胆道消融剂在选择性胆道消融栓塞中的选用

目的 观察不同胆道消融剂选择性胆道消融栓寒对肝脏结构和功能的影响。方法无水乙醇、醋酸、盐酸、氧氧化钠分别消融姐道，OB胶栓塞巴马小型猪左外叶胆管，观察术后肝功及病理变化。结果术后各组肝功能各项指标除白蛋白外．均出现一过性增高，术后两周内恢复正常。尤水乙醇肝功变化没有其他组显著。其它各组坏死范围较无水乙醇大。其中氢氧化钠出现急性肝坏死，醋酸坏死范围大于左外叶。光镜下左外叶汇管区纤维明显增生，肝细胞数目减少。假小叶形成。Masson染色提示胶原纤维显著增生。结论无水乙醇与OB胶联合使用．行选择性胆道消融栓塞能使消融栓塞胆道引流区域肝组织萎缩纤维化，肝内假小叶形成。而且对机体影响最小，是目前安全的胆道消融剂。     

Experience with 1904 laparoscopic cholecystectomies at a private hospital

The purpose of this paper is to describe our recent experience in performing laparoscopic cholecystectomies of which we performed 1904, from January 1991 to May 1997, at our private hospital, mainly to treat cholecystolithiasis. The patients included 1563 with gallbladder stones (82.0%), 82 with cholecystocholedocholithiasis (4.3%), 104 with adenomyomatosis (5.5%), 132 with polyps (6.9%), and 23 with gallbladder cancer (1.3%). A difficult pericholecystic dissection led to conversion to open surgery in 61 patients. The average operation time was 63 min. Bile duct injury or cystic artery bleeding occurred in 3 patients with acute cholecystitis, and small intestine injury occurred in 1 patient, while bile leakage or a right subphrenic abscess occurred in 6 patients postoperatively. Although this series included 69 patients with previous upper abdominal surgery, 14 with liver cirrhosis, 267 with a nonvisualized gallbladder, and 148 with acute cholecystitis, the overall conversion rate was only 3.2% and morbidity only 0.5%. Although almost all patients with cholelithiasis are now considered potential candidates for a laparoscopic cholecystectomy, difficulties during cholecystectomy have been encountered in patients with acute cholecystitis. Surgeons should thus be fully prepared to convert to open surgery whenever difficulties are encountered, in order to avoid complication.     

A Rare Case of Biliobiliary Fistula

Abstract: Biliobiliary fistula is a rare clinical entity. The case of a 72 year old female, who presented with epigastric pain and jaundice, is detailed herein. Endoscopic retrograde cholangiopancreatography (ERCP) revealed two stones, one each in the common bile duct and the gallbladder. Continuous endoscopic nasobiliary drainage (ENBD) was performed to relieve obstructive jaundice. Further study with contrast medium administered via the ENBD tube revealed a fistula between the neck of the gallbladder and the common bile duct. The cystic duct was intact. A stone was considered to have migrated into the common bile duct through the fistula. A diagnosis of biliobiliary fistula, Corlette type I was made. However, in this particular case, a biliobiliary fistula was noted at a site below the junction of the cystic duct and common bile duct. Removal of the gallbladder stones was followed by cholecystectomy. The common bile duct was then repaired by utilizing a T-tube. No evidence of malignancy was recognized in the resected gallbladder specimen. In the one year to date since surgery, the patient has been asymptomatic and without signs of biliary disease.     

肝叶切除治疗肝内胆管结石临床体会

目的探讨肝叶切除治疗肝内胆管结石的方法及疗效。方法回顾性总结1992年12月至2004年12月间肝叶切除治疗112例肝内胆管结石的经验与体会。结果本组无手术死亡,术后并发症有胆漏3例(2.7%)、膈下感染5例(4.5%)、腹腔脓肿2例(1.8%)和肝衰1例(0.9%)等。本组获随访者103例,随访时间4月至13年,平均7年3月,76.7%术后症状消失,工作生活正常,17.5%偶有轻度胆管炎发作,5.8%仍反复发作严重胆道感染。结论肝叶切除术是治疗肝内胆管结石最有效的手段。     

