BACKGROUND: Despite its rare incidence, few cases of left-side gallbladder have been already published. METHODS: We reported herein the case of a 29-year-old man with a left liver tumor in whom left lateral bisegmen- ...BACKGROUND: Despite its rare incidence, few cases of left-side gallbladder have been already published. METHODS: We reported herein the case of a 29-year-old man with a left liver tumor in whom left lateral bisegmen- tectomy was mandatory. It represents the first description of a sinistroposition of both gallbladder and common bile duct. RESULTS: Surgical exploration revealed a left-side gall- bladder , located under the left lobe of the liver. During he- patic parenchyma dissection at the left side of the round liga- ment and the Rex recessus, the common bile duct was in- jured. Complete separation of hepatic pedicle structures showed that the upper biliary convergence passed on the left side of the Rex recessus before reaching the hepatoduo- denal ligament. CONCLUSION: Only careful dissection of the hepatoduo- denal ligament up to Rex recessus level prior to liver paren- chyma resection could avoid biliary tract injury during left lobectomy.展开更多
Cholecystectomy is a common procedure.Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer.Despite frequent pre-operative imaging,the aberrant locatio...Cholecystectomy is a common procedure.Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer.Despite frequent pre-operative imaging,the aberrant location of the gallbladder is commonly discovered at surgery.This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain.A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side.The presence of a left sided gall bladder is often associated with various biliary,portal venous and other anomalies that might lead to intra-operative injuries.The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures.With proper identification of the anatomy,minimally invasive approaches are still considered safe.展开更多
Systematic study of risk factors for biliary stone post-liver transplantation is rarely performed. To investigate the risk factor of choledocholithiasis formation after liver transplantation, we c onducted a case-cont...Systematic study of risk factors for biliary stone post-liver transplantation is rarely performed. To investigate the risk factor of choledocholithiasis formation after liver transplantation, we c onducted a case-control study. Fourteen patients were selected into a study group. The stones of the bile duct of the patients were confirmed and treated successfully by endoscopic retrograde cholangiopancreatography. For univariate analysis, we selected carefully some potential risk factors such as cold ischemia time, warm ischemia time, and biliary stricture. The results revealed that cold ischemia time and biliary stenosis were significant predictors. But multivariate analysis revealed that only biliary stenosis was a significant risk factor. In conclusion, biliary stenosis is a risk factor of bile duct stones formation after liver transplantation. Endoscopic retrograde cholangiopancreatography is effective and safe in the diagnosis or treatment of bile duct stones after liver transplantation.展开更多
