目的探讨减少肝胆管结石术后残余结石的方法，降低术后结石残余率。方法回顾分析112例肝胆管结石术后残余结石病例的胆管造影X线片，观察残余结石的分布情况。结果胆总管残余结石者11例（9.8%），左肝管残余结石者15例（13.4%），右肝管残余结石者34例（30.4%），尾叶支肝管残余结石者20例（17.9%），左右肝管、胆总管残余结石者32例（28.6%）。结论合理选择手术方案是降低肝胆管结石术后残余结石的关键。
Objective To summarize the experiences in learning laparoscopic cholecystectomy （LC） and discuss young surgeons how to learn LC scientifically. Method The clinical data of 198 patients received LC by myself since I got the qualification of LC were analyzed retrospectively. Results LC was performed successfully in 187 patients with an average operation time of 68 min. Eleven patients were converted to laparotomy. In these 11 patients， 10 patients because of unclear anatomy in Calot triangle and 1 patient because of uncontrollable bleeding due to pathologic anatomy in Calot triangle caused by gallstone. All 198 patients did not suffer from complications such as severe hemorrhage or injury of biliary duct. Liquid therapy and antibiotics therapy were applied in patients with cholecystitis after LC. Food intake and ambulation were recovered at 12-24h after operation. All the patients were discharged from hospital with anaverage of 2.8d after LC. There was no complications related bile duct injury in all of the patients. Conclusion Managed by hierarchical operations management system， mastering regional physiological and variant anatomy， making use of other open cholecystectomy and laparoscopic simulative learning system well， complying with the learning curve， controlling the indications， contraindications and timing of conversion to laparotomy， young surgeons are able to master LC scientifically， safely， and solidly.
目的 总结胰腺瘘管空肠Roux-en-Y吻合术治疗胰管离断综合征的治疗效果。方法 回顾性分析2002年3月至2010年7月期间我院行胰腺瘘管空肠Roux-en-Y吻合术治疗的5例胰管离断综合征患者的临床资料，分析其治疗效果及手术并发症。结果 5例患者均为急性出血坏死性胰腺炎手术治疗后，经MRCP确诊为胰管离断综合征，手术方式为瘘管空肠Roux-en-Y吻合术，中位手术时间为178min（120～360min），中位术中失血量为300ml（150～600ml），术后中位进食时间为5d（3～8d）。随访中位时间为390d（120～712d），5例患者恢复顺利。2例患者切口感染，经切口换药治愈；1例患者出现短暂的胰肠吻合口漏，经保守治疗治愈。结论 从本组有限的病例资料看，胰腺瘘管空肠Roux-en-Y吻合术是胰管离断综合征较安全的治疗方式。
Objective To summarize the experiences in diagnosis and treatment for iatrogenic injury of cholodocho-pancreatico-duodenal junction （CPDJ）. Method The clinical data of 9 patients with CPDJ injury were analyzed retro-spectively. Results Double lumen tube drainage was emplaced in all the operations. Nutrition support and inhibitor ofpancreatic secretion were applied in all the patients. ①CPDJ injuries were observed intraoperatively for 6 out of 9 patientswith CPDJ injury. Two patients with simple perforation of posterior wall of common bile duct inferior segment and 2patients with simple duodenal perforation who were treated by perforation repair， common bile duct T tube drainage， andperitoneal drainage. Two cases of bile duct or duodenal injury with pancreatic injury were treated by choledochojejunostomyand BillrothⅡgastrojejunostomy. These 6 patients with CPDJ injury were cured and none of case was death. ②Injuries of CPDJ were observed postoperatively for 3 out of 9 patients with CPDJ injury. Total bile diversion or total bile diversion with duodenal diverticulum were performed in 2 cases of bile duct or duodenal injury with pancreatic injury， respectively. The one with total bile diversion only was died of abdominal infection， duodenal fistula， wound dehiscence， abdominal and upper gastrointestinal tract bleeding， and multiple organ failure；the one with total bile diversion with duodenal diverticulum and the one with sequent PTCD and choledochojejunostomy for biliary obstruction caused by operation ofgigantic duodenal interstitialoma were cured. Conclusions CPDJ injury usually occurs in biliary duct exploration， endoscopic sphincterectomy or duodenal operation. It is easily misdiagnosed and serious consequences may happen from this. Timely and correct treatment should be taken according to the specific injury observed during or after the operation.
