Objective To evaluate the linkage between the proxmal as well as long term outcome and choice of therapeutical modality for benign hilar stricture of bile duct prospectively. Methods 25 patients have been catergorized into 4 groups according to different pathogen and the proxmal as well as long term outcome after pathogen based management have been studied prospectively. Results The hepatic portal cholangio-jejunostomy applied for iatrogenic hilar stricture of bile duct has been proved to be effective and the incidence of refulux cholangitis is only 10%(1/10). Hepatic hilar plasty procedures keep the physiological entitity of bile duct and the vital, sufficient autologous repair materials as well as reliable operation design are needed. Resection of atrophic right liver lobe bearing hepatolithiasis combined hepatic hilar plasty has reached both elimination of liver focus and maintaining the physiological entitity of bile duct. The ballon dilation for mild ring-like hilar stricture of bile duct is valide but not for hilar tubular stricture of secondary sclerosing cholangitis.Conclusion The strategy of individualized management (pathogen based management) for benign hilar stricture of bile duct has proved to be reliable and effective.
目的 探讨先天性胆总管囊肿(congenital choledochal cyst,CCC)术式选择与疗效的关系。方法 对1989年至1998年间38例CCC手术治疗病例进行回顾性研究。结果 38例中行胆肠Roux-Y吻合术20例，肝总管十二指肠高位大口吻合术18例。术后随机获随访31例。13例胆肠Roux-Y吻合术后随访3～7年，发现5例并发十二指肠溃疡，3例并发胆道逆行感染。18例肝总管十二指肠高位大口吻合术后随访2～5年，发现1例并发胆道逆行感染，无1例并发十二指肠溃疡。结论 由于肝总管十二指肠高位大口吻合术后远期并发十二指肠溃疡发生率较低，其与胆肠Roux-Y吻合术相比，是提高CCC患儿术后远期生活质量较理想的术式。
Objective To observe the effects of basic fibroblast growth factor (bFGF) on wound healing of bilioenteric anastomosis as to prevent postoperative biliary strictures. Methods A model of choledochodundenostomy in 31 dogs were constructed at first, then bFGF was administered on the local anastomosis(bFGF group) for 1 week after the operation as compared with sodium chloride solution(control group). Both groups were observed with light microscope(HE,Masson staining) and electron microscope 3 days, 1 and 3 weeks and 3 and 6 months after the operation（n＝3）. Hydroxyproline was measured at the same time. Results bFGF group healed more quickly compared with control group. Good function of cells were detected by electron microscope. Better mucosa epithelia, fibroblast,and capillary vessel proliferation were detected by histological observation in bFGF group. In bFGF group, collagen fibers were arranged orderly. Three weeks after operation, collagen fibers in control group were orderless and in whirlpool. Hydroxyproline of bFGF group was lower than that of control group(P＜0.05）.Conclusion bFGF administered in local anastomosis is an effective method to prevent postoperative anastomotic stenosis.
The secondary anastomotic stenosis is often occured from the repair and reconstructive operation of the injured bile duct. It is difficult to treat and the outcome is serious. In order to prevent this complication, the fibrin glue instead of traditional suturing technique combined with inner support was used. Fifty-four hybrid dogs were divided into 3 groups. Group A received Roux-en-y choledochojejunostomy with fibrin glue; group B received Roux-en-y choledochojejunostomy, with a fibrin glue combined support left permanently in the bile duct and group C received Roux-en-y choledocholejejunostomy with fibrin glue combined a support left temporarily in the bile duct. The amount of collagen in the scar was measured at 3/4, 3, 6, 9, 12 months respectively after operation. The results showed: 1. the mature period of scar was shortened from 12 months to 9 months when fibrin glue instead of suture was used in choledochojejunostomy; 2. the mature period of scar was further shortened from 9 months to 6 months when fibrin glue combined with inner support instead of fibrin glue was used in choledochojejunostomy. The conclusions were as follows: 1. fibrin glue could facilitate the healing of wound by inhibiting the formation of scar and accelerrate the maturation of scar; 2. when the inner support was used with fibrin glue in the operation, the mature period of scar could be further shortened; 3. the mechanism of action of the fibrin glue included minimizing the injury, avoiding foreign-body reaction, modifying organization of hematoma, preventing formation of biliary fistular and enhancing intergration and cross-linkage of collagen.