目的探讨加速术后康复(enhanced recovery after surgery,ERAS)理念应用于微创肝切除术治疗肝内胆管结石肝萎缩病人围手术期的临床价值。方法回顾性队列研究分析青岛市市立医院肝胆外科2016年12月至2023年3月通过腹腔镜下肝切除术治疗...目的探讨加速术后康复(enhanced recovery after surgery,ERAS)理念应用于微创肝切除术治疗肝内胆管结石肝萎缩病人围手术期的临床价值。方法回顾性队列研究分析青岛市市立医院肝胆外科2016年12月至2023年3月通过腹腔镜下肝切除术治疗的63例肝内胆管结石肝萎缩病人的临床资料,根据围手术期处理方法不同将其分为ERAS组(32例)和对照组(常规组,31例)。比较分析ERAS理念对病人术中情况(手术时间及术中出血量)、住院费用、术后肝功能、康复时间及并发症等指标的影响。呈偏态分布的计量资料以M(Q1,Q3)表示,采用秩和检验。结果ERAS组与对照组比较,病人术后康复时间明显缩短[6.0(5.0,7.0)d比8.0(5.0,9.0)d,P<0.01],住院费用更少[46531(38676,51311)元比55553(47638,65529)元,P<0.01],并发症发生率更低[31.3%(10/32)比93.5%(29/31),P<0.01],术后留置T管率更低[28.1%(9/32)比58.1%(18/31),P<0.01];两组病人在手术时间、出血量以及术后1 d、3 d的血谷丙转氨酶、谷草转氨酶、C反应蛋白及预后营养指数方面差异均无统计学意义(均P>0.05)。结论ERAS理念应用于肝切除治疗肝胆管结石肝萎缩的围手术期管理是安全有效的,有助于病人的快速安全康复,值得在肝内胆管结石肝切除术中推广。展开更多
目的:探究腹腔镜下左肝蒂阻断术治疗对肝内胆管结石疗效。方法:选取2020年5月至2022年9月我院收治的63例肝内胆管结石患者作为研究对象,按照随机数字表法分为观察组(n=32)和对照组(n=31)。对照组患者接受传统开腹手术治疗,观察组患者接...目的:探究腹腔镜下左肝蒂阻断术治疗对肝内胆管结石疗效。方法:选取2020年5月至2022年9月我院收治的63例肝内胆管结石患者作为研究对象,按照随机数字表法分为观察组(n=32)和对照组(n=31)。对照组患者接受传统开腹手术治疗,观察组患者接受腹腔镜左肝蒂阻断术治疗。比较两组患者术后恢复指标、肝功能指标水平、生活质量调查量表(Medical Outcomes Study 36-Item Short Form Health Survey,SF-36)评分、两组患者切口感染、胆漏及腹腔积液等不良反应发生情况。结果:术后观察组各恢复指标、丙氨酸氨基转移酶(Alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(Aspartate aminotransferase,AST)及总胆红素(Total bilirubin,TBIL)水平均低于对照组(P<0.05);治疗后观察组SF-36各方面评分均高于对照组(P<0.05);观察组不良反应总发生率明显低于对照组(χ^(2)=4.510,P=0.034)。结论:腹腔镜下左肝蒂阻断术治疗肝内胆管结石患者有利于促进其术后恢复,缩短病程,还可促进肝功能以及生活质量的改善,安全性高。展开更多
目的探讨术前肝功能相关指标在急性结石性胆囊炎合并胆总管结石中的诊断价值。方法回顾性分析苏州大学附属第三医院2015年3月至2019年4月收治的急性结石性胆囊炎患者319例,其中单纯急性结石性胆囊炎患者204例,急性结石性胆囊炎合并胆总...目的探讨术前肝功能相关指标在急性结石性胆囊炎合并胆总管结石中的诊断价值。方法回顾性分析苏州大学附属第三医院2015年3月至2019年4月收治的急性结石性胆囊炎患者319例,其中单纯急性结石性胆囊炎患者204例,急性结石性胆囊炎合并胆总管结石患者115例;采用秩和检验比较两组患者术前肝功能相关指标(TBIL、DBIL、ALT、AST、GGT、ALP、LDH、TBA)的差异,通过ROC曲线分析各指标的诊断敏感性、特异性及相应的诊断临界值,明确其对急性结石性胆囊炎合并胆总管结石的诊断价值。结果单纯急性结石性胆囊炎患者与急性结石性胆囊炎合并胆总管结石患者TBIL[13.25(9.63,20.78)μmol/L vs 34.60(20.40,55.40)μmol/L]、DBIL[5.85(4.10,9.00)μmol/L vs 22.60(10.20,42.30)μmol/L]、ALT[25.00(15.25,39.00)IU/L vs 211.00(93.00,374.00)IU/L]、AST[23.00(17.00,36.50)IU/L vs 141.00(52.00,276.00)IU/L]、GGT[40.50(22.00,91.00)IU/L vs 315.00(155.00,520.00)IU/L]、ALP[85.00(69.00,116.50)IU/L vs 168.00(119.00,248.00)IU/L]、LDH[202.00(169.00,234.75)IU/L vs 236.00(176.00,352.00)IU/L]、TBA[5.20(2.63,9.10)μmol/L vs 43.60(6.70,146.50)μmol/L]均具有统计学差异(P<0.05)。ROC曲线分析显示,TBIL、DBIL、ALT、AST、GGT、ALP、LDH、TBA特异性分别为69.6%、78.4%、87.3%、85.8%、81.4%、71.6%、82.8%、88.7%;敏感性分别为81.7%、80.0%、77.4%、77.4%、82.6%、82.6%、45.2%、65.2%;临界值分别为18.3μmol/L、9.4μmol/L、81.0 IU/L、50 IU/L、119 IU/L、106 IU/L、254 IU/L、18.9μmol/L。结论术前血清肝功能相关指标对急性结石性胆囊炎合并胆总管结石具有重要的诊断价值,当高于其相应的临界值及指标异常数目≥5个时诊断价值更大。展开更多
文摘BACKGROUND: Despite its rare incidence, few cases of left-side gallbladder have been already published. METHODS: We reported herein the case of a 29-year-old man with a left liver tumor in whom left lateral bisegmen- tectomy was mandatory. It represents the first description of a sinistroposition of both gallbladder and common bile duct. RESULTS: Surgical exploration revealed a left-side gall- bladder , located under the left lobe of the liver. During he- patic parenchyma dissection at the left side of the round liga- ment and the Rex recessus, the common bile duct was in- jured. Complete separation of hepatic pedicle structures showed that the upper biliary convergence passed on the left side of the Rex recessus before reaching the hepatoduo- denal ligament. CONCLUSION: Only careful dissection of the hepatoduo- denal ligament up to Rex recessus level prior to liver paren- chyma resection could avoid biliary tract injury during left lobectomy.
