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.
ObjectiveTo compare the efficacy and safety in the treatment of malignant gastric outlet obstruction between gastrojejunostomy (GJ) and self-expandable metallic stent (SEMS) placement.MethodsThe relevant literatures of efficacy and safety of GJ and SEMS placement in the treatment of malignant gastric outlet obstruction were searched in the PubMed, Embase, Cochrane Library, Web of Science, Clinical Trial, VIP, CNKI, Wanfang Data databases. The data were extracted and evaluated by the RevMan 5.3 software.ResultsA total of 12 articles with 1 505 patients were included, of which 620 underwent the GJ (GJ group) and 885 underwent the SEMS placement (SEMS group); 3 RCTs, 9 non-RCTs. The meta-analysis results showed: the length of hospital stay [MD=5.83, 95%CI (4.24, 7.42), P<0.000 01] and time of postoperative recovery diet [MD=3.41, 95%CI (1.79, 5.03), P<0.000 1] of the SEMS group were significantly shorter than those of the GJ group; Although the incidence of complications of the GJ group was significantly higher than that of the SEMS group [OR=1.85, 95%CI (1.27, 2.70), P=0.001], the technical success rate [OR=2.72, 95%CI (1.13, 6.53), P=0.03] and clinical success rate [OR=1.86, 95%CI (1.35, 2.57), P=0.000 2] were higher and the survival time was longer [MD=38.31, 95%CI (28.98, 47.64), P<0.000 01] of the GJ group as compared with the SEMS group.ConclusionsSEMS placement is more effective in recovering dietary capacity, length of hospital stay, and incidence of complications, while GJ is more effective in survival time, technical success rate, and clinical success rate. In clinical practice, we could choose different surgical method according to patient situation.
The secondary anastomotic stenosis is often occured from the repair and reconstructive operation of the injured bile duct. It is difficult to treat and the outcome is serious. In order to prevent this complication, the fibrin glue instead of traditional suturing technique combined with inner support was used. Fifty-four hybrid dogs were divided into 3 groups. Group A received Roux-en-y choledochojejunostomy with fibrin glue; group B received Roux-en-y choledochojejunostomy, with a fibrin glue combined support left permanently in the bile duct and group C received Roux-en-y choledocholejejunostomy with fibrin glue combined a support left temporarily in the bile duct. The amount of collagen in the scar was measured at 3/4, 3, 6, 9, 12 months respectively after operation. The results showed: 1. the mature period of scar was shortened from 12 months to 9 months when fibrin glue instead of suture was used in choledochojejunostomy; 2. the mature period of scar was further shortened from 9 months to 6 months when fibrin glue combined with inner support instead of fibrin glue was used in choledochojejunostomy. The conclusions were as follows: 1. fibrin glue could facilitate the healing of wound by inhibiting the formation of scar and accelerrate the maturation of scar; 2. when the inner support was used with fibrin glue in the operation, the mature period of scar could be further shortened; 3. the mechanism of action of the fibrin glue included minimizing the injury, avoiding foreign-body reaction, modifying organization of hematoma, preventing formation of biliary fistular and enhancing intergration and cross-linkage of collagen.
Objective To explore the diagnostic and treating scheme of primary sclerotic cholangitis. Methods 24 cases of primary sclerotic cholangitis identified by radiological and pathological examinations from 1972 to 1998 were analysed retrospectively. According to Thompson, 1 case was classified as type Ⅰ, 5 cases were type Ⅱ, 10 cases were type Ⅲ and 8 cases were type Ⅳ. The operation were as follows,resection of gallbladder plus T tube drainage in 8 cases, plus Roux-en-Y anastomosis of bile duct and jejunum in 12 cases, plus U tube stent and drainage in 4 cases. Results The total mortality rate was 25% (6/24) in 2～18 years follow-up after operation. Conclusion Early diagnosis and operation may resolve the drainage of bile into the jejunum. When serious lesions and worse liver functions exist, liver transplantation should be considered.
ObjectiveTo summarize the application and the complications of pancreaticogastrostomy (PG) after pancreaticoduodenectomy(PD). MethodThe domestic and international publications involving the theory, methods, and clinical application of PG were retrieved and reviewed. ResultsPG was gradually concerned on the choice of the method of the digestive tract reconstruction after PD, in view of its advantages in theory and operation. The literatures about PG were increased in recent years. But the discussion of decreasing complications of PG after PD had yet to be unified. ConclusionsPG is one of the important operations of digestive tract reconstruction after PD. The factors of operator and patient should be comprehensively considered in the choice of PG.
Objective To investigate the risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy. Methods The clinical data of patients with liver metastases treated by radiofrequency ablation in our hospital from January 2010 to April 2022 were collected retrospectively and analyzed by univariate and multivariate logistic regression analysis. Results A total of 57 patients were included in the study, and the total number of postoperative infections was 19 (33.33%). Univariate logistic regression analysis showed that the tumor location, maximum tumor diameter, number of tumors, ablation times, and ablation duration were related to the occurrence of infection after radiofrequency ablation (P<0.01). The results of multivariate logistic regression analysis showed that the tumor location [OR=6.45, 95%CI (1.11, 37.35), P=0.037] and ablation duration [OR=1.49, 95%CI (1.16, 1.91), P=0.002] were independent risk factors for infection after radiofrequency ablation in patients with choledocho-jejunostomy. Conclusions For patients with metastatic liver cancer with a history of choledochojejunostomy, the tumor location and the duration of ablation are closely related to postoperative infection. We should strengthen the indivi-dualized management of such patients during and after operation should be strengthened to promote disease recovery.
