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.
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.
Thirty seven rabbits were randomly divided into three groups fed with different feeds,the basic feed group as a control,high cholesterol group(feed containing 1.2% cholesterol)and high cholesterol feed added to Dong Li San which is a chinese medicine that can promote the contracition of gallbladder.All animals were fed with the corresponding feeds for four weeks.The results showed that 12 out of 14 rabbits in the high cholesterol group developed gallstone and 2 of 10 rabbits in the high cholesterol and Dong Li San feeding group had gallstone formation.The latter showed much higher emptying rate of gallbladder,lower level of mucin in the bile and much lower resistance to the cystic duct than those of the former.The results suggest that Dong Li San can effectively prevent gallstone formation by promoting gallbladder contraction ,reducing mucin in bile,decreasing cystic duct resistance and promoting the emptying capacity of gallbladder.
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.
Objective To investigate the roles of NF-κB and EGFR in hepatolithiasis associated with intrahepatic cholangiocarcinoma. Methods Ninety cases of liver tissue specimens from hepatectomies performed in the 2nd Affiliated Hospital of Sun Yat-sen University between August 1989 and June 2009 were enrolled in the study. Among them, 33 cases of hepatolithiasis associated with intrahepatic cholangiocarcinoma were considered as observing group, 32 cases of hepatolithiasis as control group, and 25 cases of normal bile duct tissues as normal control group. The SP method of immunohistochemical staining was applied to detect the expressions of NF-κB and EGFR in intrahepatic biliary ducts epithelial cells, and their relations with clinicopathologic factors and the accumulated survival rate of hepatolithiasis associated with intrahepatic cholangiocarcinoma were analyzed. Results Expression rates of NF-κB and EGFR were gradually raised from normal control group, control group to observing group (Plt;0.01). Expression of EGFR in tumor patients was related to histopathologic differentiation grading and the depth of tumor invasion (Plt;0.05), but not to gender, age, or lymph node metastasis (Pgt;0.05)； there were no significant relationships between the expression of NF-κB and factors described above (Pgt;0.05). The survival rate of patients with tumor expressed EGFR was significantly lower than that of patients with tumor non-expressed EGFR (Plt;0.01). Conclusions NF-κB expression is in the early stage during intrahepatic cholangiocarcinoma genesis. NF-κB and EGFR play cooperating roles during hepatolithiasis carcinogenesis process. Over expression of EGFR is related with poor differentiation and prognosis of tumor.
ObjectiveTo summarize the clinical experience on combination of laparoscopy, choledochoscopy, and duodenoscopy in treatment of cholecystolithiasis with small diameter of choledocholith during the same period via multiple approach. MethodsThe clinical data of 71 cases of cholecystolithiasis with small diameter(The internal diameter of common bile duct was 4-8 mm)of choledocholith underwent laparoscopic cholecystectomy(LC)plus laparoscopic and endoscopic cholelithotomy plus laparoscopic and endoscopic sphincterotomy(LC+LEC+LEST)from February 2001 to December 2013 in this hospital were analyzed retrospectively. Firstly, the LC and common bile duct exploration was performed, then the ureteral catheter or zebra guide wire was inserted into the common bile duct and duodenum cavity through cystic duct or common bile duct incision. Under the guidance of ureteral catheter or zebra guide wire, the choledochoscope was inserted into the common bile duct and cholelithotomy was performed by stone net or electrohydraulic lithotripsy. Then, the duodenoscope was inserted into the papillary of duodenum, the papillary of duodenum was cut by the pin-headlike electro-knife along the ureteric catheter or zebra guide wire, choledocholith was removed with the reticulation of choledochoscopy and duodenoscopy. ResultsLC+LEC+LEST was successfully performed on 71 cases of cholecystolithiasis with small diameter of choledocholith. The placement of a catheter via cystic incision was in 59 cases, via common bile duct incision was in 22 cases. The common bile duct stones of 64 patients were completely removed under the choledochoscope, of 12 patients were completely removed under the combination of choledochoscope and duodenoscope. No case was converted to laparotomy. The bile leakage occurred in 5 cases and cured by patent drainage. The slight pancreatitis occurred in one case after operation. There was no patient with residual stones, perforations of intestine and bile duct, hemorrhoea, severe pancreatitis, or death. ConclusionIf patients are indicated, LC+LEC+LEST is safe and effective to remove the cholecystolithiasis with small diameter of choledocholith.
