Five thousands five hundreds and eighty two patients with cholelithasis in 46 hospitals were collected through questionnaire and analysed, of which 2 735 cases were gallstones (accounted for 48.99%),and 2 847 cases were intraand extrahepatobiliary tract stones (accounted for 51.00%). In the gallstone group, there were 487 cases (8.72%) complicated with choledocholithasis, 54 cases (1.97%) complicated with acute cholecystitis, 189 cases (6.91%) with acute cholangitis, and 215 cases (7.86%) with obstructive jaundice. In 2 847 cases with intra and extrahepatobiliary tract stones, 1 284 cases were found to be extrahepatic duct stones (23.00%), 668 cases were left intrahepatic duct stones (1.97%), 384 cases were right intrahepatic duct stones (6.88%), and 511 cases stone in both sides (9.15%); complications in this group were acute severe cholangitis 683 cases (23.99%), acute cholangitis 1 169 cases (41.06%), obstructive jaundice 431 cases (15.14%), and biliary cirrbosis 278 cases (9.76%). The operative procedure for patients with gallstones were cholecystectomy (2 697 cases), chelangioduodenostomy or cholangiojejunostomy (36 cases), and Oddi’s sphincteroplasty (7 cases); and for patients with intraand extrahepatobiliary tract stones were choledocholithotomy and T tubule drainage (2 275 cases), differecnt forms of choledochoenterostomy (534 cases), and Oddi’s sphincteroplasty (38 cases). The postoperative complicatioin rate in patients with gallstones was 1.13%, with intraand extrahepatobiiary tract stones was 14.47%, mortality of the latter was 1.62%. The authors consider that cholecystectomy should be performed in elderly patients (over 50 years) with or without symptoms, and proper choice of operative procedure for hepatobiliary tract stones is important.
Objective To observe the expression and distribution of transforming growth factor-β1 (TGF-β1) in the healing process of bile duct and discuss its function and significance in the process of benign biliary stricture formation. Methods An injury to bile duct of dog was made and then repaired. The expression and distribution of TGF-β1 in the tissue at different time of the healing process were studied after operation with immunohistochemical SP staining. Results TGF-β1 staining was observed in the granulation tissue, fibroblasts and endothelial cells of blood vessels. High expression of TGF-β1 was observed in the healing process lasting for a long time. Conclusion The high expression of TGF-β1 is related closely with the fibroblast proliferating activity, extracellular matrix overdeposition and scar proliferation in the healing process of bile duct.
Repair of the defects of the biliary ducts is a difficult problem in the biliary duct surgery. The experiences of using pcdiculated cystic flap in the repair of such defects in 3 cases were reported. It was hold that, under the following conditions as normal function of the Oddi s sphincter, the intrahepatic and extrahepatic pathology completely corrected, and the inflammatory reaction of the local biliary tree less severe, one should strive to try the above mentioned procedure, because it was an operation ...
Objective To investigate the phenotypic change and proliferation of fibroblasts in human inflammatory strictured bile duct wall. Methods We observed the density and ultrastructure of fibroblasts, and the histologic structure in human normal bile duct wall and inflammatory strictured bile duct wall by light and electron microscope.Results The results showed that fibroblasts were the main source of extracellular matrix production in bile duct wall. The phenotype of fibroblasts in inflammatory strictured bile duct wall changed obviously, quiescent fibroblasts were activated and transformed to myofibroblasts, with massive proliferation. Conclusion These data suggest that massive proliferation of activated fibroblasts and myofibroblasts is the main source of extracellular matrix overproduction which results in inflammatory bile duct stricture.
Twenty five children with congenital biliary dilatation were treated with hepatico-jejuno-duodenostomy following excision of choledochal cysts between 1983 and 1985. The age ranged from two months to eleven years. The last follow-up ranged from 6-9 years (mean 7.5 years). All patients were free of jaundice with normal growth and development and none had peptic ulcer. The results from the last follow-up was better than that of the first one. This procedure was safe, effective and physiologically appealing.
Objective To investigate feasibility and clinical efficacy of exploration and stone removal through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy for hepatolithiasis. Methods The patients who had left extrahepatic bile duct stones with choledocholithiasis from January 2012 to December 2016 were retrospectively collected. Among these patients, 29 cases underwent an exploration and stone removal through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy (observation group) and 26 cases underwent an exploration and stone removal through choledochoscope via incision of common bile duct during laparoscopic left lateral hepatectomy (control group). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative nutritional, and complications rate were compared between these two groups. Results The operations were performed successfully and no perioperative death happened in both groups. There were no significant differences in the operative time and intraoperative blood loss between the two groups (P>0.05). Moreover, the postoperative hospital stay of the observation group was significantly shorter than that of the control group (P<0.05). In addition, there were no significant differences in the complications of the bile leakage, subphrenic infection, and biliary residual stones between the two groups (P>0.05). Also, the levels of prealbumin and the lymphocytes in the observation group were significantly higher than those in the control group on the 3rd and 6th day after the operation (P<0.05). Conclusions Preliminary results of limited cases in this study show that exploration and removal of stones through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy for hepatolithiasis is relatively safe and reliable, its procedure is simplified, could avoid relevant complications due to biliary incision and T tube drainage.
目的 了解肝部分切除治疗肝内胆管结石的效果。方法回顾性分析1984年3月至1997年8月对95例肝内胆管结石施行肝部分切除，并辅以狭窄胆管切开整形及胆肠吻合等手术的治疗情况。结果 临床疗效优良者达93.7%，术后残留结石10例，残石率为10.5%。结论 肝部分切除治疗肝内胆管结石是目前较理想有效的手术方式。
Objective To investigate the diagnosis and treatment of congenital choledochal cysts(CCC) in children. MethodsThe manifestation, auxiliary examination, mode of operation and effect of 42 patients with CCC in children from Jan., 1980 to June, 1999 were analyzed retrospectively.Results The patients with the triad of jaundice, an abdominal mass, and pain was 38.1% among the 42 patients. B-ultrasonic diagnosis was made with a correct diagnostic rate of 95.2%. The effective rate of internal drainage was significantly lower than that of resection of the cyst(χ2=19.36, P＜0.001) while the reoperation rate and incidence of carcinoma of internal drainage were higher than those of resection of the cyst(χ2=11.59, P＜0.001 and χ2=4.97, P＜0.05). Conclusion B-ultrasonic diagnosis is recommended as the first examination method. Internal drainage should be abandoned. Resection of the cyst with Roux-Y hepaticojejunostomy is recommended as the treatment of choice on extrahepatic cholangiectasis. Liver transplantation is a reasonable choice to treat the diffuse intrahepatic cholangiectasis.