ObjectiveTo investigate the clinical effect of “Double R” pancreatojejunostomy in laparoscopic pancreaticoduodenectomy (LPD).MethodsThe clinical data of 20 patients underwent “Double R” pancreaticojejunostomy in the LPD from November 2018 to December 2019 in this hospital were collected retrospectively. The duration of pancreaticojejunostomy, incidence of postoperative pancreatic fistula, incidence of other complications, mortality, length of stay, and other clinical outcomes were analyzed.ResultsThere were 5 males and 6 females. The age was (56±10) years old. The body mass index was (22.6±4.4) kg/m2. The LPDs were successfully performed in all 20 patients, no patient transferred to the laparotomy, and no patient died within 30 d. There were 6 patients with papillary adenocarcinoma of the duodenum, 5 patients with adenocarcinoma of the lower part of the common bile duct, 2 patients with adenocarcinoma of the pancreatic duct, 3 patients with serous cystadenoma of the pancreatic head, 2 patients with intraductal papillary myxoma of the main pancreatic duct of the pancreatic head, 1 patient with duodenal adenoma with high grade intraepithelial neoplasia, 1 patient with metastatic renal clear cell carcinoma of the pancreatic head, 5 patients with soft pancreas, 12 patients with medium texture, 3 patients with hard texture. The diameter of distal pancreatic duct was (2.1±1.7) mm. The operative time was (380±69) min, the duration of pancreaticojejunostomy was (29±15) min, the intraoperative blood loss was (180±150) mL, the postoperative time of anal exhaust (2.2±0.8) d, postoperative time of fluid intake (3.5±1.1) d, postoperative time of half fluid intake (5.5±0.7) d, postoperative time of hospitalization (14±10) d. There were 3 complications in 2 patients, one of which suffered the pulmonary infection, the other suffered the delayed gastric emptying and gastrointestinal anastomosis bleeding, no bile leakage and abdominal hemorrhage happened. There were 2 cases of pancreatic fistula after the operation, all of them were biochemical pancreatic fistula.Conclusions“Double R” pancreaticojejunostomy method has some advantages of convenient operation, short operation time, and low incidence of pancreatic fistula. However, due to the limited sample size, its safety and feasibility still need to be verified by larger samples and more institutions.
ObjectiveTo compare and analyze the short-term efficacy of different surgical methods for Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma.MethodsWe selected 82 patients who accepted radical resection of esophagogastric junction carcinoma from March 2015 to March 2018 in our department, including 53 males and 29 females, aged 48-72 (61±6) years. The patients were divided into four groups according to the surgical method: a left thoracotomy group (n=14), a laparoscopic left small thoracotomy group (n=33), a thoracoscopic Ivor-Lewis group (n=17), and a thoracoscopic McKeown group (n=18). Their clinical characteristics, operative situations, postoperative complications and survival rate were analyzed.ResultsAmong the four groups, the left thoracotomy group cost the shortest operation time, followed by laparoscopic left small thoracotomy group, thoracoscopic McKeown group and thoracoscopic Ivor-Lewis group. The thoracoscopic McKeown group/laparoscopic left small thoracotomy group had the least bleeding. The fewest lymph nodes were dissected in the left thoracotomy group and the most in the thoracoscopic McKeown group. The laparoscopic left small thoracotomy group had the lowest total complication rate and the incidence of pneumonia and arrhythmia among the four groups (P<0.05). There was no significant difference in survival rate among the four groups (P>0.05).ConclusionFor Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma, thoracoscopy combined with laparoscopic radical resection is safe and reliable. Laparoscopic left small thoracotomy has the advantages of minimal invasiveness and complete lymph node dissection, especially for the patients with poor cardiopulmonary function, which will significantly shorten operation time and reduce postoperative complications, so it is worth to be popularized.
Twenty one cases of hepatocholelithiasis treated through hepatic round ligament approach for hepaticojejunostomy is reported. Of them 5 were introgenic injury to the biliary tract， 8 were left hepatolithiasis (7 complicated with bile duct stricture), 2 were intrahepatic sandy stone with acute suppurative cholangeitis, and 3 were residual stone in left hepatic duct with cystlike dilatation after T-tube drainage; while traumatic injury to the biliary passages, previous multiple biliary tract operations and left hepatic duct stone with acute hemorrhage were present in one of case individually 75.9% each. The ages of the patients were between 32 to 50 years. Clinical follw-up in this series was satisfactory. The authors consider that this approach gives good exposure with little injury to the liver and no liver resection needed. The indication for this approach mode of anastomosis and some operative details are discussed.
Objective To evaluate the application of a surgical method in pancreaticoduodenectomy. Methods All the 211 cases of purse-string invaginated pancreaticojejunostomy performed from Dec.1985 to Dec.2007 were reviewed. Firstly, an accordant plastic tube was put and fastened in main pancreatic duct, and pancreas was ligated at 2-3 cm apart from the pancreatic stump to let secretin flow far away. Furthermore, invaginated pancreaticojejunostomy was performed to get closer between pancreas and jejunum. Results Pancreatic fistula and perioperative death didn’t occur among these 211 cases. The complications included 2 cases of incision dehiscence, 4 cases of biliary fistula and 1 case of scission of superior mesentric artery. Conclusion Purse-string invaginated double-layer anastomosis of pancreaticojejunal would be feasible for pancreaticoduodenectomy preventing pancreatic fistula.