腹腔镜联合胆道镜对胆或肝总管结石患者围术期指标及残石率的影响

目的探讨腹腔镜联合胆道镜对胆或肝总管结石患者围术期指标及残石率的影响。方法选取北京市和平里医院2014年9月-2016年6月收治的符合纳入标准的胆或肝总管结石患者100例。根据选取手术方法的不同,分为对照组(n=43)与试验组(n=57),分别采取常规开腹手术与腹腔镜联合胆道镜进行治疗。观察并比较两组患者的出血量、平均手术时间、肛门排气时间、下床时间、住院时间等指标;记录两组患者术后止痛药使用及并发症情况。结果试验组患者术中出血量[(24.19±8.49)mL]明显少于对照组[(92.17±15.36)mL](t=28.21,P<0.01),且试验组患者平均手术时间、肛门排气时间、下床时间、住院时间明显短于对照组,其差异均具有统计学意义(t=8.75、12.32、22.75、5.27,P均<0.01)。但两组患者住院费用差异无统计学意义(t=1.84,P=0.07>0.05)。试验组切口感染率、肺部感染率、止痛药使用率、胆漏发生率及残石率均低于对照组(χ~2=8.67、6.32、7.68、119.77、16.44,P均<0.01)。结论腹腔镜联合胆道镜治疗胆或肝总管结石患者能够有效降低残石率及并发症的发生率,提高患者治疗及预后效果,值得临床推广。

腹腔镜联合胆道镜治疗胆(肝)总管结石与常规开腹手术的临床疗效比较

目的探讨腹腔镜联合胆道镜治疗胆(肝)总管结石临床价值。方法选取近三年于我院就诊治疗的胆(肝)总管结石患者60例,常规治疗组30例,观察组30例。常规治疗组患者采用常规开腹手术进行治疗,而观察组患者则采用腹腔镜联合胆道镜的治疗手段。对两组患者的临床资料进行回顾性对比分析。结果观察组患者的术中出血量较少,手术下床时间、肛门排气时间以及住院时间均短于对照组,具有统计学差异。观察组患者的残石率、术后并发症发生率均明显低于对照组。结论腹腔镜联合胆道镜治疗胆(肝)总管结石可明显减轻患者的术后痛苦,减低术后并发症发生率和残石率,是值得临床推荐的胆(肝)总管结石治疗策略。

腹腔镜联合胆道镜治疗胆(肝)总管结石的疗效及并发症分析

目的:研究腹腔镜联合胆道镜治疗胆(肝)总管结石的疗效及并发症。方法:选取我院2013年3月~2016年3月106例胆(肝)总管结石患者为研究对象,将纳入患者抽签随机分为微创组与开腹组,每组53例。微创组采用腹腔镜联合胆道镜治疗,开腹组采用传统开腹手术,比较两组术中与术后指标、结石清除率、并发症发生率。结果:微创组的术中出血量、术后排气时间、术后住院时间、切口感染率、肺部感染率分别为(36.32±15.49)ml、(1.16±0.33)d、(8.74±2.24)d、0.0%、1.9%显著低于或短于开腹组的(84.19±22.54)ml、(2.52±1.57)d、(14.86±7.83)d、7.5%、13.2%(P<0.05)。结论:腹腔镜联合胆道镜可以有效清除胆(肝)总管结石,缓解患者病症,同时对患者机体损伤较小,并发症发生率低,有利于术后康复。

Surgical treatment of the biliary ductal stricture complicating localized left hepatolithiasis

AIM To summarize the experience in the clinical treatment of the biliary ductal strictures complicating localized left hepatolithiasis in recent two decades.

Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

AIM： To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis.METHODS： The medical records of patients with cholelithiasis who underwent cholecystectomy between July 2003 and June 2007 were retrospectively reviewed. Imaging studies to detect common bile duct （CBD） stones were performed in 186 patients, who constituted the study population. Biochemical liver tests before and after surgery, and with the presence or absence of CBD stones were analyzed.RESULTS： In 96 patients with cholelithiasis and cholecystitis without evidence of CBD stones, 49 （51.0%） had an alanine aminotransferase level elevated to 2-3 times the upper limit of normal, and 40 （41.2%） had an elevated aspartate aminotransferase level. Similar manifestations of hepatocellular injury were, as would be expected, even more obvious in the 90 patients with CBD stones. These markers of hepatocellular injury resolved almost completely within 2 wk to 1 mo after cholecystectomy. Compared to 59 patients with histologically less severe cholecystitisin the group undergoing urgent surgery （total 74 patients）, the 15 patients with a gangrenous gallbladder had a higher mean level of total bilirubin （2.14 ± 1.27 mg/dL vs 2.66 ± 2.97 mg/dL, P 〈 0.001） and white cell count （9480 ± 4681/μL vs 12840 ± 5273/μL, P = 0.018）.CONCLUSION： Acute hepatocellular injury in cholelithiasis and cholecystitis without choledocholithiasis is mild and transient. Hyperbilirubinemia and leukocytosis may predict severe inflammatory changes in the gallbladder.

Risk factors for hilar cholangiocarcinoma:A case-control study in China

AIM:To study the association between hilar cholangiocarcinoma(HC) and pre-existing medical conditions. METHODS:Three hundred and thirteen HC patients admitted to the Eastern Hepatobiliary Surgery Hospital(Shanghai,China) in 2000-2005 and 608 healthy controls were enrolled in this study.Association between HC and pre-existing medical conditions was studied with their adjusted odds ratio(OR) calculated by logistic regression analysis. RESULTS:The prevalence of choledocholithiasis(adjusted OR=2.704,P=0.039) ,hepatolithiasis(adjusted OR=3.278,P=0.018) ,cholecystolithiasis(adjusted OR =4.499,P<0.0001) ,cholecystectomy(adjusted OR =7.012,P=0.004) ,biliary ascariasis(adjusted OR= 7.188,P=0.001) ,liver fluke(adjusted OR=10.088,P =0.042) and liver schistosomiasis(adjusted OR=9.913,P=0.001) was higher in HC patients than in healthy controls. CONCLUSION:Biliary tract stone disease(choledocho-lithiasis,hepatolithiasis,cholecystolithiasis) and parasitic liver disease(biliary ascariasis,liver fluke,liver schistosomiasis) are the risk factors for HC in Chinese population.

Liver fibrosis caused by choledocholith to regress after biliary drainage

AIM: To study the correlation between liver flbrosis severity and biliary drainage in patients with choledocholith. METHODS: A follow-up study on seven patients with liver fibrosis due to choledocholith was made. The data, including biochemical tests (aspartate aminotransferase, alanine aminotransferase) and liver histological features before and after biliary drainage, were collected and studied. The fibrosis severity was scored on a scale from 0 to 3, with 0 denoting none, 1 portal and periportal fibrosis, 2 the presence of numerous fiber septa, and 3 cirrhosis. The average liver fibrosis severity scores of the first and second biopsy were compared with statistical method. RESULTS: The first, second liver fibrosis severity scores of these seven patients were 2,1; 2,1; 1,0; 1,1; 2,1; 2,1; 1,0 respectively. The results showed that the average liver fibrosis severity score of the second liver biopsy decreased significantly compared with the first liver biopsy (n=7,t=4.25,P<0.05). CONCLUSION: Liver fibrosis due to choledocholith may regress after biliary drainage.