with residual of part of gallbladder neck, 18 patients with residual of part of gallbladder body and neck. Fifty-one cases were followed-up for 3 months to 4 years, there were 2 patients with the change like “mini gallbladder” by B ultrasound and no obviously clinical symptoms. There was no ostcholecystectomy syndrome in the patients with follow-up. ConclusionsLSC is a safe, effective, feasible procedure for severe gallstone gallbladder inflammation, adhesion, or atrophy, which can effectively prevent bile duct injury, bleeding, or other serious complications. While it can also reduce the rate of conversion to laparotomy.