OBJECTIVE: To avoid the pitfalls of choledochotomy with T-tube drainage in the treatment of choledocholith. METHODS: A novel operation was designed as cholecysto-choledochostomy plus construction of subcutaneous chole...OBJECTIVE: To avoid the pitfalls of choledochotomy with T-tube drainage in the treatment of choledocholith. METHODS: A novel operation was designed as cholecysto-choledochostomy plus construction of subcutaneous cholecystic tunnel. After the common bile duct was cut open and stones were removed, the gallbladder was appropriately dissociated and the cholecystic ampulla was incised. Then, the incision of the cholecystic ampulla was anastomosed to the opened common bile duct, and the cholecystic fundus was fixed out of the abdominal muscular stratum. RESULTS: Twenty-one patients with choledocholith underwent this operation successfully and recovered well without postoperative complications. One of them was diagnosed as having recurrent stones in 2 years and 3 months after operation. Consequently, the subcutaneous cholecystic tunnel was opened under local anesthesia to remove successfully the stones with choledochoscope. CONCLUSION: This operation provides a convenient way to remove postoperative recurrent stones with choledochoscope and avoid receliotomy.展开更多
Objective To explore the effect of duodenoscope in the treatment for the elderly cases.Method Retrospective analysis of the treatment by duodenoscope for 63 elderly patients (all aged over 80 years old) with high risk...Objective To explore the effect of duodenoscope in the treatment for the elderly cases.Method Retrospective analysis of the treatment by duodenoscope for 63 elderly patients (all aged over 80 years old) with high risk choledocholith from Jan 2006 to Dec 2010.Results All of the 63 cases obtained a success in the endoscopic operation.The operative time was within 15~60 min.Endoscopic stone extraction was performed on 21 cases,bile duct plastic stent in 35,of them 2 cases had the second operation because their stones were too big.In 2 cases of 9 who suffered from acute obstructive suppurative cholangitis (AOSC),plastic stents were placed.In the rest 7 cases,nasobiliary drainages (NBD) were inserted,on 4 of the 7 cases,stone extraction were performed 5-7 days later,in 3 of the 7 cases,stents were inserted for the second time,of the 3 cases,2 were found blood oozing on the surface of wound after EST (endoscopic sphicterectomy),the bleeding was stopped by local spray of noradrenaline,no hematorrhea or perforation occurred.Postoperative choledochitis was found in 1 case,to whom antiinflammatory therapy was applied.Pancreatitis was found in 3 cases,blood amylase increasing in 12,who were cured with fast,pancreatic secretion inhibition and antiinflammatory drugs.One patient died of acute left heart failure (ALHF),no death from the bile duct diseases or concerned were found.Conclusion Although many basal diseases of the elderly increase the risks in the endoscopic treatment,it proves to be practical for it has less complications,high security and definite curative results.展开更多
Objective To explore the effect of extracorporeal shock wave lithotripsy(ESWL) for the postoperative residual bilestone of choledocholithiasis.Method Inject contrast medium of biligrafin via T tube.After accurate appo...Objective To explore the effect of extracorporeal shock wave lithotripsy(ESWL) for the postoperative residual bilestone of choledocholithiasis.Method Inject contrast medium of biligrafin via T tube.After accurate apposition with X ray,take lithotripsy with extracorporeal shock wave. In some cases T tube washing and transcutaneous choledochoscope were used to take out bilestones.Results The lithotripsies were successful in all the 48 patients and the lithotriptic rate was 100%.The removing rate of bilestones was over 90% with washing method.Choledochoscope was used in 6 cases,and 48 patients were completely healed.In them 24 suffered from slight expanding pain in right upper abdomen or nausea and no any complications and sequelae in others.Conclusion ESWL is an effect method to heal patients with the postoperative residual bilestones of choledocholithiasis.展开更多
