From the March of 1993 to the May of 1994, we had performed laparoscopic cholecystectomy (LC) for 200 patients of the age ranged 19-77 years. In these cases, 12 had previous abdominal surgery; 3 cases had hepatic cysts; 11 cases had stones in the neck of gall bladders. We had successfully performed LC for 190 cases (95%). But we also had some unsuccesful experiences, including accidental injury to the stomach or duodenum, and bleeding from cystic arteris of the gallbladder. Operation (LC) was abandoned in one patient because of severe cardiac arrhyshmia developed during operation, and billiary tract injury was found postoperatively in three patients with no postoperative death. The operative indications and technical problems of LC are discussed in detail and measures in avoiding injury to billiary or GI tract from LC are introduced.
目的探讨腹腔镜胆道再次手术的适应证、手术方法及临床效果。方法回顾性分析我院2003年2月至2010年11月期间46例腹腔镜胆道再次手术患者的临床资料，对术中及术后结果进行总结。结果本组45例在腹腔镜下完成手术，1例中转开腹。手术时间为45～270 min(平均120 min)，残株胆囊切除时间为(40±10) min，胆总管切开取石+T管引流时间为(150±50) min，胆总管切开取石+等离子碎石+T管引流时间为(180±40) min，术后出血及漏胆腹腔镜探查术时间为（40±15）min。结石一次性取尽23例，术后残余结石2例，住院4～21 d，平均8.6 d。胆管残余结石患者在术后1个月后经T管瘘道用胆道镜取石。术中十二指肠球部损伤3例，及时发现修补; 术后出现右侧胸腔积液4例、肺部感染2例和漏胆1例，均经非手术治疗痊愈。术后电话随访6～24个月（平均15个月），未见异常。结论腹腔镜胆道再次手术可行，并具有创伤小、恢复快等优点，但术前应严格掌握手术适应证，对手术医生的技术要求也较高。
目的 探讨纤维胆道镜在胆道探查术中及术后的应用价值。方法 对113例在胆道探查术中及术后应用纤维胆道镜治疗患者的疗效进行回顾性分析。结果 23例胆总管扩张合并黄疸且术前未见结石的患者，其中19例术中胆道镜发现结石并于术中取净结石，2例炎性狭窄，1例胆管癌，1例未见异常。58例胆总管结石患者术中胆道镜取净结石。32例肝内、外胆管结石患者术中胆道镜取净结石21例; 2例胆道镜发现结石集中于肝左外叶合并肝内胆管狭窄, 行肝左外叶切除; 其余9例患者的结石术中未取净，于术后6～8周再经胆道镜T管窦道取净结石。113例患者术后均无严重并发症发生。术后获随访98例（86.7%），随访时间6～24个月，平均14个月，2例复发，其余96例未见结石复发。结论术中应用纤维胆道镜可明确胆管内病变，降低胆管残余结石的发生率; 术后经T管窦道取石是治疗胆管残余结石的有效方法，可避免再次手术的痛苦。
Twenty five children with congenital biliary dilatation were treated with hepatico-jejuno-duodenostomy following excision of choledochal cysts between 1983 and 1985. The age ranged from two months to eleven years. The last follow-up ranged from 6-9 years (mean 7.5 years). All patients were free of jaundice with normal growth and development and none had peptic ulcer. The results from the last follow-up was better than that of the first one. This procedure was safe, effective and physiologically appealing.
