Objective To investigate the recurrence of hepatolithiasis and reoperation and their relation to the location of intrahepatic stone. MethodsTwo hundred and twentysix patients of hepatolithiasis operated upon in the period of 1990-1995 were retrospectively analysed.ResultsAmong those patients, there were 101 patients (44.7%) had previous operation for the gallstones diseases including cholecystectomy for gallbladder stones (n=21, 20.8%), choledocholithotomy (n=72, 71.3%),liver segmentectomy (n=6， 5.9%), and choledochojejunostomy (n=2, 2.0%). The operative mortality was 5.0% for the reoperation group and none for the first time operation for hepatolithiasis.Conclusion Although the liver resection is an ideal surgical method to eradicate the diseased lesion and to minimize the malignant changes especially in primary hepatolithiasis (type I, or IE)， choledochojejunostomy is only recommended for the secondary type (type IE or IE) where possible. In the management of hepatolithiasis, the complete information of biliary tract is needed for the choice of surgical methods.
目的:探讨门静脉高压症(Portal hypertension,PHT)合并胆石症的合理处理方式。方法:回顾分析2003年9月于2008年9月64例PHT合并胆石症患者不同方式手术治疗的结果。根据手术方式不同将64例患者分为三组。A组:仅行胆道手术(n=20);B组:在行PHT手术的同时行胆道手术(n=20);C组:在行PHT手术时对胆囊或胆道结石未作处理(n=24)。结果:死亡率A组10%,B组28.5%,C组4.3%。并发症:A组40%,B组70%,C组25%。结论:PHT合并胆石症无论仅行胆道手术或同期行PHT手术和胆道手术,手术死亡率和术后并发症均显著增加,尤以同期手术为明显。根据患者情况选择正确的手术方式,可有效降低手术风险。
目的:探讨胆石症再次手术的原因及预防措施。方法:对我院过去5年收治的134例胆石症再次手术病例的临床资料进行回顾性分析。结果:胆石症再次手术主要原因为结石残留或复发(86.57%),医源性胆管损伤(4.48%),拔除T管后胆汁性腹膜炎(4.48%),残留胆囊炎伴结石(2.99%),胆肠吻合口狭窄伴结石(1.49%)等。再次手术方式以胆总管切开取石胆道镜检查取石“T”形管引流术、胆总管十二指肠侧侧吻合术,肝胆管空肠Roux-en-Y吻合术,肝叶段切除,残留胆囊切除术为主。本组患者痊愈131例,死亡3例,死亡率2.29%,术后残石率5.17%.结论:对于胆石症,无论是首次手术还是多次手术,均应做好术前检查,制定周密的手术计划,利用胆道外科和肝脏外科技术,努力贯彻去除病灶,解除梗阻,通畅引流三原则,力争将残石率、复发率、再手术率降低到最低限度。
【Abstract】ObjectiveTo improve curative effects in the treatment of hilar bile duct stricture. MethodsIntrahepatic cholelithiasis was associated with the development of hilar bile duct stricture.Plastics of hilar bile duct stricture (PHBDS) using pedicled cholecystic graft and Roux-en-Y cholangiojejunostomy (RYCJ) were performed. The patients with hepatolithiasis treated with PHBDS or RYCJ between Jan. 1994 and Jan. 2004 were retrospectively analyzed.ResultsFollow-up was carried out from 16 months to 87 months with an average of 47 months. The postoperative morbidity of cholangitis was 5.66% and 21.88% (P=0.010) and recurring rate of hepatolithiasis was 3.77% and 16.67%(P=0.021).ConclusionPHBDS can preserve the physiological compatible, convenient and effective in treatment of hilar bile duct stricture. The late result after operation of PHBDS is better than that of RYCJ.
Objective To evaluate the methodological and reporting quality of randomized controlled trials involving traditional Chinese medicine in the treatment of cholelithiasis. Methods We searched CNKI (1994 to 2007), CMCC (1994 to 2007), VIP (1989 to 2007), MEDLINE (1966 to April 2007) and The Cochrane Library (Issue 4, 2006). Data from randomized controlled trials (RCTs) and quasi-RCTs were extracted by two reviewers independently. The methodological quality of included trials was assessed by using the quality assessment criteria recommended by The Cochrane Collaboration, and the reporting quality was assessed by using the CONSORT for TCM checklist. Results Seventeen studies including 16 RCTs and one quasi-RCT were included. The methodological and reporting qualities of included studies were generally low. All studies were graded C. The highest score evaluated by the CONSORT for TCM checklist was 18. Conclusion The quality of RCTs and quasi-RCTs involving traditional Chinese medicine for cholelithiasis is generally low, with a high risk of biases. The reporting of these trials is also incomplete, which would affect a reader’s understanding and evaluation of the validity, importance and applicability of the study results. Therefore, new randomized controlled trials of high quality are required to provide reliable evidence.