ObjectiveTo summarize the experience of the transabdominal reverse guide technique of endoscopic nasobiliary drainage during the course of laparoscopic common bile duct exploration with endoscopic nasobiliary drainage (LENBD). MethodsFrom May 2008 to March 2015, there were 237 cases undergoing LENBD, involving choledochotomy, electrohydralic lithothipsy, incision on the stenosis of papillary, bile duct drainage through the endoscopic nasobiliary drainage, and primary closure of duct incision. ResultsEndoscopic nasobiliary drainage:the procedure were successful in 215 cases (90.7%) of nasobiliary drainage out of 237 cases. Nasal bile duct intubation failed in 6 cases (2.5%), wherein the transfered for ureteral catheter drainage of bile duct in 5 cases, bile duct drainage was given up in 1 cases. Nasobiliary discount caused no liquid outflow in 9 cases (3.8%). Nasal bile duct early slipped in 7 cases (3.0%). Primary closure of bile duct incision:the procedure were successful in 229 cases (96.6%) of primary closure out of 237 cases. Primary closure failed in 8 cases (3.4%) that the transfered for ureteral catheter drainage of bile duct in 5 cases (2.1%) and the bile leakage occurred in 3 cases (1.3%) with primary closure of duct incision and cured by patent drainage. Six cases (2.5%) were a slight pancreatitis after operation. Head of the nose bile duct was wrong to sew in 1 case (0.4%). No case residual stones in the biliary duct of 237 cases. No other serious complications and no case died postoperatively. ConclusionIf patients are suitable, transabdominal reverse guide technique in laparoscopic common bile duct exploration of endoscopic nasobiliary drainage is safe and effective in the hands of skilled endoscopists.
ObjectiveTo summarize clinical experiences of combination of laparoscope,choledochoscope,and balloon nasobiliary exploration (LCBNE) in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter (0.3-0.8 cm) of common bile duct (CBD). MethodsFrom April 2010 to May 2015,there were 43 cases of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD underwent LCBNE,involving choledochotomy,choledochoscopic exploration,electrohydralic lithothipsy,balloon nasobiliary dilatation for removing cholelith,nasobiliary drainage,and the primary closure of incision. ResultsThe procedure was successful in 27 cases of removing the bile duct residual stones through the choledochoscopic procedure,9 cases through the balloon nasobiliary procedure,and 7 cases were converted to endoscopic sphincterotomy for choledocholithasis.No case was converted to open CBD exploration.No case had residual stone.Bile leakage occurred in 1 case,which was cured by peritoneal drainage and nasobiliary drainage.One patient had a slight pancreatitis after operation.One patient had the stenosis of primary suture of CBD incision.Total postoperative complications rate was 7.0%(3/43).No case had perforations of intestine and bile duct,bleeding,severe pancreatitis,and death after operation. ConclusionFrom preliminary results of limited cases in this study,if patients are indicated,combination of LCBNE in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD is safe and effective.
ObjectiveTo investigate the clinical value of MRCP and (or) MRI on combination of choledochoscopy and duodenoscopy during the course of therapeutic laparoscopy with preoperative or intraoperative help diagnosis and treatment of gallbladder stone with common bile duct stones of diameter in the normal range. MethodsThe clinical data of 998 patients with calculus of bile duct with diameter in the normal range of common bile duct (common bile duct diameter of 0.2-0.8 cm) by MRCP and (or) MRI assist in diagnosis and treatment from Oct. 2001 to Dec. 2015 in the Second People's Hospital of Chengdu City were retrospectively analized. ResultsThe 998 cases of common bile duct diameter≤0.8 cm were diagnosed and treated by using MRCP and (or) MRI examination. Choledochoscopy group: There were 399 cases, 352 cases (88.2%) were successful removed the bile duct residual stones through the choledochoscopic procedure, converted to intraoperative endoscopic sphincterotomy in 47 cases (11.8%). The false positive rate of MRCP and (or) MRI was 3.7% (13/352), the false negative rate of color Doppler ultrasound was 79.3% (279/352). Duodenoscopy treatment group: It was performed in 408 cases. The stones of common bile duct removed with duodenoscopic papillo-tomy in 381 cases (93.4%), the stone expulsion after duodenoscopic papillotomy in 18 cases (4.4%), 9 cases (2.2%) were shifted to other operation. False negative rate of color Doppler ultrasound was 79.5% (303/381). Three endoscopy group: There were 191 cases that intraoperative choledochoscopic exploration or intraoperative endoscopic papillotomy. The false positive rate of MRCP and (or) MRI was 2.6% (5/191), the false negative rate of color Doppler ultrasound was 76.4% (146/191). ConclusionsRoutine use of MRCP and MRI, in preoperative or intraoperative help diagnosis and treatment of gallbladder stone with common bile duct stones of diameter in the normal range, on combination of choledochoscopy and duodenoscopy during the course of therapeutic laparoscopy. It is necessary, feasible, effective and safe.