ObjectiveTo discuss the reason and treatment strategy of gallbladder muddy stones after cholecysto-lithotomy. MethodsThe clinical data of 62 patients with gallbladder muddy stones after cholecystolithotomy who were treated in our hospital from December 2008 to December 2014 was analyzed retrospectively. ResultsThere were 43 patients without any symptom and 19 patients with acute cholecystitis in 62 patients. Four patients were diagnosed with septation gallbladder, 6 patients with long and tortuous cystic duct, 3 patients with calculus of cystic duct, 4 patients with common bile duct stones, 39 patients with periampullary diverticula, 18 patients with pancreaticobiliary maljunction, 6 patients with duodenal papilla stenosis, 29 patients with duodenal papillitis, and 3 patients with duodenal papilla adenocarcinoma. Two patients were treated with laparoscopic cholecystectomy (LC), 1 patient with endoscopic sphincterotomy (EST) /endoscopic balloon dilation (EPBD) and LC, 1 patient with percutaneous transhepafic gallbladder drainage (PTGD) and open cholec-ystectomy, 14 patients with PTGD and EST/EPBD, 1 patient with PTGD and hepatocholangioplasty with the use of gallbladder (HG), 34 patients with EST/EPBD, 3 patients with EST/EPBD and endoscopic biliay metal stent drainage (EBMSD), 5 patients with HG, and 1 patient with EST/EPBD and HG. The gallbladder muddy stones disappeared after operations in 55 patients with gallbladder reserved, and gallbladder ejection fraction increased from (42±12) % to (59±16) %. Of the 62 patients, 53 patients were followed up for 6 months to 6 years (the median time was 3.6-year). During the follow-up period, 3 patients were diagnosed with gallbladder stones, 2 patients with common bile duct stones, and 2 patients with intrahepatic and extrahepatic bile duct stones. ConclusionBile efferent tract obstruction is the important reason for the formation of gallbladder stones. HG, EST, and balloon expansion are the efficient methods to resolve the bile efferent tract obstruction.
ObjectiveTo discuss the clinical effects of T-tube with side holes in the gallbladder-common hepatic duct anastomosis. MethodsThe clinical data of 60 cases that performed gallbladder-common hepatic duct anastomosis from Jul. 2009 to Jul. 2012 were retrospectively analyzed. The contractile functions and mucosal recovery of gallbladder were compared between the conventional T-tube and T-tube with side holes. ResultsTwenty-four cases of gallbladder-common hepatic duct anastomosis used conventional T-tube, the gallbladder were not developing in 6-8 weeks after operation by T-tube cholangiography, the gallbladder mucosa of 17 cases were normal without edema, congestion and edema were observed in 6 cases, and the normal gallbladder mucosa structure disappeared in 1 case. The gallbladder were developing in 6-8 weeks after operation by T-tube cholangiography in 36 cases that used T-tube with side holes, the gallbladder mucosa structure had not congestion, edema, and erosion. The gallbladder contractile function were normal. ConclusionsThe floc, blood clots, and inflammatory substances in gallbladder can be discharged into the intestine or drainage in vitro, and the bile can go into gallbladder and can be concentrated through the T-tube with side holes. Physiological flow of bile can return to normal and the function of gallbladder can recover early.
ObjectiveTo discuss the relation between bile duct anastomotic stricture and bile duct injury by endo-scopic observation following liver transplantation and it, s efficacy of endoscopic treatment. Method The clinical data of 24 cases of bile duct anastomotic stricture following liver transplantation diagnosed by cholangiography were analyzed retro-spectively. Results①Twenty-four cases of bile duct anastomotic strictures were included in 3 cases of typeⅠa, 2 cases of typeⅠb, 4 cases of typeⅡ, 1 case of typeⅢa, 5 cases of typeⅢb, and 9 cases of typeⅢc.②The redness of intrahepatic bile duct mucosa, banding erosion, ulcer and fusion of anastomotic stricture mucosa could be seen in typeⅠa andⅢa. The redness of intrahepatic bile duct and anastomotic stricture mucosa could be seen in typeⅡwithout ulcer and fusion. The extensive erosion and ulcer of intrahepatic bile duct and redness of anastomotic stricture mucosa could be seen in typeⅢb. The extensive erosion, ulcer and partial necrosis of intrahepatic bile duct and anastomotic stricture mucosa could be seen in typeⅠb andⅢc.③Seventeen cases were cured by choledochoscopy through T tube, the biliary casts were moved out and the anastomotic strictures were relieved by balloon dilatation and placement of plastic stenting for 2 to 6 months, no recurrence happened. One case of typeⅠb treated by percutaneous transhepatic cholangial drainage(PTCD) and percuta-neous transhepatic cholangioscopy(PTCS) was developed into the stricture of typeⅡduring following-up for 19 months. Two cases of typeⅠa were treated by ERCP, the biliary casts were moved, one of which was cured, another 1 case was developed into the stricture of typeⅡduring following-up for 5 months. Two cases of typeⅡwere treated by ERCP, the biliary casts were moved, balloon dilatation and placement of plastic stent were performed, one of which was cured, another 1 case was recurrent during following-up for 1 months. The strictures were not relieved by multiple plastic stents for 4 to 6 months in 3 patients with recurrence and progress, but which was relieved by full-covered self-expanding removable metal stents for 4 to 7 months, there was no recurrence during following-up. One case of typeⅢb and one case of typeⅢc received the secondary open operation or choledochoscopy and placement of plastic stent for biliary infection and jaundice after the treatment of ERCP were cured. ConclusionsBiliary stricture following liver transplantation accompanies different degree biliary injury. The slightest is typeⅡand typeⅠa, typeⅢa is the second, typeⅢb is more serious, and typeⅠb and typeⅢc are the worst. Choledochoscopy is a better choose for anastomotic strictures. ERCP is not a better choose for anastomotic strictures of typeⅠb, Ⅲb, andⅢc.