肝脏移植、心脏移植及肾脏移植等已广泛开展，大批受者长期存活。本文现就这组特殊人群在移植术后患胆道结石病的机理及其处理原则介绍如下。1器官移植受体胆石病的发生机理肝移植术后胆管结石与胆泥形成并引起胆道梗阻可随时发生。除了明确的结石外，胆泥形成胆管铸形并广泛分布于肝内胆管也有报道。胆管粘膜损害、胆管梗阻、移植肝的冷、热缺血、感染及胆固醇过饱和等都在胆管结石形成过程中发挥作用，但胆管梗阻可能是肝移植术后胆管结石形成的最重要因素［1］。胆管结石和胆泥形成的患者，绝大多数都伴有胆管狭窄，这个狭窄可以发生在胆管胆管吻合口和胆管空肠吻合口，也可发生在非吻合口处的胆管。胆管内异物如T型管或内支撑管也可作为结石形成的核心。除了这些引起胆汁淤积的物理学原因外，环孢素A（CsA）在胆石发生中也起了作用［2］： 它可抑制胆汁分泌，促进胆汁淤积，而FK506（普乐可复）似乎没有这方面的副作用。此外，肝移植受者胆汁中胆固醇呈过饱和状态，且T管引流及胆酸池的减少还加重这种状态。目前还不清楚胆道重建方式对胆道结石形成有没有影响。但从理论上讲，胆肠吻合会增加肠源性细菌进入胆道的机会，从而导致胆红素去结合化，并进一步形成色素石。但到底是胆管对端吻合还是胆肠吻合后更易形成结石，目前尚无详尽研究。
Four hundred and twenty six laparoscopic cholecystectomy(LC)were peformed on patients with acute and subacute cholecystitis,including ①emergency LC(59 patients),②selected LC(215 patients following administration of antibiotic and antispasmotic drugs for 10-15days),and ③selected LC(152 patients with mild biliary colic without any medication).Operative findings were ①congestion and edema of the gallbladder(208cases,11 of them were achieved laparocystectomy),②impaction of stones in the cystic infundibulum or duct with hydrops of gallbladder(142 cases,14 of them were achieved by laparocystectomy),and ③gangrene or empyema of gallbladder(76 patients,20 of them were achieved by laparocystectomy).LC was done successfully on 377 cases,conversion to open surgery was 45 cases (10.6%),severe complication occured on 4 patients for LC(reoperation,0.9%).The quthors believe that LC for patients with acute and subacute cholecystitis issafe and suitable,but LC cannot replace the classical laparocystectomy.
ObjectiveTo investigate the causal relationship between gut microbiota and cholelithiasis using a two-sample Mendelian randomization method. MethodsThe genome-wide association studies (GWAS) data of gut microbiota from the MiBioGen study and the GWAS data of cholelithiasis from the FinnGen Biobank were utilized. Genetic variants significantly associated with the relative abundance of gut microbiota were identified as instrumental variables (IVs) based on a specified threshold. The inverse variance weighted (IVW) method was employed as the primary analytical approach, with results assessed based on the odds ratio (OR) and 95% confidence interval (CI). The robustness and reliability of the findings were ensured through quality control measures, including sensitivity analysis, assessment of heterogeneity, and evaluation for horizontal gene pleiotropy. ResultsClostridiumsensustricto1 [OR=1.160, 95%CI (1.023, 1.314), P=0.020], Coprococcus3 [OR=1.136, 95%CI (1.014, 1.272), P=0.028] and Peptococcus [OR=1.074, 95%CI (1.023, 1.128) , P=0.004] increased the risk of cholelithiasis. Bacilli [OR=0.897, 95%CI (0.818, 0.984), P=0.022], Family Ⅹ ⅢAD3011group [OR=0.908, 95%CI (0.830, 0.992), P=0.033] and Lactobacillales [OR=0.884, 95%CI (0.802, 0.974), P=0.013] were protective factors for cholelithiasis. ConclusionThe study has identified 6 kinds of specific gut microbiota that are causally linked to the development of cholelithiasis, providing new ideas for the diagnosis and treatment of cholelithiasis.
Eighty two cases of acute gallstone pancreatitis on early operation are reported and the significance of the clinical picture and pathology are analysed. The data showed that gallstone was found in 85.5%, among the cases of them mulliple gallstone was 71.1%, dilated cystic duct was 26.4%, common bile duct stone 36.8%, distal bile ductal stricture was found in 9.3%, and anomalous conjunction of biliary and pancreatic duct was 20.1%. Sixteen cases with serious pancreatitis were determined on operation, but death rate was 3.7% only. The authors claim that early operation may be of value in patients of acute gallstone pancreatitis with or without jaundice espesially in bile duct obstruction.