BACKGROUND:Magnetic resonance cholangiography (MRC)is a non-invasive method for imaging biliary ducts.When used to exclude common bile duct(CBD) stones,MRC may obviate the need for intra-operative cholangiography(IOC)...BACKGROUND:Magnetic resonance cholangiography (MRC)is a non-invasive method for imaging biliary ducts.When used to exclude common bile duct(CBD) stones,MRC may obviate the need for intra-operative cholangiography(IOC).In this prospective study,MRC and IOC were compared for the diagnosis of suspected stones of the CBD. METHODS:Thirty patients with gallstones and suspected CBD lithiasis(abnormal serum liver tests and CBD>7 mm on ultrasound)had MRC followed by open cholecystectomy and IOC.MR imaging was done using a 1.5-T whole body scanner(Signa,General Electric Medical Systems).A torso phased-array coil with a 4-channel receiver was used for data acquisition. RESULTS:Over a period of 18 months,30 patients(average age 53.9±13.3 years;range 38-76 years)were enrolled in this study.Eleven patients were male(36.7%)and 19 female(63.3%).MRC revealed CBD stones in 19 patients, while IOC revealed CBD stones in 22.The sensitivity of MRC in detecting CBD stones was 81.8%,and the specificity was 87.5%.The positive predictive value was 94.7%,and the negative predictive value was 63.3%. CONCLUSIONS:Pre-operative MRC may obviate the need for IOC.MRC reduces operative time,is less invasive, and may also alleviate damage to the CBD that can occurduring IOC.MRC can identify CBD stones pre-operatively and can help surgeons plan safe procedures.Pre-operative MRC should be done routinely in patients whose clinical or biochemical findings suggest the possibility of CBD stones.展开更多
AIM: To evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in nonteaching rural hospitals of a developing country without intra-operative cholangiography (IOC). To evaluate the possibi...AIM: To evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in nonteaching rural hospitals of a developing country without intra-operative cholangiography (IOC). To evaluate the possibility of reduction of costs and hospital stay for patients undergoing LC.METHODS: A prospective analysis of patients with symptomatic benign diseases of gall bladder undergoing LC in three non-teaching rural hospitals of Kashmir Valley from Jan 2001 to Jan 2007. The cohort represented a sample of patients requiring LC, aged 13 to 78 (mean 47.2) years. Main outcome parameters included mortality, complications, re-operation, conversion to open procedure without resorting to IOC, reduction in costs borne by the hospital, and the duration of hospital stay.RESULTS: Twelve hundred and sixty-seven patients (976 females/291 males) underwent laparoscopic cholecystectomy. Twenty-three cases were converted to open procedures; 12 patients developed port site infection, nobody died because of the procedure. One patient had common bile duct (CBD) injury, 4 patients had biliary leak, and 4 patients had subcutaneous emphysema. One cholecystohepatic duct was detected and managed intraoperatively, 1 patient had retained CBD stones, while 1 patient had retained cystic duct stones. Incidental gallbladder malignancy was detected in 2 cases. No long-term complications were detected up to now.CONCLUSION: LC can be performed safely even in non-teaching rural hospitals of a developing country provided proper equipment is available and the surgeons and other team members are well trained in the procedure. It is stressed that IOC is not essential to prevent biliary tract injuries and missed CBD stones. The costs to the patient and the hospital can be minimized by using reusable instruments, intracorporeal sutures, and condoms instead of titanium clips and endobags.展开更多
BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to ...BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also analyzed.RESULTS: The ALT and AST values were significantly increased after IOC(P<0.001) and parenchymal resection(P<0.001).However, the median values of TB, ALP and GGT were not significantly influenced by IOC(P>0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.展开更多
Background Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans...Background Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration, and identified the factors that positively predict the presence of common bile duct stones. Methods From January 2008 to January 2011, 252 of 1013 patients undergoing laparoscopic cholecystectomy received selective trans-cystic intra-operative cholangiography and primary suture following three-port laparoscopic common bile duct exploration. Their clinical data were analyzed retrospectively. Results All operations were successful and none was converted to open surgery. The intra-operative cholangiography time was (8.3±2.5) minutes, and the operative duration was (105.4±23.1) minutes. According to selective intra-operative cholangiography, the positive predictive values of current jaundice, small gallstones (〈0.5 cm) and dilated cystic duct (〉0.3 cm), dilated common bile duct (〉0.8 cm), history of jaundice or gallstone pancreatitis, abnormal liver function test, and preoperative demonstration of suspected common bile duct stones on imaging were 87%, 25%, 42%, 15%, 32%, and 75% for common bile duct stones, respectively. Patients with several factors suggestive of common bile duct stones yielded higher numbers of positive cholangiograms. Unexpected stones were found in 13 patients (5.2%) by intra-operative cholangiography. The post-operative hospital stay was (4.7±2.2) days. Post-operative bile leakage occurred in two cases, and these patients recovered by simple drainage for 3-7 days without re-operation. Of the 761 patients who underwent laparoscopic cholecystectomy alone, 5 (0.7%) presented with a retained common bile duct stone requiring intervention. The median follow-up was 12 months, and only one patient who once suffered from bile leakage presented with obstructive jaundice due to bile duct stenosis 6 months postoperatively. The other patients recovered without any serious complications. Conclusions Selective intra-operative cholangiography yields acceptably high positive results. It is a safe, effective, and minimally invasive approach in patients with suspected choledocholithiasis and primary suture following three-port laparoscopic common bile duct exploration.展开更多
Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct in...Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems.A series of methods have been proposed to prevent bile duct injury,among them the use of indocyanine green(ICG)fluorescence.The most commonly reported method of ICG injection is the intravenous administration,while literature is lacking studies investigating the direct intragallbladder ICG injection.This narrative mini-review aims to assess the potential applications,usefulness,and limitations of intragallbladder ICG fluorescence in LC.Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy,as well as special issues regarding its use.Literature search retrieved four prospective cohort studies,three case-control studies,and one case report.In the three case-control studies selected,intragallbladder near-infrared cholangiography(NIRC)was compared with standard LC under white light,with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography(IOC).In total,133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC.Literature includes several reports of intragallbladder ICG administration,but a standardized technique has not been established yet.Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping,overwhelming limitations of IOC including intervention and radiation exposure,as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence.Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.展开更多
Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, ...Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, a parallel-plate ionization chamber and an electrometer were used to measure the depth dose rate, isotropy of dose distribution in X/Y plane, dosimetry reproducibility of bare probe and spherical applicators of different size which were used in comparison with the system data. Results: The difference in depth dose rate between the measurement and system data for bare probe is -2.16% ± 1.36%, the range of the relative deviation for isotropy in the X/Y plane is between -1.9% and 2.1%. The difference in depth dose rate, transfer coefficient, isotropy in X/Y plane between the measurement and system data for the whole set of spherical applicators is -10.0% - 2.3%, -8.9% - 4.2% and -1.6% - 2.6%, respectively. Higher surface dose rate and steeper gradient depth dose are observed in smaller spherical applicators. The depth dose rate and isotropy for bare probe and spherical applicators have been shown good reproducibility. The uncertainty of measurement is associated with the positioning accuracy, energy response, noise current and correction function f’(R). Conclusions: Thorough commissioning of the low energy photon IORT system helps us better understand the dosimetry characteristics, verify the system data, obtain adequate data for clinical application and routine quality assurance. The steep gradient depth dose and limited treatment range may restrain its potential in clinical application.展开更多
Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our serie...Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our series and other studies in literature for insight. A chart review was carried out to identify all patients who underwent a thyroidectomy between 2005 and 2010. IONM was implemented by the Otolaryngology service in 2007. All identified patients were separated into three groups: 1) Otolaryngology service with IONM, 2) Otolaryngology service without IONM, and 3) General Surgery service without IONM. Several factors were noted, including age, sex, thyroid disease, extent of thyroidectomy, and RLN injury along with recovery. 230 patients underwent thyroidectomy from 2005-2010. 60 patients were isolated in the IONM-Otolaryngology group with 3 patients suffering injury. 109 patients underwent a thyroidectomy by the Otolaryngology service without IONM with 8 patients suffering nerve damage. In the third group, 61 patients underwent a thyroidectomy by General Surgery without IONM with 4 patients suffering damage. Of the thyroid pathology, 10 patients had Multinodular Goiter while 4 had Papillary Cancer and 1 had a Follicular Adenoma. The most severe complication of a thyroidectomy is RLN injury. In order to further decrease the risk of RLN injury, IONM has been employed. From our review and other studies, there does not appear to be a significant difference in rates of RLN injury with or without use of nerve monitoring. An interesting note is the increased prevalence of nerve injuries in Multinodular Goiter—a finding that merits further study to evaluate the role of IONM.展开更多
BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications o...BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.展开更多