ObjectiveTo investigate the clinical effect of biliary stent implantation through T-tube lumen and nasobiliary drainage through intrahepatic bile duct in the treatment of biliary leakage after biliary tract exploration.MethodsRetrospective analysis was performed on the clinical data of one case of bile leakage after common bile duct exploration admitted to the Department of Hepatobiliary Surgery of Nanchong Central Hospital in December 2016.ResultsIn this case, the biliary stent was placed in the T-tube lumen and the nasal bile duct was placed in the intrahepatic bile duct for biliary drainage. The guidewire was inserted into the hilum of liver through the tunnel in the T-tube cavity, and nasobiliary drainage was placed to the hilum of liver. In addition, a guide wire was inserted through the T-tube into the duodenum, and a 8.5F plastic stent was placed into the duodenum. One end of the stent was placed in the common bile duct, and the other end was placed in the intestinal cavity for biliary drainage. After drainage, the patient’s bile leakage stopped and the abdominal infection was controlled. Ten days after the biliary stent implantation, the patient was discharged successfully, the T-tube and nasobiliary duct were clamped 20 days after the surgery, and T-tube angiography and abdominal B-ultrasound were performed 2 months later, and it found that the scaffold of the lower common bile duct had fallen off, so removed the T-tube. The patient recovered completely after 2 years of follow-up.ConclusionThe means of T-tube tunnel biliary stent and the nasobiliary duct drainage through the intrahepatic bile duct are effective methods to treat biliary leakage, the operations are simple and easy to operate.
ObjectiveTo detect the expression of Prox1 (prospero-related homeobox 1) gene in primary hepatocellular carcinoma (HCC), and to analyze the correlation of Prox1 gene expression with pathological grade and clinical stage of HCC. MethodsThe expressions of Prox1 gene in carcinoma tissues and adjacent cancerous tissues in HCC as well as normal liver tissues were detected by semi-quantitative RT-PCR, then the correlation of Prox1 gene expression with HCC pathological grade and clinical stage were analyzed. ResultsThe expression of Prox1 gene in carcinoma tissues (0.243±0.102) and adjacent cancerous liver tissues (0.537±0.235) was significantly lower than that in normal liver tissue (0.812±0.372), respectively （ Plt;0.01 or Plt;0.05）. Furthermore, the expression of Prox1 gene in carcinoma tissues was significantly lower than that adjacent cancerous liver tissues (Plt;0.05). The expressions of Prox1 gene in different pathological grade (F=97.950, Plt;0.001) and clinical stage were significantly different (F=228.300, Plt;0.001), and when compared with each other, the differences of pathological grade and clinical stage were also significant (Plt;0.001 or Plt;0.01). The expressions of Prox1 gene in HCC carcinoma tissue were negatively correlated with pathological grade (r=-0.930, Plt;0.01) and clinical stage (r=-0.980, Plt;0.01) of HCC. ConclusionsExpression of Prox1 gene may be related to the initiation and development of HCC, however, that whether Prox1 gene functions as tumor suppressor in HCC needs further investigation.
ObjectiveTo observe the impact of antiviral therapy on prognosis in patients after curative resection for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). MethodsThe data of 50 patients who had undergone liver resection for HBV-related HCC in our department from August 2008 to June 2012 were retrospectively analyzed. The patients were divided into two groups:21 patients who had not antiviral therapy (untreated group) and 29 patients who received antiviral therapy using nucleotide analogues (antiviral therapy group). ResultsAfter radical resection of HCC, the disease-free survival rate of 1-year, 3-year, and 5-year were 72.4%, 58.6%, and 31.0% in antiviral therapy group and 61.9%, 38.1%, and 14.3% in untreated group, respectively. The overall survival rate of 1-year, 3-year, and 5-year were 86.2%, 68.9%, and 55.2% in antiviral therapy group and 71.4%, 47.6%, and 28.6% in untreated group, respectively. The cumulative disease-free survival rate and overall survival rate of antiviral therapy group were significantly higher than those in the untreated group (P < 0.05). Univariate analysis revealed that the number of tumor, antiviral therapy, and TNM staging were risk factor for tumor-free survival rate, The tumor size, the number of tumor, antiviral therapy, and TNM staging were risk factor for overall survival rate. Multivariate analysis revealed that the number of tumor and TNM staging were independent risk factor for tumor-free survival rate (OR:2.95, 95% CI:1.502-6.114, P < 0.05; OR:4.12, 95% CI:1.972-8.960, P < 0.05), the antiviral therapy and TNM staging were independent risk factor for overall survival rate (OR:3.86, 95% CI:1.745-7.028, P < 0.05; OR:5.17, 95% CI:2.356-11.479, P < 0.05). ConclusionUsing nucleotide analogs antiviral therapy may improve the prognosis after resection of patients with HBV-related HCC.