文摘Cholecystectomy is a common procedure.Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer.Despite frequent pre-operative imaging,the aberrant location of the gallbladder is commonly discovered at surgery.This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain.A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side.The presence of a left sided gall bladder is often associated with various biliary,portal venous and other anomalies that might lead to intra-operative injuries.The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures.With proper identification of the anatomy,minimally invasive approaches are still considered safe.
基金supported by grants from the Team Program of Science and Technology Bureau of Zhejiang Province(2009R50038)the Health Bureau of Zhejiang Province Foundation (B1652)
文摘Systematic study of risk factors for biliary stone post-liver transplantation is rarely performed. To investigate the risk factor of choledocholithiasis formation after liver transplantation, we c onducted a case-control study. Fourteen patients were selected into a study group. The stones of the bile duct of the patients were confirmed and treated successfully by endoscopic retrograde cholangiopancreatography. For univariate analysis, we selected carefully some potential risk factors such as cold ischemia time, warm ischemia time, and biliary stricture. The results revealed that cold ischemia time and biliary stenosis were significant predictors. But multivariate analysis revealed that only biliary stenosis was a significant risk factor. In conclusion, biliary stenosis is a risk factor of bile duct stones formation after liver transplantation. Endoscopic retrograde cholangiopancreatography is effective and safe in the diagnosis or treatment of bile duct stones after liver transplantation.
文摘目的:探究腹腔镜下左肝蒂阻断术治疗对肝内胆管结石疗效。方法:选取2020年5月至2022年9月我院收治的63例肝内胆管结石患者作为研究对象,按照随机数字表法分为观察组(n=32)和对照组(n=31)。对照组患者接受传统开腹手术治疗,观察组患者接受腹腔镜左肝蒂阻断术治疗。比较两组患者术后恢复指标、肝功能指标水平、生活质量调查量表(Medical Outcomes Study 36-Item Short Form Health Survey,SF-36)评分、两组患者切口感染、胆漏及腹腔积液等不良反应发生情况。结果:术后观察组各恢复指标、丙氨酸氨基转移酶(Alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(Aspartate aminotransferase,AST)及总胆红素(Total bilirubin,TBIL)水平均低于对照组(P<0.05);治疗后观察组SF-36各方面评分均高于对照组(P<0.05);观察组不良反应总发生率明显低于对照组(χ^(2)=4.510,P=0.034)。结论:腹腔镜下左肝蒂阻断术治疗肝内胆管结石患者有利于促进其术后恢复,缩短病程,还可促进肝功能以及生活质量的改善,安全性高。
文摘目的探讨术前肝功能相关指标在急性结石性胆囊炎合并胆总管结石中的诊断价值。方法回顾性分析苏州大学附属第三医院2015年3月至2019年4月收治的急性结石性胆囊炎患者319例,其中单纯急性结石性胆囊炎患者204例,急性结石性胆囊炎合并胆总管结石患者115例;采用秩和检验比较两组患者术前肝功能相关指标(TBIL、DBIL、ALT、AST、GGT、ALP、LDH、TBA)的差异,通过ROC曲线分析各指标的诊断敏感性、特异性及相应的诊断临界值,明确其对急性结石性胆囊炎合并胆总管结石的诊断价值。结果单纯急性结石性胆囊炎患者与急性结石性胆囊炎合并胆总管结石患者TBIL[13.25(9.63,20.78)μmol/L vs 34.60(20.40,55.40)μmol/L]、DBIL[5.85(4.10,9.00)μmol/L vs 22.60(10.20,42.30)μmol/L]、ALT[25.00(15.25,39.00)IU/L vs 211.00(93.00,374.00)IU/L]、AST[23.00(17.00,36.50)IU/L vs 141.00(52.00,276.00)IU/L]、GGT[40.50(22.00,91.00)IU/L vs 315.00(155.00,520.00)IU/L]、ALP[85.00(69.00,116.50)IU/L vs 168.00(119.00,248.00)IU/L]、LDH[202.00(169.00,234.75)IU/L vs 236.00(176.00,352.00)IU/L]、TBA[5.20(2.63,9.10)μmol/L vs 43.60(6.70,146.50)μmol/L]均具有统计学差异(P<0.05)。ROC曲线分析显示,TBIL、DBIL、ALT、AST、GGT、ALP、LDH、TBA特异性分别为69.6%、78.4%、87.3%、85.8%、81.4%、71.6%、82.8%、88.7%;敏感性分别为81.7%、80.0%、77.4%、77.4%、82.6%、82.6%、45.2%、65.2%;临界值分别为18.3μmol/L、9.4μmol/L、81.0 IU/L、50 IU/L、119 IU/L、106 IU/L、254 IU/L、18.9μmol/L。结论术前血清肝功能相关指标对急性结石性胆囊炎合并胆总管结石具有重要的诊断价值,当高于其相应的临界值及指标异常数目≥5个时诊断价值更大。