The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspe...The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspect of holistic patient care.There are a multitude of other potential avenues in which gastrointestinal care may be involved.We aim to review the role of AI in colorectal cancer as a whole.We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer.All trials including qualitative research were included from the year 2000 onwards.Studies were grouped into pre-operative,intra-operative and post-operative aspects.Preoperatively,the major use is with endoscopic recognition.Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic,Japan Narrow-band Imaging Expert Team,Paris and Kudo.However,novel detection and diagnostic methods have arisen from advances in AI classification.Intra-operatively,adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes.Post-operatively,monitoring and surveillance have taken strides with potential socioeconomic and environmental savings.The uses of AI within the umbrella of colorectal surgery are multiple.We have identified existing technologies which are already augmenting cancer care.The future applications are exciting and could at least match,if not surpass human standards.展开更多
目的:探讨电子计算机断层扫描(CT)胆管成像与磁共振胆胰管成像(MRCP)对良恶性胆道梗阻的诊断价值。方法:选择2017年6月—2022年12月在兴化市人民医院接受诊治的胆道梗阻患者83例,所有患者均接受CT胆管成像及MRCP检查,比较这两种检查方...目的:探讨电子计算机断层扫描(CT)胆管成像与磁共振胆胰管成像(MRCP)对良恶性胆道梗阻的诊断价值。方法:选择2017年6月—2022年12月在兴化市人民医院接受诊治的胆道梗阻患者83例,所有患者均接受CT胆管成像及MRCP检查,比较这两种检查方法在鉴别良恶性胆道梗阻中的诊断价值。结果:以患者术后病理检查结果为金标准,分为恶性组23例和良性组60例。CT胆管成像检查中恶性组患者胆道狭窄(78.26%vs 36.67%)、胆道边缘模糊(69.57%vs 25.00%)及胆道形态变异(73.91%vs 28.33%)的发生率较良性组显著升高(均P<0.05)。MRCP检查中恶性组患者胆胰管汇合角度[(43.58±1.48)°vs(25.78±2.58)°]、胆总管直径(6.79±0.24 mm vs 4.78±0.32 mm)及胰管直径(2.99±0.13 mm vs 2.11±0.26 mm)显著高于良性组(均P<0.05)。CT胆管成像与MRCP对胆道梗阻良恶性的诊断敏感度分别为91.30%、95.65%,特异度分别为100.0%、100.0%,Kappa值分别为93.80%和97.00%。结论:CT胆管成像与MRCP在鉴别良恶性胆道梗阻方面都有较高的诊断价值。展开更多
AIM: To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system.METHODS: MEDLINE and Pub Med searches were performed using the key words "fluorescent ...AIM: To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system.METHODS: MEDLINE and Pub Med searches were performed using the key words "fluorescent cholangiography", "fluorescent angiography", "intraoperative fluorescent imaging", and "laparoscopic cholecystectomy" in order to identify relevant articles published in English, French, German, and Italian during the years of 2009 to 2014. Reference lists from the articles were reviewed to identify additional pertinent articles. For studies published in languages other than those mentioned above, all available information was collected from their English abstracts. Retrieved manuscripts(case reports, reviews, and abstracts) concerning the application of fluorescent cholangiography were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. In contrast to classic meta-analyses, statistical analysis was performed where the outcome was calculated as the percentages of an event(without comparison) in pseudo-cohorts of observed patients.RESULTS: A total of 16 studies were found that involved fluorescent cholangiography during standard laparoscopic cholecystectomies(n = 11), singleincision robotic cholecystectomies(n = 3), multiport robotic cholecystectomy(n = 1), and single-incision laparoscopic cholecystectomy(n = 1). Overall, these preliminary studies indicated that this novel technique was highly sensitive for the detection of important biliary anatomy and could facilitate the prevention of bile duct injuries. The structures effectively identified before dissection of Calot's triangle included the cystic duct(CD), the common hepatic duct(CHD), the common bile duct(CBD), and the CD-CHD junction. A review of the literature revealed that the frequenciesof detection of the extrahepatic biliary system ranged from 71.4% to 100% for the CD, 33.3% to 100% for the CHD, 50% to 100% for the CBD, and 25% to 100% for the CD-CHD junction. However, the frequency of visualization of the CD and the CBD were reduced in patients with a body mass index > 35 kg/m2 relative to those with a body mass index < 35 kg/m2(91.0% and 64.0% vs 92.3% and 71.8%, respectively).CONCLUSION: Fluorescent cholangiography is a safe procedure enabling real-time visualization of bile duct anatomy and may become standard practice to prevent bile duct injury during laparoscopic cholecystectomy.展开更多
BACKGROUND: Hilar cholangiocarcinoma is one of the most difficult carcinomas to manage because of the location of the main tumor at the hepatic hilus and the complex anatomy of the biliary, arterial, and portal system...BACKGROUND: Hilar cholangiocarcinoma is one of the most difficult carcinomas to manage because of the location of the main tumor at the hepatic hilus and the complex anatomy of the biliary, arterial, and portal systems. To plan an operation, it is important to acquire accurate information about the relationship between hilar cholangiocarcinoma and adjacent vessels. This study aimed to evaluate the clinical value of cholangiography combined with spiral CT three-dimensional (3D) angiography for a preoperative assessment of hilar cholangiocarcinoma. METHODS: From March 2007 to August 2009, cholangiography was performed in 13 patients with hilar cholangiocarcinoma. Meanwhile, contrast-enhanced abdominal scanning was performed using 16-slice spiral CT, and the 3D images of the hepatic artery and portal vein were acquired. The level and range of invasion of the hepatic artery, the portal vein, and the bile duct, the preoperative Bismuth classification, and T-staging were recorded and compared with those after surgical exploration. RESULTS: The hepatic artery and portal vein were reconstructed successfully in all these patients. Percutaneous transhepatic cholangiography was performed in 9 patients, endoscopic retrograde cholangiopancreatography in 1, and magnetic