From December 1981 to October 1997, we had performed 1559 cases of intrahepatobiliary tract stones by surgery alone/or with cholangioscopy, of which 332 cases were left intrahepatobiliary tract stones (accounted for 33.9%), 111 right intrahepatobiliary tract stones (accounted for 11.3%) and 545 cases in both sides (54.7%). 324 patients complicated with stricture of biliary tract (32.3%), of which 156 cases (48.2%) were stricture of left intrahepatobiliary tract, 107 cases (33.0%) stricture of right intrahepatobiliary tract, 61 cases (18.8%) stricture of hepatic hilus biliary tract. The operative procedure were: ①hapatic lobe or segment resection, ②high cholangiotomy and palstic repair, ③choledochojejunostomy and ④T-tube or U-tube drainage with removal of stones by cholangioscopy later. The operative procedure should be based on different types of intrahepatobiliary tract stones and patholigical features. The result indicates that cholangioscopy may play an important role in the treatment of intrahepatobiliary tract stones.
An retrospective analysis of 112 cases with localized left hepatolithiasis (LLH) treated in our center in recent two decades was made. The results showed: ①Coexisting involvements of both left external hepatic duct (LEHD) and left medial hepatic duct (LMHD) were the most common pathological pattern (83.08%), came next the only LEHD involvement (12.31%). There was no localized LMHD caculi in this group. ②The rate of concomitant LHD stricture was 59.82% and that of LMHD or LEHD were 84.85% and 84.00% respectively, in which severe degrees dominate. ③Lateral segmentectomy was the most common clinical practice for LLH (58.93%), and left lebectomy was much less frequently used (12.50%), although the latter led to a significantly smaller rate of residual (7.14% vs 21.21%) and had a satification follow-up rate of 85.71% being superior to lateral segmentectomy (46.97%), or cholangiojejunostomy (40.00%), bile duct exploration and drainage (0). ④The most common prognostic factors were residual or recurrent stones of LMHD (62.50%) and residual LHD stricture (37.50%). ⑤There was no significant difference between left lobectomy and lateral segmentectomy in length of operation, intraoperative bleeding, and postoperative complications. The results indicate that too much dependence on lateral segmentectomy in the management of LLH is one of the most important factors affecting the longterm results, for which left lobectomy is an applicable and safe therapy of choice.
Objective To explore and describe the clinical feasibility and value of reconstruction of complex urethral stricture with free postauricular graft. Methods Urethroplasties-with free postauricular grafts were performed in 17 patients with complex urethral strictures, including 6 cases in anterior urethras and11 cases in posterior urethras.The grafts were transplanted onto the opened urethras in the first stage;6 months later, the new urethras were shaped with the second stage urethroplasties in 14 patients.There patients succeeded in single-stage urethroplasties. The urethras and bladders were washed with antibiotic solution everyday after urethroplasties. Results Good- and satisfactoryresults were obtained in 15 cases 6 months after urethroplasties, regardless of the strictured sites and lengths. Maximal urinary flow rates ranged 14-32 ml/s. There were 2 cases accompanied with complications 6 months after urethroplasties,1 case of fistula was repaired,1 case of severe urethral stricture was reconstructed with opposite side free postauricular graft later. Three patients had mild urethral strictures 6 months after urethroplasties, they were cured with urethral dilatationsfor 4-8 times. Conclusion Reconstruction of complex urethralstricture with freepostauricular graft is a good and effective method to treat long or complex urethral strictures, especially for patients without adequate foreskin or penis skin.