ObjectiveTo analyze the reason of 45 patients with cardiac valve reoperation and to evaluate the safety of redo heart valve replacement. MethodsWe retrospectively analyzed the clinical data of 45 patients in our hospital between January 2010 and January 2015. There were 45 patients with 14 males and 31 females at an average age of 51.21± 8.36 years. ResultsThree of 45 patients (6.67%) were died after surgery. Mean follow-up was 36 (4-68) months. A total of 42 patients were alive and without reoperation again. The main reasons of heart valve reoperation included lesions of untreated valve, paravalvular leakage, thrombosis associated with valvular dysfunction, bioprosthesis degeneration, endocarditis, valvular lesions after angioplasty. ConclusionTricuspid regurgitation should be treated aggressively when the mitral valve involved in the first operation. Patients received the secondary heart valve replacement is safe and effective. Strict follow-up system should be established and surgical intervention should be taken timely and appropriately.
ObjectiveTo investigate the ideal digestive tract reconstruction method for radical distal gastrectomy (DG). MethodsClinical and follow-up data of 862 patients with gastric cancer who underwent DG in Xijing Hospital of Digestive Diseases of The Fourth Military Medical University from January 2010 to January 2013 were analyzed retrospectively. According to reconstruction methods, patients were divided into three groups:Billroth Ⅰ group (B-Ⅰgroup), Billroth Ⅱ (B-Ⅱ)+Braun group (B-Ⅱ+Braun group), and Roux-en-Y group. In order to reduce the difference of clinicopa-thological characteristics, Gmatch method was used to select patients basing on gender, age (±5 years), tumor size (±1 cm), pT staging, and pN staging. The perioperative data, recent (30 days after surgery) complications, gastroscopic results over one year, and postoperative survival rate were compared respectively among the 3 groups. Results① Perioperative indexes. The operative time, postoperative hospitalization, and semi liquid diet time were significantly different among 3 groups (P < 0.050). As compared with B-Ⅱ+Braun group and Roux-en-Y group, B-Ⅰ group had a significantly shorter operative time (P < 0.012 5), and there was no significant difference between B-Ⅱ+Braun group and Roux-en-Y group (P > 0.012 5). As compared with B-Ⅱ+Braun group, B-Ⅰ group had a significantly shorter semi liquid diet time (P < 0.012 5), but there was no significant difference between B-Ⅱ+Braun group and Roux-en-Y group, as well as Roux-en-Y group and B-Ⅰ group (P > 0.012 5). As compared with B-Ⅰ group and B-Ⅱ+Braun group, Roux-en-Y group had a significantly longer postoperative hospitalization (P < 0.012 5), and there was no significant difference between B-Ⅰ group and B-Ⅱ+ Braun group (P > 0.012 5). ② There was no significant difference in recent complications between Roux-en-Y group (12.5%, 4/32), B-Ⅱ+Braun (6.2%, 2/32), and B-Ⅰ group (3.1%, 1/32), P=0.495. ③ Results of endoscopic examination over 1 year after radical DG showed that there was significant difference among 3 groups (P < 0.050). Compared with B-Ⅰ group and B-Ⅱ+Braun group, the rates of reflux gastritis, bile reflux, and reflux esophagitis of Roux-en-Y group were all lower (P < 0.012 5), but there was no significant difference between B-Ⅰ group and B-Ⅱ+Braun group (P > 0.012 5).④ The 3-year survival rates of Roux-en-Y group, B-Ⅱ+Braun group, and B-Ⅰ group were 70.0% (21/30), 73.3% (22/30), and 75.0% (24/32) respectively, and there was no significant difference in the survival situation (P=0.911). ConclusionsThe effect of Rouxen-Y anastomosis on resisting gastrointestinal reflux is remarkable. B-Ⅰanastomosis has the advantages of more simple operation, faster recovery, and more similar to the physiological structure. Thus, B-Ⅰ anastomosis and Roux-en-Y anastomosis are recommended for digestive tract reconstruction in DG.