孤立性左肝胆管结石并肝管狭窄的外科治疗

目的总结近２０年来孤立性左肝胆管结石并发左肝胆管狭窄的临床治疗体会．方法原发性肝胆管结石１０１８例，年龄２７～７２岁，其中孤立性左肝胆管结石１３３例，手术治疗１１２例，对其临床资料进行回顾性分析，包括各肝管狭窄并发率，术前各项检查确诊率，手术治疗方式，再狭窄率．结果左肝管狭窄的发生率为５９８％，左外肝管和左内肝管分别为８４０％和８４８％，均以重度狭窄为主．狭窄切开整形后高位胆肠吻合术是处理左肝管狭窄的常用手术方式（５２２％），远期再狭窄率为１７１％；左半肝切除术施实率为１９４％，再狭窄率为００％；狭窄整形术和狭窄扩张术的施实率分别为９０％和１９４％，再狭窄率分别为５００％和９２３％．左外肝管狭窄通常采用肝段或肝叶切除术（７８７％），而左内肝管狭窄的处理则通常采用非左半肝切除术（８４８％）．左内肝管狭窄的术前／后影像学确诊率明显低于左肝管和左外肝管，平均确诊率依次２５９％，９３３％和８７９％．结论二级肝管狭窄是孤立性左肝管结石的常见并发症，肝叶或肝段切除术是其首选治疗原则．过多依赖非肝叶／段切除术和不适当的肝段切除术是遗留狭窄和远期疗效差的重要原因     

Bile leak after laparoscopic cholecystectomy

Summary Laparoscopic cholecystectomy has now become the preferred surgical approach to symptomatic cholelithiasis. With the widespread use of this technique there have appeared reports of complications. We report the case of a patient who developed a cystic duct stump bile leak after laparoscopic cholecystectomy. Percutaneous drainage of the biloma, endoscopic retrograde cholangiopancreatography and papillotomy led to resolution of the problem. The literature on cystic duct stump leaks after laparoscopic cholecystectomy is reviewed and the various therapeutic modalities are outlined.     

推按运经仪治疗胆石病536例临床观察

胆石病是世界范围的胆道系统主要疾病，国内普查自然人群中，胆结石患病率为１－１０％，而且有逐年增高的趋势。以往应用传统手术疗法虽有一定疗效，但也存在不少问题。运用推按运经仪治疗胆石病５３６例，总有效率为９１．９７％。     

提高灌注溶石疗法的研究(附87例分析)

应用2%复方去氧胆酸钠、2%复方偏磷酸钠及Ⅰ号或Ⅱ号复方桔皮油乳剂等溶石剂经胆道引流管灌注治疗87例胆道残石病例。治疗前经 X 线或胆道镜确诊。残石部位:肝外胆管31例;肝内胆管37例;肝内外胆管19例。治疗中从引流瓶及大便淘洗中发现大量胆石碎片,经化学分析及电镜检查,与体外溶石试验结果一致。治疗结果:56例全溶,占64.37%;19例残石变小或变少,占21.24%;4例因肝内胆管病变中转手术,占4.86%;8例因治疗反应停止溶石,占9.20%。4例肿大的肝脾缩小,脸色由灰暗变为红润。对改善溶石治疗的有关措施进行了讨论。     

胆囊息肉样病变23例分析

我院自1969年7月至1990年7月,收治各种类型的胆道系统疾病共2018例,施行胆囊切除和胆总管切开取石以及其他各种胆道手术等共1821例,其中发现胆囊息肉样病变23例,术后经病理检查证实,其发病率占1.14%.23例胆囊息肉样病变同时并发急性胆囊炎、慢性胆囊炎、胆囊炎合并结石、胆囊出血、胆囊息肉癌变等并发症.本文着重讨论了并发症的原因,诊断方法以及如何治疗等问题.作者认为该病在胆道系统疾病中占有重要的地位,也是胆道系统中一种特殊的疾病.     

脂肪饮食与胆石症关系的调查研究

本文通过荤食组、常食组、素食组与胆石症发病率关系的调查,发现荤食组的发病率14/35(40%)比其它两组8/35(22.85%)、2/35(5.71%)更高。同时发现与病人的高血脂水平呈正相关。荤食组的胆固醇和甘油三酯水平分别为5.4±0.85和1.88±1.02,并且比常食组5.08±1.18,1.76±0.62和素食组4.88±0.41,1.67±0.36更高。结果提示:限制大量的胆固醇和脂肪饮食可降低胆石症的发病率。