Objective To investigate the clinical value of " O”continuous biliary-enteric anastomosis combined with percutaneous transhepatic cholangial drainage (PTCD) in pancreaticoduodenectomy (PD). Methods The clinical data of 35 patients with PD who were admitted to Xinyang Central Hospital from June 2015 to June 2017 were retrospectively analyzed. Results All patients completed the " O” continuous biliary-enteric anastomosis combined with PTCD without perioperative death. ① The preoperative indwelling time of PTCD tube was (13.24±3.39) d, total bilirubin (TBIL) was (363.67±12.26) μmol/L on admission and (155.59±17.63) μmol/L on preoperative after PTCD, respectively. ② The operative time was (231.46±18.69) min, the intraoperative blood loss was (158.30±31.33) mL, the diameter of the hepatic ductal segment was (1.3±0.2) cm, and the duration of the " O” continuous biliary-enteric anastomosis was (7.31±1.52) min. ③ After surgery, the indwelling time of PTCD tube was (8.13±1.49) d, the hospitalization time was (27.31±5.49) d. Biliary leakage occurred in 1 case, pancreatic fistula occurred in 5 cases (3 cases of biochemical sputum and 2 cases of B-stage pancreatic fistula), abdominal infection occurred in 2 cases, pneumonia occurred in 3 cases, wound infection occurred in 2 cases. No postoperative biliary-enteric anastomosis stenosis, biliary tract infection, and intra-abdominal hemorrhage occurred. There was no laparotomy patients in this group and all patients were discharged. ④ All patients were followed-up for 180 days after surgery. No death, bile leakage, biliary-enteric anastomotic stenosis, biliary tract infection, pancreatic fistula, gastro-intestinal leakage, and abdominal infection occurred. One case of delayed gastric emptying and 2 cases of alkaline reflux gastritis were cured after outpatient treatment. Conclusions The preoperative PTCD can improve the preoperative liver function and increase the security of PD. " O” continuous biliary-enteric anastomosis is simple, safe, feasible, and has the function of preventing biliary-enteric anastomosis stenosis. For severe jaundice patients with blood TBIL >170 μmol/L, the " O” continuous biliary-enteric anastomosis combined with PTCD is an alternative surgical procedure for PD.
目的 探讨医源性胆管损伤的原因、诊治及预防。方法 回顾性分析25例医源性胆管损伤。结果 医源性胆管损伤多发生于胆囊切除术，主要原因有人为因素、胆管解剖变异、局部病理因素等。胆管一旦损伤，如果首次处理不当，则可引发一系列严重并发症。各种类型的胆管损伤应采取不同方法及早处理，对胆漏、腹腔感染较重者先行胆道及腹腔引流术，3个月后再作胆道重建或修复术，手术方法以胆管空肠RouxenY吻合术最为理想。结论 提高医生对胆管损伤的警觉性，术中细致地解剖和规范的操作，是预防医源性胆管损伤的关键。
Three types of intestinal loops were used to reestablish the internal drainage of bile in 17 cases. The leeway derived from the peristaltic cycle of the intestinal loop for gastrointestinal reflux pressure, the cholangeitis after operation from reflux following choladocho-intestinal anastomosis could be avoided, and, naturally it had changed the traditional method of purèly blockade of the reflux, thus the result from treatment was far more satisfactory.
目的 探讨输入袢空肠结扎术在胆肠和胰肠吻合中的效果。 方法 我院2006年2月至2008年3月期间共收治43例需行胆肠及胰肠吻合的患者，分别行输入袢结扎的间置空肠吻合术（观察组，n=25）和经典的Roux-en-Y吻合术（对照组，n=18），观察2组患者手术时间、住院时间、肠功能恢复时间、返流性胆管炎、胆管积气及并发症发生情况。 结果 与经典的Roux-en-Y吻合术相比，输入袢结扎的间置空肠吻合术患者消化道重建时间、术后住院时间及肠功能恢复时间明显缩短,返流性胆管炎及胆管积气发生例数均显著减少，差异有统计学意义(Plt;0.05)。对照组2例患者出现切口感染； 观察组1例切口感染，1例肺部感染，均经对症治疗后痊愈。 结论 输入袢结扎的间置空肠吻合术操作简单、术后恢复快、并发症少，在上腹部消化道重建中有一定的应用价值。