resonance cholangiopancreatography in 3. The CT angiography records of invasion of the hepatic artery were consistent with the results of explorations in these patients. The data from 5 of the 13 patients were consistent with those on invasion of the portal vein. The results of the Bismuth classification and the T-staging system were consistent with those of surgical exploration in 12 of the 13 patients. Seven of 8 patients who were estimated to be suitable for operation based on images were curatively treated and 5 who were judged to be unsuitable for curative operation by cholangiography and CT angiography were confirmed intraoperatively and underwent palliative procedures. CONCLUSIONS: Cholangiography combined with multi-slice spiral 3D CT angiography can satisfactorily delineate the local invasion of hilar cholangiocarcinoma and accurately evaluate the resectability. This approach, therefore, contributes to the planning of safe operation. (Hepatobiliary Pancreat Dis Int 2010; 9: 186-191)展开更多
Objective: To validate multi-slice three-dimensional spiral CT cholangiography (3-D CTC) in clinical di- agnosis of biliary diseases. Methods: This study included 146 patients with bili- ary diseases, involving 73 cas...Objective: To validate multi-slice three-dimensional spiral CT cholangiography (3-D CTC) in clinical di- agnosis of biliary diseases. Methods: This study included 146 patients with bili- ary diseases, involving 73 cases of biliary tumor, 87 cases of radioparent calculus, 12 cases of post cholan- gio-jejunostomy and one case of congenital choledo- chocyst. The data of thin-slice volumetric CT scan were sent to the workstation (GE Advantage Win- dows 3. 1). Rational 3-D CTC including maximum intensity projection, minimum intensity projection, surface shaded display, CT virtual endoscopy and ray sumption was performed. The diagnostic accura- cy of 3-D CTC was compared with that of conven- tional CT, ultrasonography and endoscopic retro- grade cholangiopancreaticography (ERCP). Results: Different biliary diseases showed distinct ima- ging manifestations on 3-D CTC, As a new technique for assessing the status of post cholangio-jejunosto- my, 3-D CTC was superior to conventional CT, ul- trasonography and ERCP in diagnosis of negative bil- iary calculus, extrahepatic cholangiocarcinoma, cancer embolus of the biliary duct, carcinoma of the pancreas head and periampullar carcinoma. It was also superior to conventional CT, ultrasonography or equal to ERCP in diagnosis of hilar cholangiocarcino- ma, but inferior to conventional CT and ultrasonog- raphy in diagnosis of gallbladder cancer. Conclusion: 3-D CTC as a non-invasive and sensitive technique for the diagnosis of biliary diseases with high diagnostic accuracy will greatly increase the de- tection rate of biliary diseases.展开更多
AIM:To determine the efficacy and safety benefits of performing intraoperative cholangiography(IOC)during laparoscopic cholecystectomy(LC)to treat symptomatic cholelithiasis.METHODS:Patients admitted to the Minimally ...AIM:To determine the efficacy and safety benefits of performing intraoperative cholangiography(IOC)during laparoscopic cholecystectomy(LC)to treat symptomatic cholelithiasis.METHODS:Patients admitted to the Minimally Invasive Surgery Center of Tianjin Nankai Hospital between January2012 and January 2014 for management of symptomaticcholelithiasis were recruited for this prospective randomized trial.Study enrollment was offered to patients with clinical presentation of biliary colic symptoms,radiological findings suggestive of gallstones,and normal serum biochemistry results.Study participants were randomized to receive either routine LC treatment or LC+IOC treatment.The routine LC procedure was carried out using the standard four-port technique;the LC+IOC procedure was carried out with the addition of meglumine diatrizoate(1:1 dilution with normal saline)injection via a catheter introduced through a small incision in the cystic duct made by laparoscopic scissors.Operative data and postoperative outcomes,including operative time,retained common bile duct(CBD)stones,CBD injury,other complications and length of hospital stay,were recorded for comparative analysis.Inter-group differences were statistically assessed by theχ2 test(categorical variables)and Fisher’s exact test(binary variables),with the threshold for statistical significance set at P<0.05.RESULTS:A total of 371 patients were enrolled in the trial(late-adolescent to adult,age range:16-70 years),with 185 assigned to the routine LC group and 186 to the LC+IOC group.The two treatment groups were similar in age,sex,body mass index,duration of symptomology,number and size of gallstones,and clinical symptoms.The two treatment groups also showed no significant differences in the rates of successful LC(98.38%vs97.85%),CBD stone retainment(0.54%vs 0.00%),CBD injury(0.54%vs 0.53%)and other complications(2.16%vs 2.15%),as well as in duration of hospital stay(5.10±1.41 d vs 4.99±1.53 d).However,the LC+IOC treatment group showed significantly longer mean operative time(routine LC group:43.00±4.15 min vs 52.86±4.47 min,P<0.01).There were no cases of fatal complications in either group.At the one-year follow-up assessment,one patient in the routine LC group reported experiencing diarrhea for three months after the LC and one patient in the LC+IOC group reported ongoing intermittent epigastric discomfort,but radiologicalexamination provided no abnormal findings.CONCLUSION:IOC addition to the routine LC treatment of symptomatic cholelithiasis does not improve rates of CBD stone retainment or bile duct injury but lengthens operative time.展开更多