目的分析腹腔镜胆囊切除术联合内镜括约肌切开术治疗胆总管结石后并发症情况,并分析其影响因素。方法胆总管结石病人136例,按实际治疗情况进行分组,对照组76例,行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)。观察组60例,行LC...目的分析腹腔镜胆囊切除术联合内镜括约肌切开术治疗胆总管结石后并发症情况,并分析其影响因素。方法胆总管结石病人136例,按实际治疗情况进行分组,对照组76例,行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)。观察组60例,行LC联合内镜括约肌切开术(endoscopic sphincterotomy,EST),术后随访2年,观察病人并发症发生情况、检测Oddi括约肌(spincter of oddi,SO)压力和培养胆汁,筛选和分析可能影响术后并发症的因素。结果对照组并发症发生率高于观察组,但各并发症发生率比较差异无统计学意义(P>0.05),两组肝功能异常发生率比较差异无统计学意义(P>0.05);两组胆总管(common bile duct,CBD)压力和SO基础压力均无明显变化(P>0.05),SO收缩幅度(amplitude of SO contractions,SOCA)和SO收缩频率(frequency of SO contractions,SOF)均明显降低(P<0.05)。术后,对照组感染率高于观察组(P<0.05),但两组细菌感染比例比较差异无统计学意义(P>0.05);病程、胆囊结石、CBD内径、最大结石直径和细菌感染是影响CBD结石病人LC联合EST术后并发症的单因素(P<0.05);病程>5年、患有胆囊结石、CBD内径>15 mm、最大结石直径>15 mm和细菌感染是影响CBD结石病人LC联合EST术后并发症的独立危险因素(P<0.05)。结论 LC和EST联合治疗相较于单独手术,并未增加CBD结石病人术后并发症风险,病程>5年、患有胆囊结石、CBD内径>15 mm、最大结石直径>15 mm和细菌感染是影响CBD结石病人LC联合EST术后并发症的独立危险因素。展开更多
目的探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并正常直径胆总管结石术后胆管一期缝合的可行性和安全性。方法回顾性分析东南大...目的探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并正常直径胆总管结石术后胆管一期缝合的可行性和安全性。方法回顾性分析东南大学医学院附属江阴医院自2016年1月至2019年12月256例由同一主刀医师采用LC+LCBDE治疗胆囊结石合并胆总管结石患者的临床资料。根据胆总管直径的粗细分为正常直径组(6 mm≤胆总管直径≤8 mm,A组)和胆管扩张组(胆总管直径>8 mm,B组),其中A组82例,B组174例。结果A组男34例,女48例,年龄(55.3±15.2)岁;B组男78例,女96例,年龄(57.0±15.8)岁。A组与B组患者手术成功率分别为98.8%和98.9%,手术时间分别为(98.7±28.8)min和(96.1±29.3)min、术后腹腔引流时间分别为(6.0±2.0)d和(6.2±1.8)d,术后住院时间分别为(7.8±1.9)d和(7.6±1.4)d、住院费用分别为(25436.4±3894.9)元和(25188.8±3910.4)元,两组比较差异无统计学意义(均P>0.05)。两组患者除近期并发症胆管狭窄比较差异有统计学意义外(P<0.05)外,其余在胆漏、出血、胆管狭窄等术后总并发症的发生率及远期随访结果方面,差异无统计学意义(P>0.05)。结论只要选择合适的病例,LC+LCBDE术后胆管一期缝合治疗胆囊结石合并正常直径胆总管结石是安全、可行的,值得临床中推广应用。展开更多
文摘OBJECTIVE: To avoid the pitfalls of choledochotomy with T-tube drainage in the treatment of choledocholith. METHODS: A novel operation was designed as cholecysto-choledochostomy plus construction of subcutaneous cholecystic tunnel. After the common bile duct was cut open and stones were removed, the gallbladder was appropriately dissociated and the cholecystic ampulla was incised. Then, the incision of the cholecystic ampulla was anastomosed to the opened common bile duct, and the cholecystic fundus was fixed out of the abdominal muscular stratum. RESULTS: Twenty-one patients with choledocholith underwent this operation successfully and recovered well without postoperative complications. One of them was diagnosed as having recurrent stones in 2 years and 3 months after operation. Consequently, the subcutaneous cholecystic tunnel was opened under local anesthesia to remove successfully the stones with choledochoscope. CONCLUSION: This operation provides a convenient way to remove postoperative recurrent stones with choledochoscope and avoid receliotomy.
文摘Objective To explore the effect of duodenoscope in the treatment for the elderly cases.Method Retrospective analysis of the treatment by duodenoscope for 63 elderly patients (all aged over 80 years old) with high risk choledocholith from Jan 2006 to Dec 2010.Results All of the 63 cases obtained a success in the endoscopic operation.The operative time was within 15~60 min.Endoscopic stone extraction was performed on 21 cases,bile duct plastic stent in 35,of them 2 cases had the second operation because their stones were too big.In 2 cases of 9 who suffered from acute obstructive suppurative cholangitis (AOSC),plastic stents were placed.In the rest 7 cases,nasobiliary drainages (NBD) were inserted,on 4 of the 7 cases,stone extraction were performed 5-7 days later,in 3 of the 7 cases,stents were inserted for the second time,of the 3 cases,2 were found blood oozing on the surface of wound after EST (endoscopic sphicterectomy),the bleeding was stopped by local spray of noradrenaline,no hematorrhea or perforation occurred.Postoperative choledochitis was found in 1 case,to whom antiinflammatory therapy was applied.Pancreatitis was found in 3 cases,blood amylase increasing in 12,who were cured with fast,pancreatic secretion inhibition and antiinflammatory drugs.One patient died of acute left heart failure (ALHF),no death from the bile duct diseases or concerned were found.Conclusion Although many basal diseases of the elderly increase the risks in the endoscopic treatment,it proves to be practical for it has less complications,high security and definite curative results.
