Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the wo...Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.展开更多
Background： Laparoendoscopic single-site surgery （LESS） may serve as a potential alternative to conventional laparoscopy and is developing quickly, but still in its infancy. The study is to present our two-year exp...Background： Laparoendoscopic single-site surgery （LESS） may serve as a potential alternative to conventional laparoscopy and is developing quickly, but still in its infancy. The study is to present our two-year experience in transumbilical LESS simple nephrectomy （LESS-SN） for non-functioning kidney, in an effort to evaluate its feasibility, clinical outcomes and potential advantages. Methods： From December 2008 to December 2010, a total of 11 patients with body mass index （BMI）≤30 underwent transumbilical TriPortTM LESS-SN by a single experienced urologist at our institution. The indications for nephrectomy included nonfunctioning kidney associated with ureteropelvic junction stricture （n=l）, ureteral calculi （n=6）, tuberculosis （n=3）, and ureteral stricture （n=l）. Patient demographics perioperative and follow-up data were prospectively collected and analyzed. Results： Ten procedures were successfully completed with one patient converted to open surgery due to uncontrollable bleeding. The mean operative time was 189.2 （ranging 100-320 min） with an estimated blood loss of 204.5 （ranging 50-1 000 ml）. There were two complications of bleeding （1- intra-, 1- post-）. The mean hospitalization after surgery was 7.9 d （ranging 4-17 d） With a regular follow-up of 1, 6, 12, and 24 months after surgery, all patients remained symptom-free with an intra-umbilical scar. Conclusion： Transumbilical LESS simple nephrectomy for nonfunctioning kidney can be accomplished with favorable surgical outcomes and a superiority of cosmesis. However, cases with chronic inflammation are not suitable for initial up-take and should only be attempted by the very experienced laparoscopist.展开更多
文摘Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.
基金Supported by the Military Major Project for Clinical High-tech and Innovative Technology of China (2010gxjs057)the Municipal Hospitals’ Project for Emerging and Frontier Technology of Shanghai (SHDC12010115)the Project for the Key Discipline of Shanghai
文摘Background： Laparoendoscopic single-site surgery （LESS） may serve as a potential alternative to conventional laparoscopy and is developing quickly, but still in its infancy. The study is to present our two-year experience in transumbilical LESS simple nephrectomy （LESS-SN） for non-functioning kidney, in an effort to evaluate its feasibility, clinical outcomes and potential advantages. Methods： From December 2008 to December 2010, a total of 11 patients with body mass index （BMI）≤30 underwent transumbilical TriPortTM LESS-SN by a single experienced urologist at our institution. The indications for nephrectomy included nonfunctioning kidney associated with ureteropelvic junction stricture （n=l）, ureteral calculi （n=6）, tuberculosis （n=3）, and ureteral stricture （n=l）. Patient demographics perioperative and follow-up data were prospectively collected and analyzed. Results： Ten procedures were successfully completed with one patient converted to open surgery due to uncontrollable bleeding. The mean operative time was 189.2 （ranging 100-320 min） with an estimated blood loss of 204.5 （ranging 50-1 000 ml）. There were two complications of bleeding （1- intra-, 1- post-）. The mean hospitalization after surgery was 7.9 d （ranging 4-17 d） With a regular follow-up of 1, 6, 12, and 24 months after surgery, all patients remained symptom-free with an intra-umbilical scar. Conclusion： Transumbilical LESS simple nephrectomy for nonfunctioning kidney can be accomplished with favorable surgical outcomes and a superiority of cosmesis. However, cases with chronic inflammation are not suitable for initial up-take and should only be attempted by the very experienced laparoscopist.
