A side-to-end choledochoduodenostomy between the common bile duct and the stump of the transected duodenum

A technique for treating patients with benign pyloric stenosis and associated choledocholithiasis upon a dilated common bile duct is described. The procedure consists in the performance of a Billroth II partial gastrectomy with the Hofmeinster-Finsterer modification and truncal vagotomy and a simultaneous side-to-end choledochoduodenostomy between the common bile duct and the duodenal stump. We have operated two cases in this way up to now without complications and with good postoperative results.     

Roux-en-y hepatojejunostomy in benign pathology of the common duct

Personal experience is reported of 59 hepaticojejunostomies performed on an excluded Roux loop in the treatment of benign pathologies of the main bile duct. The advantages and disadvantages of this approach are discussed. Several particular cases are described as is the surgical technique adopted. Complications arising in 5 patients included 3 duodenal ulcers, one of them bleeding and 2 cases of anastomotic stenosis. In all other cases the operation was satisfactory. Follow-up involved echographic and cholescintigraphic examinations. It is concluded that Roux en Y hepaticojejunostomy is the treatment of choice in benign pathologies of the main bile duct when transduodenal papillostomy is contraindicated.     

Palliation of malignant obstruction of the common bile duct by side to side choledochoduodenostomy

A series of forty-eight patients in whom choledochoduodenostomy was performed to relieve malignant obstruction of the common bile duct is reported. A side to side choledochoduodenostomy was performed in forty-six patients, and an end to side in only two in whom it was technically preferable. The operation uniformly cleared the jaundice rapidly, and although the immediate morbidity was high, only 15 per cent of the complications were related to the biliary-duodenal anastomosis. There were no late instances of ascending cholangitis in forty-three survivors of the operation whose progress was followed until they died of the primary disease. The various alternatives to side to side choledochoduodenostomy all appear to be inferior to this operation, for various reasons, and the theoretic objections to its use are refuted by our results.     

Choledochoduodenostomy in choledocholithiasis and benign strictures of the common bile duct

The methods of external and of internal drainages of the bile ducts are alternatives in choledocholithiasis and benign strictures of the choledochus. In the Central Research Institute of Gastroenterology, 349 operations were performed on the common bile duct, stones were found in the choledochus in 259 (74.2%) cases and benign strictures of the terminal part of the choledochus and the major duodenal papilla in 103 (29.5%) cases. Ninety-five operations were secondary or reconstructive in character. A precise diagnosis of affection of the biliary tract can be established only during an operation or by retrograde cholangiopancreatography. External drainage of the common bile duct was conducted in 229 (65.6%) cases. Choledochoduodenostomy was undertaken in 105 patients (55 were operated on for the first time and 50 underwent operation on the biliary tract for a second time). Endoscopic papillosphincterotomy was successful in 28 cases with short strictures of the choledochus and choledocholithiasis. The stones were removed from the ducts with instruments or were expelled spontaneously at days 2 to 5.     

腹腔镜胆总管探查、一期缝合的应用研究

目的研究腹腔镜胆总管探查、一期缝合的可行性与适应证。方法回顾性分析1998年5月-2004年5月我院行腹腔镜胆总管探查、切开、胆道镜取石、一期缝合治疗胆总管结石146例的临床资料。结果146例在腹腔镜下行胆总管探查、一期缝合，成功127例，置T管引流12例，中转开腹7例。手术时间90-210min，平均125min。术后住院时间5-14d，平均7d。腹腔引流管留置3-13d，平均6d。术后胆漏18例，引流胆汁量5-300ml／d，平均25ml／d，持续1-12d．均保守治愈。无胆道出血及腹腔感染，无手术死亡。115例随访0．5-6年，平均1．5年，胆总管残石3例，再发结石2例，经内镜下十二指肠乳头切开术（endoscopic sphincterotomy，EST）取石治愈。B超检查无胆管狭窄。结论腹腔镜胆总管探查、一期缝合安全可行，尤其适用于继发结石的治疗，结石单发或〈10枚，直径≤1．0cm，肝内、外胆管无狭窄、占位，下端通畅无须引流。     

A prospective single-blinded controlled study comparing laparoscopic ultrasound of the common bile duct with operative cholangiography

Background: Ultrasound examination of the bile duct during cholecystectomy compares well with operative cholangiography. Studies so for have not been blinded, nor has the stone content been validated immediately. We have, therefore, carried out a blinded comparison of laparoscopic ultrasound with fluoroscopic operative cholangiography. Methods: This study included 135 patients (average age, 53 years) undergoing laparoscopic cholecystectomy with or without bile duct exploration. Laparoscopic ultrasound examination was performed by an experienced surgeon blinded to the patient's clinical condition. This was followed by an operative cholangiogram. Bile ducts were explored if stones were seen, and the patients were followed up. Results: Laparoscopic ultrasound identified the bile ducts satisfactorily in 131 cases and operative cholangiography in 121 cases. Duct stones were present in 49 cases. They were correctly identified by ultrasound in 47 cases and by cholangiography in 42 cases. There was one false positive cholangiographic examination. The sensitivity was 96% for ultrasound and 86% for cholangiography. The specificities were 100% and 99%, respectively. Conclusion: Laparoscopic ultrasound examination of the bile duct is superior to operative cholangiography and could replace it.     

