Objective To investigate the recurrence of intrahepatic bile duct stones and study the relations to the primary intrahepatic stones.Methods One hundred and twenty nine patients who experienced complete lithotomy were followed up for 2-10 years. Results Thirty five cases had the recurrence of intrahepatic stones at 49 sites (27.13%). The recurrent stones were found at following sites: 13 at left duct, 12 right duct , 8 left medial segment, 6 right anterior segment, 4 right posterior segment, 3 left lateral segment, 3 caudate. Nine cases were asymptomic, 16 cases had slight symptoms and 10 cases suffered from the serious attacks of stones. The time of recurrence was from 2 to 9 years (5.49±2.25 years) after surgery. The recurrent rate was 27.13% in our group. Conclusion The recurrence of intrahepatic stones also developed at several sites in the liver. The recurrence of intrahepatic stones had a tendency to develop at the primary sites. The recurrence of intrahepatic stones may be asymptomic and most patients suffered from slight attack. Liver resection is the best way to prevent the recurrence from intrahepatic stones.
Objective To study the effect of laparoscopic common bile duct exploration via choledochotomy and T tube drainage. Metheods Laparoscopic exploration of common bile duct with choledochoscopy via choledochotomy was performed in 105 patients, T tube was placed in all patients with laparoscopic suturing technique.Results Except negative exploration in 2 cases, duct clearance was achieved in 99 per cent (102/103) of patients. Conclusion Laparoscopic exploratoin of common bile duct via choledochotomy and T tube drainage is one of the safe and effective management options for common bile duct calculi.
摘要:目的: 探讨血清前白蛋白(prealbumin,PAB)、胆碱脂酶(cholinesterase,ChE)、总胆汁酸(total bile acid,TBA)在肝硬化中的检测价值。 方法 :测定105例肝硬化患者和30例健康人的前白蛋白、胆碱脂酶、总胆汁酸活性及肝功能生化指标,并按ChildPugh分级进行比较。 结果 :肝硬化组前白蛋白含量、胆碱脂酶活性均较对照组显著降低;按ChildPugh分级比较,肝硬化组前白蛋白含量在Child A级与对照组、B级与A级之间、在C级与B级之间差异有显著性(Plt;001);胆碱脂酶活性在Child A级与对照组、B级与A级、C级与B级之间差异有显著性(Plt;001)。总胆汁酸在Child B级与A级,C级与B级间有显著差异性,在A级与对照组间差异无显著性。 结论 :血清前白蛋白、胆碱脂酶在肝硬化早期评估中有很重要的价值,而总胆汁酸在肝硬化预后的判定中有重要价值。 Abstract: Objective: To evaluate the role of prealbumin (PAB), cholinesterase (ChE), and total bile acid (TBA) in evaluating liver reserve function in patients with liver cirrhosis. Methods : One hundred and five serum samples from patients with liver cirrhosis were detected in PAB, ChE, TBA and other biochemical markers. All patients were classified in accordance with ChildPugh scale. Results : For PAB, the differences among ChildPugh A, B, C and healthy group were statistically significant (t=1254, 1887, 2316) (Plt;001). For ChE, the differences among ChildPugh A, B, C and healthy group were statistically significant (t=1288, 0856, 1002) (Plt;001). For TBA, the differences among ChildPugh C group, B group and A group were statistically significant (t=0526, 1081)(Plt;001), the difference among ChildPugh A group and healthy group was not statistically significant (t=5615) (Pgt;005). Conclusion : PAB and ChE reflect liver reserve function earlier in patients with liver cirrhosis. The role of TBA is important in reflecting prognosis in patients with liver cirrhosis.
Objective To investigate the feasibility and patient selection of T-tube free laparoscopic common bileduct exploration through mini-incision in confluence of common bile duct （CBD） and cystic duct. Methods The clinical data of 52 patients who underwent CBD exploration from January 2009 to December 2011 were retrospectively analyzed. A 3-4mm longitudinal incision of anterior wall of CBD was made along the confluence of CBD and cystic duct， and then the choledochoscope was inserted into CBD through this mini-incision for the exploration and treatment by laparoscopy and choledochoscopy， the incision was sewed up by T-tube free primary suture. Results All 52 cases were cured and stone clearance rate was 100% as revealed by choledochoscopy and cholangiography. The time of operation， intraoperativecholangiography， removal of stones with help of choledochoscope， and removal drainage tube after operation was from 90 to 200 min with an average of 100min， 3 to 10min with an average of 6min， 5 to 15 min with an average of 8 min，and 3-5d with an average of 3.5d ， respectively. The drainage flow was 20-60mL/d with an average of 30mL/d. No biliary leakage， abdominal pain， and choloplania or infection of incision was observed following operation. The hospital stay was 5 to 12d with an average of 6.5d after operation. No calculus regeneration or bile duct stricture occurred during following-up of 3 to 40 months with an average of 20 months. Conclusion With proper patient selection， T-tube free laparoscopic CBD exploration through mini-incision in confluence of CBD and cystic duct is safe and feasible by proficient surgeons in laparoscopy and choledochoscopy.
Schwannoma originating from the common bile duct is rare. We presented a patient who was diagnosed with biliary cystadenoma preoperatively and pathologically confirmed as a choledochal Schwannoma, analyzed the CT and MRI imaging manifestations, and illustrated its anatomical and pathological basis, and to improve the understanding of clinicians and radiologists for choledochal Schwannoma.
