Residual cystic duct stones (CDSs) after cholecystectomy have been recognized as a cause of post cholecystectomy pain. This study was undertaken to determine the incidence of CDSs during laparoscopic cholecystectomy(L...Residual cystic duct stones (CDSs) after cholecystectomy have been recognized as a cause of post cholecystectomy pain. This study was undertaken to determine the incidence of CDSs during laparoscopic cholecystectomy(LC). A cohort of 330 consecutive patients (80 males and 250females) undergoing LC between November 2006 and May2010 was studied. Their age ranged between 16 and 88 years(median 50, IQR: 36.62). The data were prospectively collected of preoperative liver function tests, imaging, the presence of intraoperative CDSs, and common bile duct stones at on-table cholangiogram. CDSs were detected intraoperatively in 64 of the 330 patients (19%). Ultrasound failed to detect CDSs in any of these cases. Deranged liver function tests were noted in 73% of the patients with CDSs and in 57% without CDSs Common bile duct stones were detected in 9% (29) of the 330patients. CDSs occur commonly at routine cholecystectomy, and preoperative investigations are not helpful in their diagnosis As CDSs may lead to postoperative morbidity, they should be actively sought out during surgery if present.展开更多
A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice.An endoscopic retrograde cholangiopancreatography with endoscopic sphincter...A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice.An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy(EST),followed by stone extraction,are usually an effective treatment for this condition.However,these procedures are associated with severe complications including pancreatitis,bleeding,and duodenal perforation.Nitrates such as glyceryl trinitrate(GTN) and isosorbide dinitrate(ISDN) are known to relax the sphincter of Oddi.In 6 cases in which a retained stone was detected following cholecystectomy,topical nitrate drip infusion via cystic duct tube(C-tube) was carried out.Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN,which was the regular dose of intravenous injection.Three other cases failed,and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed.One patient developed an adverse event of nausea.Severe complications were not observed.We consider the topical nitrate drip infusion via C-tube to be old but safe,easy,and inexpensive procedure for retained bile duct stone following cholecystectomy,inasmuch as removal rate was about 50% in our cases.展开更多
目的探讨应用超细胆道镜经胆囊管治疗胆总管结石的临床疗效和价值。方法对我院2004年6月~2006年6月实施的49例经胆囊管治疗胆总管结石症临床资料进行回顾性分析,其中开腹经胆囊管胆总管探查术（open transcystic common bile duct expl...目的探讨应用超细胆道镜经胆囊管治疗胆总管结石的临床疗效和价值。方法对我院2004年6月~2006年6月实施的49例经胆囊管治疗胆总管结石症临床资料进行回顾性分析,其中开腹经胆囊管胆总管探查术（open transcystic common bile duct exploration,OTCBDE）22例,腹腔镜经胆囊管胆道探查术（laparoscopic transcystic common bile duct exploration,LTCBDE）27例。结果OTCBDE组：22例手术成功20例（占90.9%）,平均手术时间为（76.8±26.8）min,术后平均住院日为（8.30±1.7）d,出现1例胆漏,无胆道残余结石发生。LTCBDE组：27例手术成功23例（占85.2%）,平均手术时间为（136.3±38.9）min,术后平均住院日为（5.6±2.0）d,出现1例胆漏,无胆道残余结石发生。结论经胆囊管胆道探查治疗胆总管结石避免了切开胆总管和放置T管,具有很好的临床应用价值。展开更多
目的比较分析腹腔镜下经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)与腔镜胆道探查"T"管引流(laparoscopic common bile duct exploration,LCBDE)2种术式治疗继发性肝外胆管结...目的比较分析腹腔镜下经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)与腔镜胆道探查"T"管引流(laparoscopic common bile duct exploration,LCBDE)2种术式治疗继发性肝外胆管结石的临床效果。方法选择2011年6月-2013年6月在新疆医科大学第一附属医院行腹腔镜胆总管探查取石术的58例继发性肝外胆管结石患者,分为两组,LTCBDE组26例,LCBDE组32例(其中2例为LTCBDE组术中中转)。比较两组患者手术时间、术中出血量、住院费用、术后补液量、术后带管时间、术后住院时间及术后并发症(胆漏、胆总管狭窄、胆管炎、腹腔感染、胆道出血、残余结石)。结果两组患者手术均成功,治愈后出院,无死亡病例。LTCBDE组术后无胆漏、残余结石及胆道出血,LCBDE组术后出现1例胆漏、2例残余结石、1例胆道出血,两组均无术后胆总管狭窄、胆管炎及腹腔感染病例。LTCBDE组患者术后带管时间、住院费用、术中出血量、术后住院时间、术后补液量均少于LCBDE引流组,差异有统计学意义(P<0.05);LTCBDE组手术时间长于LCBDE组,差异有统计学意义(P<0.05)。结论在严格掌握手术适应证的条件下,LTCBDE具有创伤小、并发症少、费用低、术后生活质量高等优点,可视为安全有效及经济的术式选择。展开更多
