目的 探讨成人先天性胆总管囊肿的诊治方法和手术技巧。方法 对2001年5月至2011年5月期间我院手术治疗的成人先天性胆总管囊肿38例的临床资料进行回顾性分析。结果 全部病例均行B超和磁共振（MRCP）检查确诊，均行手术治疗。其中7例行急诊囊肿外引流术。行择期手术者中24例行囊肿切除、胆肠吻合术，其中3例合并肝叶切除术； 行内引流术4例； 仅行胆囊切除术3例。囊肿剥除采用点状钳夹、电凝及推剥囊肿黏膜外纤维血管束的办法，不出血，无副损伤。无手术死亡病例，术后恢复顺利。38例患者中术后获随访28例（73.68％），失访10例； 随访时间 3～120个月，平均74个月。24例行囊肿切除者症状消失20例，偶感上腹痛、抗炎治疗后症状可缓解1例，3例失访；11例行内或外引流术者术后近期均有不同程度的胆管炎症状，其中6例于术后2～10 年再手术，另5例失放，6例再手术者中2例术中发现癌变，分别于再手术后2个月和10个月死亡，余4例临床症状消失；3例仅行胆囊切除术者，2例失访，1例仍有反复发作的畏寒、发热及右上腹痛。结论 B超和MRCP检查有助于明确诊断； 囊肿全切除、肝管空肠Roux-en-Y 吻合术应作为胆总管囊肿的首选术式，囊肿外引流术仅在合并严重感染、全身情况差的患者采用； 手术技巧的改进可为手术提供安全保障。
目的考察皮下通道型胆囊肝胆管成形术（STHG）治疗肝胆管结石及胆管狭窄的中、远期疗效。方法对该院1994年12月至2000年6月期间行STHG手术的59例患者的术后中、远期并发症进行统计分析。结果STHG的术后并发症发生率较低，而且并发症的种类也较少； 本组病例术后无返流性胆管炎的表现，也无胃肠道功能紊乱和吻合口溃疡发生。结论STHG既保存了胆囊及Oddi括约肌功能，又保证了胆汁的生理流向，还能防止肠液的返流，从而避免了术后消化功能紊乱和返流性胆管炎的发生，是一种较为理想的治疗肝胆管结石和肝门部胆管狭窄的术式。
中国的胆道疾病有自己的特点，也是东亚地区的特点。它严重危害人民的生命和健康，损害劳动力，比西方的胆道病更重。中国胆道外科应有自己的特色。自成都发现胆道蛔虫病开始，积累胆道感染和肝内结石病临床资料60年来，全国各地广泛深入的临床和实验研究已取得重大成绩。许多成绩不是单纯引进或照搬外国经验，而是针对自己面临的特殊实际情况，运用现代西方医学或与祖国传统医学相结合，独立自主研究取得的。我们已经解决或基本上解决了很多临床实际问题，但还有一些重大问题没有解决，或没有完全解决，有些问题还没有提上议事日程，它与西方的胆道外科自然有基本的共性，所以，我们的研究课题，既是中国的，也是世界的。自从改革开放以来，随着人们物质生活的改善，胆道病谱也有了明显改变，原发性胆管结石症在城市明显减少，农村乡镇所见也缓慢地趋向减少，胆囊结石病则趋向增多。但是，还不能说以原发性胆管结石病为主要对象的中国胆道外科正走向没落，没有多少研究课题了。应当着重提出，当今对胆管病研究的，实际上是整个胆道问题，包括全胆道若干艰深问题。我们的研究除深入胆管病外，也应加强胆囊病的研究力度。
ObjectiveTo discuss the effect of palliative drainage operation on the life quality of hilar cholangiocarcinoma. MethodsCholangiocarcinoma data of our hospital in recent 21 years were analysed retrospectively. They were divided into four groups: RouxenY choledochojejunostomy group, bridge internal drainage group, PTCD (or ERBD) internal drainage group, and operative external drainage group. The operative mortality, incidence of postoperative cholangitis and survival period were compared among groups.ResultsThe total perioperative mortality of 193 cases of palliative operation was 9.3%, there was no difference among groups (P＞0.05). The rate of postoperative cholangitis in the bridge internal drainage group (10.0%) was lower than that of RouxenY choledochojejunostomy group (19.4%),P＜0.05, the rate of cholangitis in PTCD (or ERBD) internal drainage group (37.5%) and operative external drainage group (38.1%) were significantly higher than that of RouxenY choledochojejunostomy group (P＜0.01). There was no significant difference between RouxenY choledochojejunostomy group 〔(9.2±1.8) months〕 and PTCD (or ERBD) internal drainage group 〔(8.8±1.9) months〕 in survival period (P＞0.05)，but the survival period of the above groups were significantly higher than that of bridge internal drainage group 〔(6.5±1.6) months〕，P＜0.05, and operative (or PTCD) external drainage group 〔(4.3±2.0) months〕,P＜0.01.ConclusionThe life quality of RouxenY choledochojejunostomy group is better than that of bridge internal drainage group and PTCD (or ERBD) internal drainage group, the life quality of external drainage is worse than that of the other groups.
ObjectiveTo summarize the research progress of near infra-red fluorescence imaging (NIRFI) in biliary tract surgery, and to provide protection for improvements of therapeutic effect and safety of biliary tract surgery.MethodThe relevant literatures about studies on NIRFI in the biliary tract surgery in recent years were reviewed.ResultsThe NIRFI had been preliminarily used in the surgical treatment of benign and malignant biliary diseases, and had shown its unique value in cholangiography. It provided a new method for effectively avoiding surgical complications, shortening operation time, reducing the rate of conversion to open surgery, evaluating blood supply of bile duct and improving the safety of operation.ConclusionsNIRFI has achieved notable successes in treatment of biliary tract diseases. With future application of fluorescence imaging in near infra-red Ⅱ window and new specific fluorescence targeting molecules, this technique will highlight its more important values in biliary surgery.
The global incidence of benign biliary tract diseases is high. Not only its anatomical variations are complex and the disease heterogeneity is strong, but also its preoperative assessment methods, surgical techniques and diagnostic and treatment strategies need to be improved. Consequently, patients have many perioperative complications and a poor long-term prognosis. According to the anatomical characteristics of the biliary tract and the pathophysiological characteristics of benign biliary diseases, we propose the surgical treatment concept of benign biliary tract diseases with the removal of the diseased bile duct tree drainage as the core, which is different from the traditional biliary surgery that takes “patency and obstruction” as the focus of treatment, and “alleviates symptoms” as the treatment goal. Through a series of improvements such as preoperative evaluation, surgical planning, surgical operations, and postoperative management, we have designed a series of innovative diagnosis and treatment strategies and procedures with the goal of curing biliary diseases, with a view to changing the diagnosis and treatment status of biliary surgery. We hope that can change the current the diagnosis and treatment status of biliary surgery.