Objective To prevent bile duct injury, a new anatomy marker, named “common bile duct window” is created. Methods From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including: age, gender, course of disease, body mass index (BMI), blood lipid level (triglyceride and cholesterol), the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of “common bile duct window” were recorded and calculated. Patients were divided into two groups according to the presence of “common bile duct window”, and the diference of data between two groups was analyzed by using χ2 test or t test. Results “Common bile duct window” was found at the end of hepatoduoduenal ligament with oval-shaped, the mean longitude of “common bile duct window” was (1.20±0.60) cm, and mean width was (0.45±0.30) cm. “Common bile duct window” were found in 81.6% (49/60) of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of “common bile duct window” （Pgt;0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P＜0.05）. Conclusion An oval-shaped “common bile duct window” can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through “common bile duct window”, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct injuries can be effectively decreased by the presence of “common bile duct window”.
Objective To summarize the research status and prospect of immunotherapy for biliary tract cancer (BTC). Method The literatures about immunotherapy of BTC at home and abroad in recent years were reviewed. Results Surgical resection was still the first choice and only radical treatment for BTC. However, the recurrence rate of BTC was high, and most of the patients were in the middle and late stage with metastasis and lose the opportunity of operation. Patients with local progression, metastasis or recurrence could only receive chemotherapy and other comprehensive treatment, but they could not get satisfactory results. The continuous update of targeted drugs brings new hope for drug therapy of BTC, and immunotherapy had become a new treatment of tumor targeted therapy following radiotherapy and chemotherapy. ConclusionImmunotherapy can be used as an option for the treatment of advanced BTC and its postoperative recurrence and metastasis, and has attracted more and more attention.
Fibropolycystic liver diseases (FLDs) is a rare genetic disorder, including bile duct hamartomas, congenital hepatic fibrosis, polycystic liver disease, Caroli’s disease, and choledochal cysts. Fibropolycystic liver diseases has received little clinical attention and exhibits a variety of imaging manifestations, leading to a high likelihood of missed diagnosis and misdiagnosis. Through this case, we delineate the characteristic imaging manifestations of the disease and its underlying pathological mechanisms. Our objective is to enhance readers' comprehension of the disease and thereby reduce the rate of missed diagnosis and misdiagnosis of the disease.
ObjectiveTo observe the effects of oral Xiaoyan Lidan tablets(XYLDT) on the bile composition(total bile acids, cholesterol, phospholipids) in patients with intrahepatic duct stones after common bile duct exploration(CBDE) with T tube drainage, to explore its possible preventive effects on stone recurrence. MethodsForty consecutive patients with intrahepatic bile duct stones who underwent CBDE with T tube drainage were randomly divided into experi mental group and control group. XYLDT were administrated at day 4 after surgery in experimental group(n=20), while none of medication were given in control group(n=20). 2 mL of bile was collected through T tube in both groups at day 1, 2, 3, 7, 14, and 21 postoperatively. Total bile acids(TBA), cholesterol(CHO), and phospholipids(PLIP) in bile were measured, and TBA/CHO ratio and PLIP/CHO ratio were calculated respectively. The results were statistical analyzed. ResultsThe demographic data in both groups including age, gender, height, weight, preoperative concomitant diseases, operative time, postoperative complications, hospital stays, serum total bilirubin, direct bilirubin, alanine aminotransferase(ALT), aspartate aminotransferase(AST), and amylase were not significantly different(P > 0.05). The measurements of TBA, CHO, PLIP, and the ratio of TBA/CHO and PLIP/CHO in bile were not significant on day 1, 2, and 3 after surgery in both groups(P > 0.05). In experimental group, the TBA, CHO, and PLIP on day 7, 14, and 21 after surgery were significantly increased compared with the control group(P < 0.05). The ratio of TBA/CHO on day 7, 14, and 21 was 2.17±0.29, 2.29±0.44, and 2.59±0.58, the ratio of PLIP/CHO was 2.03±0.68, 2.84±0.64, and 2.86±0.77, respectively, which were also significantly increased compared with the control group(P < 0.05). ConclusionsOral XYLDT can increase the secretion of TBA, CHO, and PLIP, elevate the TBA/CHO and PLIP/CHO ratio, and change the bile composition which may increase the dissolution of cholesterol in the bile. Presumably, oral XYLDT may have preventive effects in the recurrence of intrahepatic bile duct stones.
ObjectiveTo summarize experience of multidisciplinary team (MDT) in diagnosis and treatment of rare patient with circumscriptus intrahepatic pneumatosis and explore its clinical differentiation with other common types of intrahepatic pneumatosis.MethodThe clinicopathologic data of rare patient with circumscriptus intrahepatic pneumatosis admitted to the Occupational Disease Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed.ResultsA 60-year old female patient was admitted to this hospital with " abdominal pain and septic shock”. After the MDT discussion and analysis, the treatment regimens were decided as follows: the early anti-shock treatment, corrections of electrolyte disorder and hypoalbuminemia, platelet transfusion, ultrasound guided percutaneous catheter drainage (200 mL gas and 10 mL pus, the pneumonic Klebsiella which proved by the bacterial culture). The drainage tube was removed on postoperative day 6. After 5 d of the anti-inflammatory treatment with imipenem and statin sodium injection, it was downgraded to the cefazoxime (the third-generation cephalosporin) injection, and the anti-inflammatory treatment was continued for 6 d as well as the blood glucose was controlled. On the 7th day after the treatment, the right upper abdomen pain was relieved and without positive sign. The abdominal CT showed the localized pneumoconiosis in the right lobe of the liver was completely absorbed. The result of laboratory examination was basically normal. The patient was discharged on the 12th day after the operation and had no discomfort symptoms on month 1 after the operation. The abdominal CT showed the liver was not abnormal.ConclusionSurgeons should be fully aware of various types of intrahepatic pneumatosis so as to sufficiently investigate pathophysiological clue of disease to improve cure rate and reduce complications.