经胆囊管腹腔镜胆道探查术治疗胆总管结石的临床研究

目的:比较分析腹腔镜下经胆囊管和经胆总管切开T管引流两种方法胆道镜取石治疗胆囊结石继发胆总管结石的疗效,以评价经胆囊管腹腔镜胆道探查术治疗胆总管结石的临床价值。方法:2001年3月至2003年3月按胆道探查途径不同将28例胆石症患者分为胆囊管组(n=8)和胆总管切开组(n=20)。患者经B超和术中胆道造影或加内窥镜逆行胆管造影(ERC)确诊。观察两组病例的术后肛门排气时间、腹腔引流时间、术后住院日、住院费用及手术并发症的发生情况,术后对患者进行全程跟踪随访。结果:胆总管切开组肛门排气时间、腹腔引流时间、术后住院日、住院费用明显长于或高于胆囊管组(P>0.05)。胆囊管组发生手术并发症1例(12.5%);胆总管切开组5例(25.0%),其中胆道并发症4例(20.0%),需要再次微创处理2例(10.0%),需再次手术治疗的严重并发症2例(10.0%);手术并发症发生率胆总管切开组明显高于胆囊管组(P<0.05)。随访两组患者均无胆管狭窄、急性胆管炎及急性胰腺炎发生和结石复发。结论:经胆囊管途径的腹腔镜胆道探查术充分体现了微创外科技术的优点,适于胆囊结石继发胆总管结石患者,其疗效优于胆总管切开T管引流途径的腹腔镜胆道探查术。     

腹腔镜胆总管探查一期缝合术的临床研究

目的:探讨腹腔镜胆总管探查一期缝合术的可行性及临床应用价值。方法:2008年7月至2013年7月为137例患者行腹腔镜胆总管探查术,其中胆总管一期缝合67例(一期组),留置T管引流70例(T管组),对比两种术式的疗效。结果:一期组与T管组手术时间[(79±10)min vs.(92±12)min]、术后住院时间[(4.9±1.0)d vs.(7.1±1.4)d]、胆漏发生率(7 vs.1)差异有统计学意义(P<0.05)。两组术后无其他严重并发症发生及手术死亡病例。术后随访1年,B超、CT检查均未发现胆漏、胆管狭窄及结石复发。结论:腹腔镜胆总管探查术后选择性行胆总管一期缝合,避免了T管留置引起的一系列弊端,是安全、可行、有效的,值得推广应用。其主要风险为胆漏,但胆漏多为短期漏,通过引流可自愈。     

继发性胆总管结石两种开腹胆道探查手术方式的临床研究

目的 比较治疗继发性胆总管结石的两种开腹胆道探查手术方式(术中胆道镜经胆囊颈管胆总管探查术与传统胆道切开探查T管引流术)的临床效果.方法 符合入组标准病例113例,传统术式58例,经胆囊颈管胆道探查55例.对手术成功率、手术时间、术后并发症、住院时间、住院费用等指标行对照研究.结果 两组均成功完成手术且无严重术后并发症,手术时间经胆囊管胆道探查术组与传统手术组无显著差异,平均住院时间及住院费用经胆囊管胆道探查组显著低于传统手术组.结论 对于继发性胆总管结石,经胆囊颈管途径胆道探查较传统方式有较明显优势,应作为胆道探查的首选途径.     

胆总管一期缝合术与T型管引流术治疗胆总管结石的对比研究

目的 总结胆总管探查术后一期缝合术与T管引流术治疗胆总管结石的经验,探讨其各自适应证以及评价其临床疗效.方法 将2008年6月至2012年1月入住昆明医学院第一附属医院器官移植中心253例肝外胆管结石患者随机分为一期缝合组和T管引流组,通过独立样本的t检验比较患者手术并发症及术后恢复情况.结果 所有患者手术均成功,一期缝合组2例出现手术并发症,术后有少量胆漏,经腹腔引流管充分引流后治愈.T管引流组5例出现手术并发症,其中4例术后少量胆漏,经充分引流后自愈,1例出现逆行胆道感染,给予胆道冲洗、抗感染治疗后痊愈.两组的胆漏引流液均为胆汁样,每天约5～10 ml,经充分引流后于3～4d自行消失,均未出现发热、黄疸等症状,也未出现胰腺炎等严重并发症.两组患者术后胆道并发症发生率(P=0.802)、手术时间(P =0.137)、术中出血量(P=0.069)差异均无统计学意义;一期缝合组术后排气时间(P =0.037)、术后补液量(P=0.008)、术后住院时间(P=0.015)均低于T管引流组,两组差异有统计学意义.结论 胆总管探查术后一期缝合是安全有效可行的手术方式,一期缝合减黄效果与放置T管引流效果相同或相近.     

Incidence of bile infection in biliary lithiasis. Effects on postoperative bacteremia of choledochoduodenostomy, T-tube drainage, and primary closure of the common bile duct after choledochotomy--a prospective clinical trial

To assess the incidence of bile infection in patients undergoing elective biliary surgery for chronic calculous biliary disease, the authors present 737 patients with cholelithiasis or cholelithiasis choledocholithiasis in this paper. The incidence of bile infection in patients operated on electively is considerable and is associated with a significant mortality and morbidity. A relation exists between the incidence of postoperative bile infection and the supplementary procedure carried out after choledochotomy. We observed that 70 per cent of those patients with initially sterile bile became infected during the postoperative period of exogenous contamination through the T-tube. T-tube drainage should be used carefully and should be avoided in patients in whom either a primary common bile duct closure or an internal drainage can be performed.