OBJECTIVE: To evaluate the predictive value of magnetic resonance cholangiography (MRC) in selected patients before laparoscopic cholecystectomy (LC). METHODS: Patients with risk factors for common bile duct (CBD) sto...OBJECTIVE: To evaluate the predictive value of magnetic resonance cholangiography (MRC) in selected patients before laparoscopic cholecystectomy (LC). METHODS: Patients with risk factors for common bile duct (CBD) stones scheduled for elective LC from March 1999 to May 2001, underwent MRC followed by endoscopic retrograde cholangiography (ERC) to detect the stones and the accuracy of MRC. Selection of suspected patients was based on clinical, ultrasonographic, and laboratory criteria. RESULTS: During a 26-month period, a total of 267 patients were studied. Seventy-eight MRC identified patients were found to have CBD stones by ERC or laparoscopic cholangiography in the study. Seven of 78 patients were misdiagnosed as having CBD stones by MRC. In this study, MRC had a sensitivity of 100%, a specificity of 96.3%, a positive predictive value of 91.8%, and a negative predictive value of 100% for the detection of common bile duct stones. CONCLUSIONS: With the use of LC, ERC is frequently performed before LC to detect CBD stones; but it is invasive with a well-documented complication rate. MRC is a simple non-invasive method for preoperative screening for CBD stones in at-risk patients. In this study if ERC had been limited to patients with a positive MRC, it would have reduced the need for ERC by 68.2%, and the complications of preoperative examination would be minimized significantly.展开更多
文摘BACKGROUND:Magnetic resonance cholangiography (MRC)is a non-invasive method for imaging biliary ducts.When used to exclude common bile duct(CBD) stones,MRC may obviate the need for intra-operative cholangiography(IOC).In this prospective study,MRC and IOC were compared for the diagnosis of suspected stones of the CBD. METHODS:Thirty patients with gallstones and suspected CBD lithiasis(abnormal serum liver tests and CBD>7 mm on ultrasound)had MRC followed by open cholecystectomy and IOC.MR imaging was done using a 1.5-T whole body scanner(Signa,General Electric Medical Systems).A torso phased-array coil with a 4-channel receiver was used for data acquisition. RESULTS:Over a period of 18 months,30 patients(average age 53.9±13.3 years;range 38-76 years)were enrolled in this study.Eleven patients were male(36.7%)and 19 female(63.3%).MRC revealed CBD stones in 19 patients, while IOC revealed CBD stones in 22.The sensitivity of MRC in detecting CBD stones was 81.8%,and the specificity was 87.5%.The positive predictive value was 94.7%,and the negative predictive value was 63.3%. CONCLUSIONS:Pre-operative MRC may obviate the need for IOC.MRC reduces operative time,is less invasive, and may also alleviate damage to the CBD that can occurduring IOC.MRC can identify CBD stones pre-operatively and can help surgeons plan safe procedures.Pre-operative MRC should be done routinely in patients whose clinical or biochemical findings suggest the possibility of CBD stones.
文摘AIM: To evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in nonteaching rural hospitals of a developing country without intra-operative cholangiography (IOC). To evaluate the possibility of reduction of costs and hospital stay for patients undergoing LC.METHODS: A prospective analysis of patients with symptomatic benign diseases of gall bladder undergoing LC in three non-teaching rural hospitals of Kashmir Valley from Jan 2001 to Jan 2007. The cohort represented a sample of patients requiring LC, aged 13 to 78 (mean 47.2) years. Main outcome parameters included mortality, complications, re-operation, conversion to open procedure without resorting to IOC, reduction in costs borne by the hospital, and the duration of hospital stay.RESULTS: Twelve hundred and sixty-seven patients (976 females/291 males) underwent laparoscopic cholecystectomy. Twenty-three cases were converted to open procedures; 12 patients developed port site infection, nobody died because of the procedure. One patient had common bile duct (CBD) injury, 4 patients had biliary leak, and 4 patients had subcutaneous emphysema. One cholecystohepatic duct was detected and managed intraoperatively, 1 patient had retained CBD stones, while 1 patient had retained cystic duct stones. Incidental gallbladder malignancy was detected in 2 cases. No long-term complications were detected up to now.CONCLUSION: LC can be performed safely even in non-teaching rural hospitals of a developing country provided proper equipment is available and the surgeons and other team members are well trained in the procedure. It is stressed that IOC is not essential to prevent biliary tract injuries and missed CBD stones. The costs to the patient and the hospital can be minimized by using reusable instruments, intracorporeal sutures, and condoms instead of titanium clips and endobags.
基金supported by grants from the Foundation for Innovative Research Groups of the National Natural Science Foundation of China(81121002)Zhejiang Provincial Program for the Cultivation of High-Level Innovative Health Talents(2012-236)+1 种基金Zhejiang Provincial Education Department Project(Y201018972)Zhejiang Provincial Natural Science Foundation of China(LQ12H03002)
文摘BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also analyzed.RESULTS: The ALT and AST values were significantly increased after IOC(P<0.001) and parenchymal resection(P<0.001).However, the median values of TB, ALP and GGT were not significantly influenced by IOC(P>0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.
