目的 探讨对Mirizzi综合征实施临床合理有效的手术方法。方法 自1990年1月至2003年12月期间，我院采用经肝放置胆道支撑引流管治疗Ⅱ、Ⅲ型Mirizzi综合征21例,胆道支撑引流管放置6个月以上，并行胆道造影检查。结果 所有患者恢复良好,胆道造影检查见胆道通畅后拔除支撑引流管，随访2～10年,无并发症发生。结论 经肝放置胆道支撑引流管治疗Ⅱ、Ⅲ型Mirizzi综合征,是保持胆道生理功能完整的有效方法。
Objective To investigate the recurrence of hepatolithiasis and reoperation and their relation to the location of intrahepatic stone. MethodsTwo hundred and twentysix patients of hepatolithiasis operated upon in the period of 1990-1995 were retrospectively analysed.ResultsAmong those patients, there were 101 patients (44.7%) had previous operation for the gallstones diseases including cholecystectomy for gallbladder stones (n=21, 20.8%), choledocholithotomy (n=72, 71.3%),liver segmentectomy (n=6， 5.9%), and choledochojejunostomy (n=2, 2.0%). The operative mortality was 5.0% for the reoperation group and none for the first time operation for hepatolithiasis.Conclusion Although the liver resection is an ideal surgical method to eradicate the diseased lesion and to minimize the malignant changes especially in primary hepatolithiasis (type I, or IE)， choledochojejunostomy is only recommended for the secondary type (type IE or IE) where possible. In the management of hepatolithiasis, the complete information of biliary tract is needed for the choice of surgical methods.
The conectration of cholecystokinin infasting serum was determined by radioimmunoessay in 30 patients with gastric antrum cancer before and after radical sbutotal gastrectomy.It was 119.6±142.2pmol/L before the operation and 78.5±149.2pmol/L after the operation,which was significantly lower than that before the operation,P=0.022. The result suggests that the reduction of cholecytokinin secretion after gastrectomy was one of the important causes in the bile stasis,the disturbance of gallbladder emptying funcion and the formation of gallstone.
Thirty-six partial hepatectomies for patients with symptomatic intrahepatic stones is reported.Partial liver resection should be done when the liver containing strictrue(s),dilated ducts and stones.Meanwhile,additional procedures should be performed togather with partial hepatectomy,i,e,common duct exploration and drainage,cholangiotomy and cholangioplanty,and cholangeoenterostomy,according to the location of stones and ductal strictures.Postoperative long-term follow-up in this series showed that the results of 86.2% of patients were satiffactory.Partial hepatectomy can be considered as a better treatment of choice for the stones confined to one segment or lobe of liver or combined with multiple strictures of ducts.
Four hundred and twenty six laparoscopic cholecystectomy(LC)were peformed on patients with acute and subacute cholecystitis,including ①emergency LC(59 patients),②selected LC(215 patients following administration of antibiotic and antispasmotic drugs for 10-15days),and ③selected LC(152 patients with mild biliary colic without any medication).Operative findings were ①congestion and edema of the gallbladder(208cases,11 of them were achieved laparocystectomy),②impaction of stones in the cystic infundibulum or duct with hydrops of gallbladder(142 cases,14 of them were achieved by laparocystectomy),and ③gangrene or empyema of gallbladder(76 patients,20 of them were achieved by laparocystectomy).LC was done successfully on 377 cases,conversion to open surgery was 45 cases (10.6%),severe complication occured on 4 patients for LC(reoperation,0.9%).The quthors believe that LC for patients with acute and subacute cholecystitis issafe and suitable,but LC cannot replace the classical laparocystectomy.
Ｃｈｏｌｅｄｏｃｈｏｊｅｊｕｎａｌ ｓｈｕｎｔ ｗａｓ ｐｅｒｆｏｒｍｅｄ ｉｎ ｒａｂｂｉｔｓ ｂｙ ｉｎｓｅｒｔｉｎｇ ｔｕｂｅｓ ｏｆ ｄｉｆｆｅｒｅｎｔ ｃａｌｉｂｒｅ ｉｎｔｏ ｔｈｅ ｈｅｐａｔｉｃ ｄｕｃｔ ａｎｄ ｐｒｏｘｉｍａｌ ｊｅｊｕｎｕｍ ｓｅｐａｒａｔｅｌｙ ｗｉｔｈ ｌｉｇａｔｉｏｎ ｏｆ ｃｏｍｍｏｎ ｂｉｌｅ ｄｕｃｔ ａｎｄ ｃｏｎｎｅｃｔｉｎｇ ｔｗｏ ｔｕｂｅｓ ｕｎｄｅｒ ｔｈｅ ｓｋｉｎ ｏｆ ａｂｄｏｍｉｎａｌ ｗａｌｌ ｆｏｒ ｓｕｂｓｅｑｕｅｎｔ ｃｏｌｌｅｃｔｉｏｎｓ ｏｆ ｂｉｌｅ ｔｏ ｄｅｔｅｃｔ ｔｈｅ ｉｍｍｕｎｅ ｃｏｍｐｌｅｘ．Ｔｈｅ ｃｏｎｓｅｃｕｔｉｖｅ ｏｂｓｅｒｖａｔｉｏｎ ｄｅｍｏｎｓｔｒａｔｅｄ ａ ｒｅｇｕｌａｒｉｔｙ ｏｆ ｉｍｍｕｎｅ ｃｏｍｐｌｅｘ ｉｎ ｂｉｌｅ ｉｎｃｒｅａｓｉｎｇ ｆｒｏｍ ｔｈｅ ｌｏｗｅｒ ｔｏ ｔｈｅ ｈｉｇｈｅｒ ｌｅｖｅｌ ｉｎ ｔｈｅ ｐｒｏｃｅｓｓ ｏｆ ｆｏｒｍａｔｉｏｎ ｏｆ ｐｉｇｍｅｎｔａｌ ｓｔｏｎｅ．
