Objective To refine the technique of portal inflow occlusion and parenchymal transection for laparoscopic hepatectomy in the porcine model. Methods Ten pigs were used. The portal inflow complete or selective occlusion was carried out with portal triad clamping or dissection and division of the left portal pedicle. The sequential laparoscopic local hepatectomy, left lateral lobectomy, and left medial lobectomy were performed without portal inflow occlusion. Parenchymal transection was performed with harmonic scalpel, LigaSure, microwave dissector, bipolar electrocautery, surgical clips, and endoscopic stapler. The efficacy and safety of different techniques in laparoscopic parenchymal transection of the liver were compared. Results The ischemic liver was darken with complete or selective portal triad clamping. The ischemic demarcation line between left and right lobe was obvious with the dissection and division of the left portal pedicle. There was an applicable scope of each hepatic parenchymal transection apparatus. The optimal combination of different techniques could increase efficacy and reduce hemorrhage in laparoscopic parenchymal transection of the liver. Conclusion Technical refinements of portal inflow occlusion and parenchymal transection in porcine models could provide evidences to clinical appliance of laparoscopic anatomic major hepatectomy.
Objective To evaluate the efficacy of direct vision guided lithotripsy with SpyGlass DS in the treatment of pancreatic duct obstruction caused by chronic calcified pancreatitis and pancreatic duct stones. Methods The clinical data of 9 patients with chronic calcified pancreatitis and pancreatic duct stone who underwent direct-vision guided pancreatic duct stone lithotripsy with SpyGlass DS from July 2017 to September 2017 in the Department of Gastroenterology of Jilin People’s Hospital were retrospectively analyzed, then assessment of technical success rate, clinical success rate, and incidence of adverse event were performed. Results A total of 13 times of intervention were performed in 9 patients, the overall technical success rate of SpyGlass DS direct vision lithotripsy and drainage was 88.9% (8/9). Three of the 9 patients (30.3%) had adverse reactions, including self-limiting bleeding after sphincterotomy (n=1), post-encoscopic retrograde cholangio-pancreatography pancreatitis (n=2), and mild abdominal pain (n=2). Nine patients were followed-up for 3－50 months (median of 21 months), 8 patients (88.89%) reported improvement in abdominal pain, and the mean visual analogue scale score decreased from 6.22±1.47 to 2.78±1.23, P<0.01. Eight patients (88.9%) patients achieved clinical success. Conclusion The SpyGlass DS direct vision-guided lithotripsy is safe and effective for patients with pancreatic duct stones.
【Abstract】Objective To investigate prophylactic measures for nontraumatic complications of laparoscopic cholecystectomy (LC).Methods The data of 13 000 patients who underwent LC in Kunming general hospital of PLA over 13 years(1991-2004) were retrospectively reviewed. Results Nine malignant tumors and 47 common bile duct stones were missed at LC. The 9 malignant tumors included hepatic cancer (n=1), gastric cancer (n=1), gallbladder cancer (n=2), pancreatic cancer (n=2) and right colon cancer (n=3). Of all the carcinomas, 3 patients with right colon cancer underwent colectomy, the other 6 patients couldn’t be cured radically. All the 47 patients with choledocholithiasis were cured successfully, among them 31 patients were performed with ERCP and 16 were reoperated on with cholangiotomy. Conclusion This study emphasizes the necessity to analyze carefully patients’ symptoms before operation and pay attention to pathological changes of gallbladder and intraabdominal situation intraoperatively. If necessary, laparoscopic ultrosonography can be used to avoid missing malignant tumors and biliary stones.