文摘Residual cystic duct stones (CDSs) after cholecystectomy have been recognized as a cause of post cholecystectomy pain. This study was undertaken to determine the incidence of CDSs during laparoscopic cholecystectomy(LC). A cohort of 330 consecutive patients (80 males and 250females) undergoing LC between November 2006 and May2010 was studied. Their age ranged between 16 and 88 years(median 50, IQR: 36.62). The data were prospectively collected of preoperative liver function tests, imaging, the presence of intraoperative CDSs, and common bile duct stones at on-table cholangiogram. CDSs were detected intraoperatively in 64 of the 330 patients (19%). Ultrasound failed to detect CDSs in any of these cases. Deranged liver function tests were noted in 73% of the patients with CDSs and in 57% without CDSs Common bile duct stones were detected in 9% (29) of the 330patients. CDSs occur commonly at routine cholecystectomy, and preoperative investigations are not helpful in their diagnosis As CDSs may lead to postoperative morbidity, they should be actively sought out during surgery if present.
文摘A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice.An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy(EST),followed by stone extraction,are usually an effective treatment for this condition.However,these procedures are associated with severe complications including pancreatitis,bleeding,and duodenal perforation.Nitrates such as glyceryl trinitrate(GTN) and isosorbide dinitrate(ISDN) are known to relax the sphincter of Oddi.In 6 cases in which a retained stone was detected following cholecystectomy,topical nitrate drip infusion via cystic duct tube(C-tube) was carried out.Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN,which was the regular dose of intravenous injection.Three other cases failed,and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed.One patient developed an adverse event of nausea.Severe complications were not observed.We consider the topical nitrate drip infusion via C-tube to be old but safe,easy,and inexpensive procedure for retained bile duct stone following cholecystectomy,inasmuch as removal rate was about 50% in our cases.
文摘目的探讨应用超细胆道镜经胆囊管治疗胆总管结石的临床疗效和价值。方法对我院2004年6月~2006年6月实施的49例经胆囊管治疗胆总管结石症临床资料进行回顾性分析,其中开腹经胆囊管胆总管探查术（open transcystic common bile duct exploration,OTCBDE）22例,腹腔镜经胆囊管胆道探查术（laparoscopic transcystic common bile duct exploration,LTCBDE）27例。结果OTCBDE组：22例手术成功20例（占90.9%）,平均手术时间为（76.8±26.8）min,术后平均住院日为（8.30±1.7）d,出现1例胆漏,无胆道残余结石发生。LTCBDE组：27例手术成功23例（占85.2%）,平均手术时间为（136.3±38.9）min,术后平均住院日为（5.6±2.0）d,出现1例胆漏,无胆道残余结石发生。结论经胆囊管胆道探查治疗胆总管结石避免了切开胆总管和放置T管,具有很好的临床应用价值。
文摘目的比较分析腹腔镜下经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)与腔镜胆道探查"T"管引流(laparoscopic common bile duct exploration,LCBDE)2种术式治疗继发性肝外胆管结石的临床效果。方法选择2011年6月-2013年6月在新疆医科大学第一附属医院行腹腔镜胆总管探查取石术的58例继发性肝外胆管结石患者,分为两组,LTCBDE组26例,LCBDE组32例(其中2例为LTCBDE组术中中转)。比较两组患者手术时间、术中出血量、住院费用、术后补液量、术后带管时间、术后住院时间及术后并发症(胆漏、胆总管狭窄、胆管炎、腹腔感染、胆道出血、残余结石)。结果两组患者手术均成功,治愈后出院,无死亡病例。LTCBDE组术后无胆漏、残余结石及胆道出血,LCBDE组术后出现1例胆漏、2例残余结石、1例胆道出血,两组均无术后胆总管狭窄、胆管炎及腹腔感染病例。LTCBDE组患者术后带管时间、住院费用、术中出血量、术后住院时间、术后补液量均少于LCBDE引流组,差异有统计学意义(P<0.05);LTCBDE组手术时间长于LCBDE组,差异有统计学意义(P<0.05)。结论在严格掌握手术适应证的条件下,LTCBDE具有创伤小、并发症少、费用低、术后生活质量高等优点,可视为安全有效及经济的术式选择。