文摘Background Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration, and identified the factors that positively predict the presence of common bile duct stones. Methods From January 2008 to January 2011, 252 of 1013 patients undergoing laparoscopic cholecystectomy received selective trans-cystic intra-operative cholangiography and primary suture following three-port laparoscopic common bile duct exploration. Their clinical data were analyzed retrospectively. Results All operations were successful and none was converted to open surgery. The intra-operative cholangiography time was (8.3±2.5) minutes, and the operative duration was (105.4±23.1) minutes. According to selective intra-operative cholangiography, the positive predictive values of current jaundice, small gallstones (〈0.5 cm) and dilated cystic duct (〉0.3 cm), dilated common bile duct (〉0.8 cm), history of jaundice or gallstone pancreatitis, abnormal liver function test, and preoperative demonstration of suspected common bile duct stones on imaging were 87%, 25%, 42%, 15%, 32%, and 75% for common bile duct stones, respectively. Patients with several factors suggestive of common bile duct stones yielded higher numbers of positive cholangiograms. Unexpected stones were found in 13 patients (5.2%) by intra-operative cholangiography. The post-operative hospital stay was (4.7±2.2) days. Post-operative bile leakage occurred in two cases, and these patients recovered by simple drainage for 3-7 days without re-operation. Of the 761 patients who underwent laparoscopic cholecystectomy alone, 5 (0.7%) presented with a retained common bile duct stone requiring intervention. The median follow-up was 12 months, and only one patient who once suffered from bile leakage presented with obstructive jaundice due to bile duct stenosis 6 months postoperatively. The other patients recovered without any serious complications. Conclusions Selective intra-operative cholangiography yields acceptably high positive results. It is a safe, effective, and minimally invasive approach in patients with suspected choledocholithiasis and primary suture following three-port laparoscopic common bile duct exploration.
文摘Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems.A series of methods have been proposed to prevent bile duct injury,among them the use of indocyanine green(ICG)fluorescence.The most commonly reported method of ICG injection is the intravenous administration,while literature is lacking studies investigating the direct intragallbladder ICG injection.This narrative mini-review aims to assess the potential applications,usefulness,and limitations of intragallbladder ICG fluorescence in LC.Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy,as well as special issues regarding its use.Literature search retrieved four prospective cohort studies,three case-control studies,and one case report.In the three case-control studies selected,intragallbladder near-infrared cholangiography(NIRC)was compared with standard LC under white light,with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography(IOC).In total,133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC.Literature includes several reports of intragallbladder ICG administration,but a standardized technique has not been established yet.Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping,overwhelming limitations of IOC including intervention and radiation exposure,as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence.Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.
文摘Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, a parallel-plate ionization chamber and an electrometer were used to measure the depth dose rate, isotropy of dose distribution in X/Y plane, dosimetry reproducibility of bare probe and spherical applicators of different size which were used in comparison with the system data. Results: The difference in depth dose rate between the measurement and system data for bare probe is -2.16% ± 1.36%, the range of the relative deviation for isotropy in the X/Y plane is between -1.9% and 2.1%. The difference in depth dose rate, transfer coefficient, isotropy in X/Y plane between the measurement and system data for the whole set of spherical applicators is -10.0% - 2.3%, -8.9% - 4.2% and -1.6% - 2.6%, respectively. Higher surface dose rate and steeper gradient depth dose are observed in smaller spherical applicators. The depth dose rate and isotropy for bare probe and spherical applicators have been shown good reproducibility. The uncertainty of measurement is associated with the positioning accuracy, energy response, noise current and correction function f’(R). Conclusions: Thorough commissioning of the low energy photon IORT system helps us better understand the dosimetry characteristics, verify the system data, obtain adequate data for clinical application and routine quality assurance. The steep gradient depth dose and limited treatment range may restrain its potential in clinical application.
文摘Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our series and other studies in literature for insight. A chart review was carried out to identify all patients who underwent a thyroidectomy between 2005 and 2010. IONM was implemented by the Otolaryngology service in 2007. All identified patients were separated into three groups: 1) Otolaryngology service with IONM, 2) Otolaryngology service without IONM, and 3) General Surgery service without IONM. Several factors were noted, including age, sex, thyroid disease, extent of thyroidectomy, and RLN injury along with recovery. 230 patients underwent thyroidectomy from 2005-2010. 60 patients were isolated in the IONM-Otolaryngology group with 3 patients suffering injury. 109 patients underwent a thyroidectomy by the Otolaryngology service without IONM with 8 patients suffering nerve damage. In the third group, 61 patients underwent a thyroidectomy by General Surgery without IONM with 4 patients suffering damage. Of the thyroid pathology, 10 patients had Multinodular Goiter while 4 had Papillary Cancer and 1 had a Follicular Adenoma. The most severe complication of a thyroidectomy is RLN injury. In order to further decrease the risk of RLN injury, IONM has been employed. From our review and other studies, there does not appear to be a significant difference in rates of RLN injury with or without use of nerve monitoring. An interesting note is the increased prevalence of nerve injuries in Multinodular Goiter—a finding that merits further study to evaluate the role of IONM.
文摘BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.
文摘The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspect of holistic patient care.There are a multitude of other potential avenues in which gastrointestinal care may be involved.We aim to review the role of AI in colorectal cancer as a whole.We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer.All trials including qualitative research were included from the year 2000 onwards.Studies were grouped into pre-operative,intra-operative and post-operative aspects.Preoperatively,the major use is with endoscopic recognition.Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic,Japan Narrow-band Imaging Expert Team,Paris and Kudo.However,novel detection and diagnostic methods have arisen from advances in AI classification.Intra-operatively,adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes.Post-operatively,monitoring and surveillance have taken strides with potential socioeconomic and environmental savings.The uses of AI within the umbrella of colorectal surgery are multiple.We have identified existing technologies which are already augmenting cancer care.The future applications are exciting and could at least match,if not surpass human standards.