文摘Objective To explore the effect of extracorporeal shock wave lithotripsy(ESWL) for the postoperative residual bilestone of choledocholithiasis.Method Inject contrast medium of biligrafin via T tube.After accurate apposition with X ray,take lithotripsy with extracorporeal shock wave. In some cases T tube washing and transcutaneous choledochoscope were used to take out bilestones.Results The lithotripsies were successful in all the 48 patients and the lithotriptic rate was 100%.The removing rate of bilestones was over 90% with washing method.Choledochoscope was used in 6 cases,and 48 patients were completely healed.In them 24 suffered from slight expanding pain in right upper abdomen or nausea and no any complications and sequelae in others.Conclusion ESWL is an effect method to heal patients with the postoperative residual bilestones of choledocholithiasis.
文摘目的分析腹腔镜胆囊切除术联合内镜括约肌切开术治疗胆总管结石后并发症情况,并分析其影响因素。方法胆总管结石病人136例,按实际治疗情况进行分组,对照组76例,行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)。观察组60例,行LC联合内镜括约肌切开术(endoscopic sphincterotomy,EST),术后随访2年,观察病人并发症发生情况、检测Oddi括约肌(spincter of oddi,SO)压力和培养胆汁,筛选和分析可能影响术后并发症的因素。结果对照组并发症发生率高于观察组,但各并发症发生率比较差异无统计学意义(P>0.05),两组肝功能异常发生率比较差异无统计学意义(P>0.05);两组胆总管(common bile duct,CBD)压力和SO基础压力均无明显变化(P>0.05),SO收缩幅度(amplitude of SO contractions,SOCA)和SO收缩频率(frequency of SO contractions,SOF)均明显降低(P<0.05)。术后,对照组感染率高于观察组(P<0.05),但两组细菌感染比例比较差异无统计学意义(P>0.05);病程、胆囊结石、CBD内径、最大结石直径和细菌感染是影响CBD结石病人LC联合EST术后并发症的单因素(P<0.05);病程>5年、患有胆囊结石、CBD内径>15 mm、最大结石直径>15 mm和细菌感染是影响CBD结石病人LC联合EST术后并发症的独立危险因素(P<0.05)。结论 LC和EST联合治疗相较于单独手术,并未增加CBD结石病人术后并发症风险,病程>5年、患有胆囊结石、CBD内径>15 mm、最大结石直径>15 mm和细菌感染是影响CBD结石病人LC联合EST术后并发症的独立危险因素。
文摘目的探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并正常直径胆总管结石术后胆管一期缝合的可行性和安全性。方法回顾性分析东南大学医学院附属江阴医院自2016年1月至2019年12月256例由同一主刀医师采用LC+LCBDE治疗胆囊结石合并胆总管结石患者的临床资料。根据胆总管直径的粗细分为正常直径组(6 mm≤胆总管直径≤8 mm,A组)和胆管扩张组(胆总管直径>8 mm,B组),其中A组82例,B组174例。结果A组男34例,女48例,年龄(55.3±15.2)岁;B组男78例,女96例,年龄(57.0±15.8)岁。A组与B组患者手术成功率分别为98.8%和98.9%,手术时间分别为(98.7±28.8)min和(96.1±29.3)min、术后腹腔引流时间分别为(6.0±2.0)d和(6.2±1.8)d,术后住院时间分别为(7.8±1.9)d和(7.6±1.4)d、住院费用分别为(25436.4±3894.9)元和(25188.8±3910.4)元,两组比较差异无统计学意义(均P>0.05)。两组患者除近期并发症胆管狭窄比较差异有统计学意义外(P<0.05)外,其余在胆漏、出血、胆管狭窄等术后总并发症的发生率及远期随访结果方面,差异无统计学意义(P>0.05)。结论只要选择合适的病例,LC+LCBDE术后胆管一期缝合治疗胆囊结石合并正常直径胆总管结石是安全、可行的,值得临床中推广应用。
