ObjectiveTo introduce the experience in diagnosing and treating cholecystoenteric fistula (CEF) during laparoscopic cholecystectomy (LC). MethodsFive cases with CEF in a series of 4 200 LC cases were reviewed.All of the five patients were proved to have CEF during operations.There were four cholecystoduodenal fistulas and one cholecystocolic fistula. One case with cholecystoduodenal fistula was treated by a suturing of the fistula under laparoscopy; 1 case was closed with titaniun and 2 cases were converted to laparotomy and fistulectomy.The patient with cholecystocolic fistula clips was treated by a suturing of the fistula under laparoscopy. ResultsAll the patients had got good recovery without complications.Conclusion CEF is a rare complication of cholelithiasis.If the diagnosis is made before operation, open operation might be a better choice.But if the diagnosis was made during the LC operation, suture closure or clip closure or stapler closure of CEF under laparoscope might be chosen for an experienced surgeon.
The authors analysed the medical records of 30 patients with congenital cystic disease of the liver treated in this hospital and with a review of the article some problems of diagnosis and treatment are discussed. B-altrasonic scaner (B-US), computerized tomographic scanning and magnetic resonance imaging appeared to be most helpful in diagnosing and treating this disease. After comparing different treatments, such as aspiration .alcohol sclerotherapy, fenetration, cyst resection and partial hepatectomy, the arthors state the best results could be achieved by alcohol sclerotherapy under B-US guidence (6 cases) or fenestration (15 cases) with no postoperative complication. Malignant change was found in one patient of this group.
目的:总结彭氏多功能手术解剖器及刮吸解剖法在结直肠癌手术中的应用经验。方法:自2007年3月至2008年12月对428例结直肠癌患者使用彭氏多功能手术解剖器(PMOD),均采用刮吸解剖法进行手术操作。结果:彭氏多功能手术解剖器及刮吸解剖法使手术视野清晰,使复杂的手术简单化,手术时间显著缩短,减少了术中出血及损伤,提高了手术切除率和根治率。结论:使用彭氏多功能手术解剖器及刮吸解剖法是一种高效、实用、安全的操作方法。
Objective To summarize the relationship between microRNA and the occurrence and progression of colorectal cancer， and to investigate the application value of microRNA in the diagnosis， treatment， and prognosis evaluation of colorectal cancer. Methods Domestic and international publications involving the relationship between microRNA and colorectal cancer were retrieved and reviewed. Results MicroRNA acted as an oncogene or tumor suppressor gene to participate in cell proliferation， differentiation， apoptosis， metabolism， tumor genesis， and tumor progression. The abnormal expression of microRNA was closely related to the occurrence and progression of colorectal cancer. As specific biomarker， microRNA could be applied in early diagnosis， chemotherapy strategy-making， and prognostic evaluation of colorectal cancer. Conclusion MicroRNA is definitely related to the occurrence and progression of colorectal cancer， and it has great prospect in the basic research and clinical applications of colorectal cancer.
目的 探讨老年人自发性乙状结肠穿孔的病因、诊断及治疗方法。方法 对四川大学华西医院胃肠外科中心2009～2011年期间收治的9例自发性乙状结肠穿孔老年患者的临床资料进行回顾性分析。结果 9例患者中7例有长期便秘史，术前均诊断为“全腹膜炎、腹腔脏器穿孔”而行急诊手术。术中见穿孔位于直乙交界处6例，乙状结肠中上段3例，均在系膜对侧缘。3例行病变处肠段切除加远端封闭、近端造瘘术（Hartmann术），4例行乙状结肠部分切除吻合、横结肠双腔造瘘术，1例行穿孔修补术，1例行穿孔修补加横结肠造瘘术。8例患者治愈出院，1例患者因经济原因放弃治疗。结论 老年人自发性乙状结肠穿孔临床上较少见，其发病与解剖学因素、病理学因素密切相关，便秘等是其重要诱因。及时手术、选择适宜的手术方式以及彻底清除腹腔污染是治疗成功与否的关键。
Objective To prevent bile duct injury, a new anatomy marker, named “common bile duct window” is created. Methods From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including: age, gender, course of disease, body mass index (BMI), blood lipid level (triglyceride and cholesterol), the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of “common bile duct window” were recorded and calculated. Patients were divided into two groups according to the presence of “common bile duct window”, and the diference of data between two groups was analyzed by using χ2 test or t test. Results “Common bile duct window” was found at the end of hepatoduoduenal ligament with oval-shaped, the mean longitude of “common bile duct window” was (1.20±0.60) cm, and mean width was (0.45±0.30) cm. “Common bile duct window” were found in 81.6% (49/60) of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of “common bile duct window” （Pgt;0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P＜0.05）. Conclusion An oval-shaped “common bile duct window” can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through “common bile duct window”, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct injuries can be effectively decreased by the presence of “common bile duct window”.
Objective To explore the operative managements of ectopic gallbladder during laparoscopic cholecystectomy (LC).Methods Twenty one cases of ectopic gallbladder undergone LC in this hospital were analyzed regarding the perioperative management, principle, and technique of operation.Results There were 2 cases of situs transversus, 1 case with gallbladder under right posterior lobe of liver, 2 under left lateral lobe of liver and 16 in the liver. All 21 cases of ectopic gallbladder had undergone LC successfully, and no complications were found during and after operation. Conclusion Anatomic ectopia of gallbladder tosses a challenging problem to laparoscopic surgeon. It is safe for surgeons to recognise actual anatomical anomaly and to manage them appropriately.