文摘目的:探讨电子计算机断层扫描(CT)胆管成像与磁共振胆胰管成像(MRCP)对良恶性胆道梗阻的诊断价值。方法:选择2017年6月—2022年12月在兴化市人民医院接受诊治的胆道梗阻患者83例,所有患者均接受CT胆管成像及MRCP检查,比较这两种检查方法在鉴别良恶性胆道梗阻中的诊断价值。结果:以患者术后病理检查结果为金标准,分为恶性组23例和良性组60例。CT胆管成像检查中恶性组患者胆道狭窄(78.26%vs 36.67%)、胆道边缘模糊(69.57%vs 25.00%)及胆道形态变异(73.91%vs 28.33%)的发生率较良性组显著升高(均P<0.05)。MRCP检查中恶性组患者胆胰管汇合角度[(43.58±1.48)°vs(25.78±2.58)°]、胆总管直径(6.79±0.24 mm vs 4.78±0.32 mm)及胰管直径(2.99±0.13 mm vs 2.11±0.26 mm)显著高于良性组(均P<0.05)。CT胆管成像与MRCP对胆道梗阻良恶性的诊断敏感度分别为91.30%、95.65%,特异度分别为100.0%、100.0%,Kappa值分别为93.80%和97.00%。结论:CT胆管成像与MRCP在鉴别良恶性胆道梗阻方面都有较高的诊断价值。
文摘AIM: To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system.METHODS: MEDLINE and Pub Med searches were performed using the key words "fluorescent cholangiography", "fluorescent angiography", "intraoperative fluorescent imaging", and "laparoscopic cholecystectomy" in order to identify relevant articles published in English, French, German, and Italian during the years of 2009 to 2014. Reference lists from the articles were reviewed to identify additional pertinent articles. For studies published in languages other than those mentioned above, all available information was collected from their English abstracts. Retrieved manuscripts(case reports, reviews, and abstracts) concerning the application of fluorescent cholangiography were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. In contrast to classic meta-analyses, statistical analysis was performed where the outcome was calculated as the percentages of an event(without comparison) in pseudo-cohorts of observed patients.RESULTS: A total of 16 studies were found that involved fluorescent cholangiography during standard laparoscopic cholecystectomies(n = 11), singleincision robotic cholecystectomies(n = 3), multiport robotic cholecystectomy(n = 1), and single-incision laparoscopic cholecystectomy(n = 1). Overall, these preliminary studies indicated that this novel technique was highly sensitive for the detection of important biliary anatomy and could facilitate the prevention of bile duct injuries. The structures effectively identified before dissection of Calot's triangle included the cystic duct(CD), the common hepatic duct(CHD), the common bile duct(CBD), and the CD-CHD junction. A review of the literature revealed that the frequenciesof detection of the extrahepatic biliary system ranged from 71.4% to 100% for the CD, 33.3% to 100% for the CHD, 50% to 100% for the CBD, and 25% to 100% for the CD-CHD junction. However, the frequency of visualization of the CD and the CBD were reduced in patients with a body mass index > 35 kg/m2 relative to those with a body mass index < 35 kg/m2(91.0% and 64.0% vs 92.3% and 71.8%, respectively).CONCLUSION: Fluorescent cholangiography is a safe procedure enabling real-time visualization of bile duct anatomy and may become standard practice to prevent bile duct injury during laparoscopic cholecystectomy.
文摘BACKGROUND: Hilar cholangiocarcinoma is one of the most difficult carcinomas to manage because of the location of the main tumor at the hepatic hilus and the complex anatomy of the biliary, arterial, and portal systems. To plan an operation, it is important to acquire accurate information about the relationship between hilar cholangiocarcinoma and adjacent vessels. This study aimed to evaluate the clinical value of cholangiography combined with spiral CT three-dimensional (3D) angiography for a preoperative assessment of hilar cholangiocarcinoma. METHODS: From March 2007 to August 2009, cholangiography was performed in 13 patients with hilar cholangiocarcinoma. Meanwhile, contrast-enhanced abdominal scanning was performed using 16-slice spiral CT, and the 3D images of the hepatic artery and portal vein were acquired. The level and range of invasion of the hepatic artery, the portal vein, and the bile duct, the preoperative Bismuth classification, and T-staging were recorded and compared with those after surgical exploration. RESULTS: The hepatic artery and portal vein were reconstructed successfully in all these patients. Percutaneous transhepatic cholangiography was performed in 9 patients, endoscopic retrograde cholangiopancreatography in 1, and magnetic resonance cholangiopancreatography in 3. The CT angiography records of invasion of the hepatic artery were consistent with the results of explorations in these patients. The data from 5 of the 13 patients were consistent with those on invasion of the portal vein. The results of the Bismuth classification and the T-staging system were consistent with those of surgical exploration in 12 of the 13 patients. Seven of 8 patients who were estimated to be suitable for operation based on images were curatively treated and 5 who were judged to be unsuitable for curative operation by cholangiography and CT angiography were confirmed intraoperatively and underwent palliative procedures. CONCLUSIONS: Cholangiography combined with multi-slice spiral 3D CT angiography can satisfactorily delineate the local invasion of hilar cholangiocarcinoma and accurately evaluate the resectability. This approach, therefore, contributes to the planning of safe operation. (Hepatobiliary Pancreat Dis Int 2010; 9: 186-191)