ObjectiveTo investigate the clinical value of preoperative biliary drainage in patients with malignant obstructive jaundice and its influence on postoperative complications.MethodsThis study retrospectively analyzed patients from June 2006 to June 2018 at Department of Hepatobiliary Surgery of Gaozhou People’s Hospital, Guangdong Medical University, who had underwent pancreaticoduodenal surgery. In this study, bilirubin was divided into bilirubin normal group and bilirubin abnormal group according to the level of bilirubin, then the bilirubin abnormal group was divided into non-drainage group and drainage group. The main observation indexes were the incidence of complications and their severity.ResultsThere was no difference in intraoperative blood loss, operative time, and postoperative hospitalization among the three groups (P>0.05), but there was significant difference among the three groups on incidence of bile leakage, pulmonary infection, and the comprehensive complication index (CCI) value (P<0.05). The trend of clotting time, serum albumin, and hemoglobin in the bilirubin normal group, non-drainage group, and drainage group after operation were basically the same. The transaminase was recovered after operation in the bilirubin normal group and the drainage group, which were better than that of the non-drainage group within 7 days .ConclusionsThe preoperative biliary drainage in patients with malignant obstructive jaundice complicated with hyperbilirubinemia, cholangitis, and hepatic dysfunction do not significantly improve the incidence of complications, but could significantly improve the severity of the overall complication.
Objective To study the effect of laparoscopic common bile duct exploration via choledochotomy and T tube drainage. Metheods Laparoscopic exploration of common bile duct with choledochoscopy via choledochotomy was performed in 105 patients, T tube was placed in all patients with laparoscopic suturing technique.Results Except negative exploration in 2 cases, duct clearance was achieved in 99 per cent (102/103) of patients. Conclusion Laparoscopic exploratoin of common bile duct via choledochotomy and T tube drainage is one of the safe and effective management options for common bile duct calculi.
Objective To evaluate the therapeutic effects of endoscopic treatment on biliary tract complications after liver transplantation. Methods The clinical data of 55 patients with biliary tract complications after liver transplantation undergoing endoscopic treatment from January 2006 to June 2009 were analyzed retrospectively. Results Ninety-eight times of endoscopic treatment were performed in 55 patients. There were 11 cases of biliary fistula, 4 cases of bile duct stricture with biliary fistula, 21 cases of bile duct stricture, 12 cases of bile duct stricture with biliary sludge or stones, 3 cases of biliary sludge or stones, 2 cases of angular distortion of the bile duct and papilla duodeni stenosis in 2 cases. Different procedures including biliary tract dilation, endoscopic nasobiliary drainage, endoscopic sphincterotomy, stone extraction technique and biliary stent placement were performed in different biliary tract complications. The endoscopic treatments were successful in 46 cases (83.6%). The procedure related complications were found in 13 times (13.3%). Conclusion Endoscopy may serve as the primary modality for treating biliary tract complications after liver transplantation with safety and effectiveness.
ObjectiveTo discuss the effect of palliative drainage operation on the life quality of hilar cholangiocarcinoma. MethodsCholangiocarcinoma data of our hospital in recent 21 years were analysed retrospectively. They were divided into four groups: RouxenY choledochojejunostomy group, bridge internal drainage group, PTCD (or ERBD) internal drainage group, and operative external drainage group. The operative mortality, incidence of postoperative cholangitis and survival period were compared among groups.ResultsThe total perioperative mortality of 193 cases of palliative operation was 9.3%, there was no difference among groups (P＞0.05). The rate of postoperative cholangitis in the bridge internal drainage group (10.0%) was lower than that of RouxenY choledochojejunostomy group (19.4%),P＜0.05, the rate of cholangitis in PTCD (or ERBD) internal drainage group (37.5%) and operative external drainage group (38.1%) were significantly higher than that of RouxenY choledochojejunostomy group (P＜0.01). There was no significant difference between RouxenY choledochojejunostomy group 〔(9.2±1.8) months〕 and PTCD (or ERBD) internal drainage group 〔(8.8±1.9) months〕 in survival period (P＞0.05)，but the survival period of the above groups were significantly higher than that of bridge internal drainage group 〔(6.5±1.6) months〕，P＜0.05, and operative (or PTCD) external drainage group 〔(4.3±2.0) months〕,P＜0.01.ConclusionThe life quality of RouxenY choledochojejunostomy group is better than that of bridge internal drainage group and PTCD (or ERBD) internal drainage group, the life quality of external drainage is worse than that of the other groups.