Objective To evaluate the effectiveness and safety of Chinese medicine treatment of cholelithiasis. Methods We searched electronic databases including MEDLINE (1966 to Feb. 2009), EMbase (1974 to Feb. 2009), The Cochrane Library (Issue 4, 2008), Chinese Biomedical Literature Database (CBM, 1978 to Feb. 2009), CJFD (CNKI, 1994 to Feb. 2009), the Chinese Scientific and Technical Journals database (VIP, 1989 to Feb. 2009), and a database of Chinese biomedical journals (CMCC, 1994 to Feb. 2009). At the same time, we searched references of the included studies. Metaanalysis was performed using RevMan 5 if there was no significant heterogeneity. We described the date which could not be combined. Results A total of 18 randomized controlled trials involving 2 276 patients were included. According to measurement indicators and interventions, subgroup analysis was performed. Efficacy was reported in 10 studies, which showed that part of proprietary Chinese medicines had a higher efficiency for cholelithiasis. Gallbladder emptying index and the trend of bile into the stone were compared in 5 studies, suggesting that the bile of proprietary Chinese medicines reduced the stone index, which eased the bile tendency to rock. Three studies reported the rate of cholecystokinin. Metaanalysis results suggested that the difference was significant. Two studies reported adverse drug reactions (ADRs), such as epigastric discomfort and diarrhea. Most ADRs were slight, and could be self relieved. Conclusion Results suggest that Chinese medicines produce effects on clinical symptoms of cholelithiasis, gallbladder function and reduce the trend of bile into stones. However, the therapeutic effects for long-term are rarely reported. The conclusion needs further verification due to low methodological quality and apparent heterogeneity.
Objective To evaluate the methodological and reporting quality of randomized controlled trials involving traditional Chinese medicine in the treatment of cholelithiasis. Methods We searched CNKI (1994 to 2007), CMCC (1994 to 2007), VIP (1989 to 2007), MEDLINE (1966 to April 2007) and The Cochrane Library (Issue 4, 2006). Data from randomized controlled trials (RCTs) and quasi-RCTs were extracted by two reviewers independently. The methodological quality of included trials was assessed by using the quality assessment criteria recommended by The Cochrane Collaboration, and the reporting quality was assessed by using the CONSORT for TCM checklist. Results Seventeen studies including 16 RCTs and one quasi-RCT were included. The methodological and reporting qualities of included studies were generally low. All studies were graded C. The highest score evaluated by the CONSORT for TCM checklist was 18. Conclusion The quality of RCTs and quasi-RCTs involving traditional Chinese medicine for cholelithiasis is generally low, with a high risk of biases. The reporting of these trials is also incomplete, which would affect a reader’s understanding and evaluation of the validity, importance and applicability of the study results. Therefore, new randomized controlled trials of high quality are required to provide reliable evidence.
目的:探讨门静脉高压症(Portal hypertension,PHT)合并胆石症的合理处理方式。方法:回顾分析2003年9月于2008年9月64例PHT合并胆石症患者不同方式手术治疗的结果。根据手术方式不同将64例患者分为三组。A组:仅行胆道手术(n=20);B组:在行PHT手术的同时行胆道手术(n=20);C组:在行PHT手术时对胆囊或胆道结石未作处理(n=24)。结果:死亡率A组10%,B组28.5%,C组4.3%。并发症:A组40%,B组70%,C组25%。结论:PHT合并胆石症无论仅行胆道手术或同期行PHT手术和胆道手术,手术死亡率和术后并发症均显著增加,尤以同期手术为明显。根据患者情况选择正确的手术方式,可有效降低手术风险。
目的:探讨胆石症再次手术的原因及预防措施。方法:对我院过去5年收治的134例胆石症再次手术病例的临床资料进行回顾性分析。结果:胆石症再次手术主要原因为结石残留或复发(86.57%),医源性胆管损伤(4.48%),拔除T管后胆汁性腹膜炎(4.48%),残留胆囊炎伴结石(2.99%),胆肠吻合口狭窄伴结石(1.49%)等。再次手术方式以胆总管切开取石胆道镜检查取石“T”形管引流术、胆总管十二指肠侧侧吻合术,肝胆管空肠Roux-en-Y吻合术,肝叶段切除,残留胆囊切除术为主。本组患者痊愈131例,死亡3例,死亡率2.29%,术后残石率5.17%.结论:对于胆石症,无论是首次手术还是多次手术,均应做好术前检查,制定周密的手术计划,利用胆道外科和肝脏外科技术,努力贯彻去除病灶,解除梗阻,通畅引流三原则,力争将残石率、复发率、再手术率降低到最低限度。