文摘Objective: To validate multi-slice three-dimensional spiral CT cholangiography (3-D CTC) in clinical di- agnosis of biliary diseases. Methods: This study included 146 patients with bili- ary diseases, involving 73 cases of biliary tumor, 87 cases of radioparent calculus, 12 cases of post cholan- gio-jejunostomy and one case of congenital choledo- chocyst. The data of thin-slice volumetric CT scan were sent to the workstation (GE Advantage Win- dows 3. 1). Rational 3-D CTC including maximum intensity projection, minimum intensity projection, surface shaded display, CT virtual endoscopy and ray sumption was performed. The diagnostic accura- cy of 3-D CTC was compared with that of conven- tional CT, ultrasonography and endoscopic retro- grade cholangiopancreaticography (ERCP). Results: Different biliary diseases showed distinct ima- ging manifestations on 3-D CTC, As a new technique for assessing the status of post cholangio-jejunosto- my, 3-D CTC was superior to conventional CT, ul- trasonography and ERCP in diagnosis of negative bil- iary calculus, extrahepatic cholangiocarcinoma, cancer embolus of the biliary duct, carcinoma of the pancreas head and periampullar carcinoma. It was also superior to conventional CT, ultrasonography or equal to ERCP in diagnosis of hilar cholangiocarcino- ma, but inferior to conventional CT and ultrasonog- raphy in diagnosis of gallbladder cancer. Conclusion: 3-D CTC as a non-invasive and sensitive technique for the diagnosis of biliary diseases with high diagnostic accuracy will greatly increase the de- tection rate of biliary diseases.
文摘AIM:To determine the efficacy and safety benefits of performing intraoperative cholangiography(IOC)during laparoscopic cholecystectomy(LC)to treat symptomatic cholelithiasis.METHODS:Patients admitted to the Minimally Invasive Surgery Center of Tianjin Nankai Hospital between January2012 and January 2014 for management of symptomaticcholelithiasis were recruited for this prospective randomized trial.Study enrollment was offered to patients with clinical presentation of biliary colic symptoms,radiological findings suggestive of gallstones,and normal serum biochemistry results.Study participants were randomized to receive either routine LC treatment or LC+IOC treatment.The routine LC procedure was carried out using the standard four-port technique;the LC+IOC procedure was carried out with the addition of meglumine diatrizoate(1:1 dilution with normal saline)injection via a catheter introduced through a small incision in the cystic duct made by laparoscopic scissors.Operative data and postoperative outcomes,including operative time,retained common bile duct(CBD)stones,CBD injury,other complications and length of hospital stay,were recorded for comparative analysis.Inter-group differences were statistically assessed by theχ2 test(categorical variables)and Fisher’s exact test(binary variables),with the threshold for statistical significance set at P<0.05.RESULTS:A total of 371 patients were enrolled in the trial(late-adolescent to adult,age range:16-70 years),with 185 assigned to the routine LC group and 186 to the LC+IOC group.The two treatment groups were similar in age,sex,body mass index,duration of symptomology,number and size of gallstones,and clinical symptoms.The two treatment groups also showed no significant differences in the rates of successful LC(98.38%vs97.85%),CBD stone retainment(0.54%vs 0.00%),CBD injury(0.54%vs 0.53%)and other complications(2.16%vs 2.15%),as well as in duration of hospital stay(5.10±1.41 d vs 4.99±1.53 d).However,the LC+IOC treatment group showed significantly longer mean operative time(routine LC group:43.00±4.15 min vs 52.86±4.47 min,P<0.01).There were no cases of fatal complications in either group.At the one-year follow-up assessment,one patient in the routine LC group reported experiencing diarrhea for three months after the LC and one patient in the LC+IOC group reported ongoing intermittent epigastric discomfort,but radiologicalexamination provided no abnormal findings.CONCLUSION:IOC addition to the routine LC treatment of symptomatic cholelithiasis does not improve rates of CBD stone retainment or bile duct injury but lengthens operative time.
文摘OBJECTIVE: To evaluate the predictive value of magnetic resonance cholangiography (MRC) in selected patients before laparoscopic cholecystectomy (LC). METHODS: Patients with risk factors for common bile duct (CBD) stones scheduled for elective LC from March 1999 to May 2001, underwent MRC followed by endoscopic retrograde cholangiography (ERC) to detect the stones and the accuracy of MRC. Selection of suspected patients was based on clinical, ultrasonographic, and laboratory criteria. RESULTS: During a 26-month period, a total of 267 patients were studied. Seventy-eight MRC identified patients were found to have CBD stones by ERC or laparoscopic cholangiography in the study. Seven of 78 patients were misdiagnosed as having CBD stones by MRC. In this study, MRC had a sensitivity of 100%, a specificity of 96.3%, a positive predictive value of 91.8%, and a negative predictive value of 100% for the detection of common bile duct stones. CONCLUSIONS: With the use of LC, ERC is frequently performed before LC to detect CBD stones; but it is invasive with a well-documented complication rate. MRC is a simple non-invasive method for preoperative screening for CBD stones in at-risk patients. In this study if ERC had been limited to patients with a positive MRC, it would have reduced the need for ERC by 68.2%, and the complications of preoperative examination would be minimized significantly.