Objective To investigate feasibility and clinical efficacy of exploration and stone removal through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy for hepatolithiasis. Methods The patients who had left extrahepatic bile duct stones with choledocholithiasis from January 2012 to December 2016 were retrospectively collected. Among these patients, 29 cases underwent an exploration and stone removal through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy (observation group) and 26 cases underwent an exploration and stone removal through choledochoscope via incision of common bile duct during laparoscopic left lateral hepatectomy (control group). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative nutritional, and complications rate were compared between these two groups. Results The operations were performed successfully and no perioperative death happened in both groups. There were no significant differences in the operative time and intraoperative blood loss between the two groups (P>0.05). Moreover, the postoperative hospital stay of the observation group was significantly shorter than that of the control group (P<0.05). In addition, there were no significant differences in the complications of the bile leakage, subphrenic infection, and biliary residual stones between the two groups (P>0.05). Also, the levels of prealbumin and the lymphocytes in the observation group were significantly higher than those in the control group on the 3rd and 6th day after the operation (P<0.05). Conclusions Preliminary results of limited cases in this study show that exploration and removal of stones through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy for hepatolithiasis is relatively safe and reliable, its procedure is simplified, could avoid relevant complications due to biliary incision and T tube drainage.
Objective To study the etiology of primary intrahepatic stones. MethodsThe literatures in the recent years on the etiology of intrahepatic stone were revieved. Results The formation of intrahepatic stone mainly caused by bacteria infection, parasitic infestation, bile stasis, congenital anatomic abnormalities and immunoreaction of bile tract. Further investigation found that metabolic, low protein diet, environment and ethnic factors and gene mutation were considered to play important roles in the formation of the intrahepatic stone. Conclusion The formation of intrahepatic stone is complex and are result of multiple factors. It closely related to the infection and stasis of the bile duct.
Objective To evaluate effectiveness and safety of electronic choledochoscopy in treatment of intrahepatic bile duct stones. Methods From July 2013 to February 2016, 280 patients with intrahepatic bile duct stones in the Department of General Surgery of the Affiliated Hospital of Shandong Academy of Medical Sciences were selected as the research objects. All the patients were randomly divided into a choledochoscopy treatment group and a conventional treatment group by envelope principle method. There were 140 patients in each group. The safety and short- and long-term effectiveness were compared in these two groups. This study was approved by the ethics committee of the hospital. Results ① The age, gender, body mass index, course of disease, and location of stone had no significant differences in these two groups (P>0.05). ② The operations and the net stones were successfully completed in all the patients. The operative time was shorter, the blood loss was less, the incision length was smaller, the postoperative anal exhaust time was earlier, and the hospitalization time was shorter in the choledochoscopy treatment group as compared with the conventional treatment group (P<0.05). ③ The total postoperative complication rate on day 14 in the choledochoscopy treatment group was 2.9% (4/140), which was significantly lower than that in the conventional treatment group (11.4%, 16/140, P<0.05). ④ The curative excellent and good rates was 97.9% and 85.0% in the choledochoscopy treatment group and conventional treatment group respectively, which was a significant difference in these two groups (P<0.05). ⑤ The postoperative serum ALT and AST values on month 6 in the choledochoscopy treatment group were significantly lower than those in the conventional treatment group (P<0.05). Conclusion Electronic choledochoscopy in treatment of intrahepatic bile duct stones could promote rehabilitation of patient, reduce incidence of postoperative complications, and it is conducive to promoting recovery of liver function and improving follow-up effect.
