目的考察皮下通道型胆囊肝胆管成形术（STHG）治疗肝胆管结石及胆管狭窄的中、远期疗效。方法对该院1994年12月至2000年6月期间行STHG手术的59例患者的术后中、远期并发症进行统计分析。结果STHG的术后并发症发生率较低，而且并发症的种类也较少； 本组病例术后无返流性胆管炎的表现，也无胃肠道功能紊乱和吻合口溃疡发生。结论STHG既保存了胆囊及Oddi括约肌功能，又保证了胆汁的生理流向，还能防止肠液的返流，从而避免了术后消化功能紊乱和返流性胆管炎的发生，是一种较为理想的治疗肝胆管结石和肝门部胆管狭窄的术式。
Objective To discuss the effective surgical treatment of intrahepatic lithiasis combined with high hepatic duct strictures. MethodsTwo hundreds and sixteen cases of intrahepatic lithiasis and high hepatic duct strictures treated in this hospital from January 1993 to October 2002 were analysed retrospectively.ResultsOne hundred and eightythree cases underwent different selective operation by selected time; 33 cases complicated with acute obstructive suppurative cholangitis underwent emergency were performed single biliary drainage, in which 30 cases were reoperated. The operative procedure were: hepatic lobectomy,high cholangiotomy and plastic repair,exposure of hepatic duct of the 2nd and the 3rd order,and plastic repair with own patch and choledochojejunostomy.Two hundreds and six cases were cured,the curative rate was 95.4%; 8 cases improved (3.7%), and 2 cases died (0.9%).Conclusion The best effective surgical treatment of intrahpatic lithiasis is hepatic lobectomy. Exposure of hepatic duct of the 2nd and the 3rd order is a satisfactory to release the hepatic duct strictures and to clear the intrahepatic lithiasis. For patients with normal extrahepatic bile duct and Oddi’s function, plastic repair of bile duct with own patch is possible to keep the normal form and function. Cholangioscopy may play an important role in the treatment of intrahepatic tract lithiasis during operation.
Objective To investigate the phenotypic change and proliferation of fibroblasts in human inflammatory strictured bile duct wall. Methods We observed the density and ultrastructure of fibroblasts, and the histologic structure in human normal bile duct wall and inflammatory strictured bile duct wall by light and electron microscope.Results The results showed that fibroblasts were the main source of extracellular matrix production in bile duct wall. The phenotype of fibroblasts in inflammatory strictured bile duct wall changed obviously, quiescent fibroblasts were activated and transformed to myofibroblasts, with massive proliferation. Conclusion These data suggest that massive proliferation of activated fibroblasts and myofibroblasts is the main source of extracellular matrix overproduction which results in inflammatory bile duct stricture.
Eighty two cases of acute gallstone pancreatitis on early operation are reported and the significance of the clinical picture and pathology are analysed. The data showed that gallstone was found in 85.5%, among the cases of them mulliple gallstone was 71.1%, dilated cystic duct was 26.4%, common bile duct stone 36.8%, distal bile ductal stricture was found in 9.3%, and anomalous conjunction of biliary and pancreatic duct was 20.1%. Sixteen cases with serious pancreatitis were determined on operation, but death rate was 3.7% only. The authors claim that early operation may be of value in patients of acute gallstone pancreatitis with or without jaundice espesially in bile duct obstruction.
目的 减少肝内胆管结石术后的残留。方法 回顾性分析近5年我科收治的50例肝内胆管结石病例行病灶肝切除并结合术中、术后胆道镜应用的近期疗效及术后残石率。结果 术后近期并发症发生率为8%，无胆漏、肝衰及手术死亡发生，术后B超、逆行T管造影及术后胆道镜检查证实的即期残石率仅4%（2例）。结论 减少肝内胆管结石术后结石残留的关键是术中术后胆道镜的使用，肝内及肝门胆管狭窄的彻底处理； 依据狭窄胆管所引流区域行“根治性”的肝组织切除是取尽结石，清除病灶的合理方法。
目的 探讨胆道术后肝内、外胆管狭窄的治疗方法。方法 回顾性分析吉林大学第一医院自2003年1月至2007年12月期间应用胆道镜对37例胆道术后肝内、外胆管狭窄患者行气囊扩张治疗的结果。结果 本组37例患者42处肝内、外胆管狭窄均行胆道镜下气囊导管扩张，29例（78.4%）系胆管狭窄伴肝内胆管结石，经气囊扩张后，胆道镜通过狭窄部位，取净远端胆管结石； 另8例（21.6%）系单纯胆管狭窄无结石,仅行导管扩张。本组成功率达97.3%（36/37）； 1例因胆汁性肝硬变伴弥漫性胆管狭窄扩张失败后行肝叶切除手术。27例狭窄仅需一次性扩张,9例因胆管多处严重狭窄而行多次扩张。全部患者均获随访，随访时间6~24个月,平均12个月，未见结石复发。结论 胆道镜下气囊导管扩张治疗胆管狭窄微创、直观、安全、简便易行且疗效可靠,是治疗胆管狭窄并取净结石的理想方法。但需注意操作方法及技巧，防止并发症的发生。
ObjectiveTo evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) for biliary strictures post-orthotopic liver transplantation (OLT). MethodsA systematic review was performed by searching electronic bibliographic databases, including the Cochrane Library, Medline, EMbase, CNKI, and WanFang from 1994 to 2014. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were used to describe the diagnostic value. Summary receiver operating characteristic (SROC) curve with area under the SROC curve (AUC) were used to summarize overall diagnostic performance. ResultsSix studies involving 261 subjects were eligible for the analysis. The summary estimates of pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and AUC of MRCP for the diagnosis of biliary strictures after OLT were 89% (95% CI:0.83-0.94), 94% (95% CI:0.88-0.98), 8.04 (95% CI:2.83-22.85), 0.11 (95% CI:0.04-0.37), and 0.961, respectively. ConclusionMRCP is a sensitive and specific technique to diagnose biliary strictures after OLT.
In 1983-1994,748 cases hepatocholelithiasis had been treated in our department, in which 372 patients underwent hepatectomy and 43 patients underwent hepatectomy of the quadrate lobe. Hepatectomy of the quadrate lobe has been performed to treat all kinds of hepatocholelithiasis, it is easy to expose 1 or 2 degree branch of biliary tree, incise the hepatobiliary stricture and perform hepatocholangiojejunostomy in the hepatic hilum.
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.