目的 了解肝部分切除治疗肝内胆管结石的效果。方法回顾性分析1984年3月至1997年8月对95例肝内胆管结石施行肝部分切除，并辅以狭窄胆管切开整形及胆肠吻合等手术的治疗情况。结果 临床疗效优良者达93.7%，术后残留结石10例，残石率为10.5%。结论 肝部分切除治疗肝内胆管结石是目前较理想有效的手术方式。
Objective To explore the indications for liver transplantation among patients with hepatolithiasis. Methods Data from 1431 consecutive patients with hepatolithiasis who underwent surgical treatment from January 2000 to December 2006 were retrospectively collected for analysis. Surgical procedures included T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones, hepatectomy, cholangiojejunostomy, and liver transplantation. Results Nine hundred and sixty-one patients who had a stone located in the left or right intrahepatic duct underwent hepatectomy or T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones. The rate of residual stones was 7.5% (72/961). Four hundred and seventy patients who had a stone located in the bilateral intrahepatic ducts underwent surgical procedures other than liver transplantation; the rate of residual stones was 21.7% (102/470). Only 15 patients with hepatolithiasis underwent liver transplantation; they all survived. According to the degree of biliary cirrhosis, recipients were divided into 2 groups: a group with biliary decompensated cirrhosis (n=7), or group with biliary compensated cirrhosis or noncirrhosis group (n=8). There were significant differences in operative times, transfusion volumes and blood losses between 2 groups (P＜0.05). In the first group, 6 of 7 patients experienced surgical complications, and in the second, 8 recipients recovered smoothly with no complications. Health status, disability and psychological wellness of all recipients (n=15) were significantly improved in 1 year after transplantation as compared with pretransplantation (P＜0.05). Conclusion Liver transplantation is a possible method to address hepatolithiasis and secondary decompensated biliary cirrhosis or difficult to remove, diffusely distributed intrahepatic duct stones unavailable by hepatectomy, cholangiojejunostomy, and choledochoscopy.
Objective To summarize contents of enhanced recovery after surgery (ERAS) and understand it’s status and prospect in application of patients with hepatolithiasis. Methods The descriptions of ERAS in recent years and applications in hepatolithiasis were reviewed. Results The ERAS programme mainly included the preoperative managements, such as the education, nutrition management, and gastrointestinal tract management; the intraoperative managements, such as the minimally invasive surgery, reasonable choice of anesthesia, infusion volume management, and maintenance of body temperature, analgesia, and preventing postoperative nausea and vomiting medication selection; the postoperative early feeding, early exercise, early extubation, multimodal analgesia, T tube management, reasonable discharge standard and follow-up management. Although the ERAS was rarely reported in patients with hepatolithiasis, it had some advantages of promoting recovery and improving patient satisfaction, and it was still effective and safe. Conclusions Application of ERAS concept in patients with hepatolithiasis has achieved precision management and individualized treatment during perioperative period. It could achieve a good short-term therapeutic effect and optimize medical management model. However, there are still some problems at the present stage in implementation and promotion of patients with hepatolithiasis, such as lacks of criteria and specifications, evidence-based medicine. It is needed to further strengthen communication and collaboration among multiple disciplinary teams so as to further improve ERAS programme and popularize it.
目的 探讨胆管良性疾病再次手术的原因及其诊断与治疗。方法 回顾性分析1991年1月至2005年12月期间我院收治的胆管良性疾病再次手术91例患者的临床资料。结果 91例中接受2次手术者87例（95.60%），3次手术者4例（4.40%），无手术死亡。再次手术原因： 结石残留或复发42例（46.15%），胆管损伤36例（39.56%），残留胆囊5例（5.49%），胆肠吻合口狭窄2例（2.20%），返流性胆管炎2例（2.20%），胆总管下端炎性狭窄2例（2.20%），肠瘘2例（2.20%）； 再次手术方式： 胆肠Roux-en-Y吻合、T管支撑56例（61.54%），肝叶切除13例（14.29%），肝门整形、肝管空肠Roux-en-Y吻合10例（10.99%），残余胆囊切除5例（5.49%），胆总管切开取石、T管引流3例（3.29%），胆管修复、T管支撑2例（2.20%），胆管对端吻合、T管支撑2例（2.20%）。结论 降低结石残留以及预防胆管损伤是防止再次胆道手术的关键。进行胆道再次手术时应积极术前准备，制定合理治疗方案，以避免多次手术。
Objective To discuss the therapeutic effectiveness of surgical approach to complex intrahepatolithiasis with biliary liver cirrhosis.Methods A case of complex intrahepatolithiasis with biliary liver cirrohosis, portal hypertension was treated with splenectomy and pericardial devascularization plus left hepatectomy and portal cholangio plasty with T tube drainage. Results Follow up one year and a half after operation, no symptom of cholangitis was found, and there is no relapse up to date. Conclusion Combined operation of hepatectomy with splenectomy is an ideal and effective treatment for complex intrahepatolithiasis with biliary liver cirrhosis.