[PATHOLOGY OF THE TERMINAL COMMON BILE DUCT].
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Objective: To explore the operative techniques and decrease the complications in laparoscopic cholecystectomy (LC). Methods: 120 clinical data of patients who received LC in our hospital from January 2010 to January 2011 were analyzed with retrospective method, observed the operations process and complications. Results: 2 cases of 120 operations was convered to laparotomy, all patients had no bile duct injury, postoperative bleeding, bile leakage, wound infection, intestinal obstruction, abdominal cavity infection and other complications. Conclusion: LC is safe, reasonable selecting to operative indication and convererion to laparotomy in time can decrease complications.
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Objective To study the diagnosis and treatment of iatrogenic bile duct injury(IBDI).Methods The clinical data of 92 patients with IBDI who had been admitted to our hospital from January 1994 to December 2007 were retrospectively analyzed.Results The diagnosis of IBDI was based on the clinical findings,diagnostic abdominocentesis and imaging examination.Sixteen patients gave up treatment because of economic reasons,and 2 patients who were complicated with sepsis and multiple organ dysfunction syndrome died shortly after being transferred to our hospital.Forty-eight patients were treated by Roux-en-Y choledochojejunostomy,14 by endoscopic treatment.2 by bile duet repair+T tube drainage,3 by percutaneous catheter drainage,1 by choledochoduodenostomy,4 by percutaneous transhepatic cholangiodrainage,and 2 by ultrasound guided percutaneous puncture drainage.Sixty-two patients were followed up for 4 month to 10 years(mean,3.6 years),and satisfactory results were obtained.Conclusions Detection of IBDI during operation and prompt repair yield favorable outcome.Roux-en-Y choledochojejunostomy is the best choice for bile duct injury complicated with biliary stricture.Endoscopic and interventional treatments are important auxiliary measures in the treatment of bile duct injury.
Key words:
cholecystectomy; Iatrogenic injury; Bile duct injut
Iatrogenic injury
Bile Duct Diseases
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Objective To analyze the treatment method of acute cholecystitis with cervical obstruction by stone with laparoscope.Methods 29 cases of such patient were underwent laparoscopic cholecystomy.Results 29 cases were anastomosed end to end of bile duct Except 1 case suffered bile duct injury.the othercases.had satisfied curative effect.Conclusion There might possible to treat such patient with laparoscopic cholecystomy.The key point is well-trained technique and proper method.
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Objective To analyze the causes of complications in laparoscopic cholecystectomy(LC)and explore the prevention and treatment of these complications.Methods In 382 patients underwent LC from January 2006 to June 2013,15 cases had complications,whose data were retrospectively analyzed.Results Among these cases,there were 5 cases with bile duct injury(33.3%),3 cases with bile leakage(20.0%),3 cases with bleeding(20.0%),2 cases with digestive duct injury(13.3%),1 cases with remnant common bile duct calculi(6.7%),and 1 cases with deep venous thrombosis after operation(6.7%).Conclusion Operation must be performed with strict indications.It is critical to do the preparation well before operation.Surgeons must be familiar with regional anatomy and the cause of complications in LC.Besides,timely conversion to open cholecysteetomy is an important way to reduce complications in LC.
Iatrogenic injury
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Objective To explore the using skills and its safety of electrocautery in Laparoscopic Cholecystectomy,and investigate it's clinical application value.Methods 2512 cases information of LC from 1996 to 2010 in our hospital was retrospective analyzed and concluded.Results Among 2512 cases of LC patients,2471 cases of patients were successfully operated on Laparoscopic cholecystectomy,accounted for 98.4%,only 41 patients were converted to open surgery.Conversive rate was 1.6%.Biliary leakage happened in 3 cases and was cured with indwelling abdominal drainage.There was no phenomenon of postoperative hemorrhage and bile duct stricture.Surgery time lasted 21 to 125 minutes,the average was 42.8 minutes.1923 patients of LC after a follow-up 6 months to 3 years(the remaining cases due to contact difficulties did not undergo follow-up),no postoperative bile duct stricture,sclerosing cholangitis and long-term liver dysfunction and other complications occurred,postoperative recovery,treatment and the cosmetic results was satisfactory.Conclusion Master the use of electrocautery in laparoscopic cholecystectomy was not only safe and effective,but inexpensive,which was worth to promote in primary hospitals.
Open cholecystectomy
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Objective To investigate the cause,clinic character,treatment and experiences for dealing with the reoperation for biliary duct.Methods The clinical data obtained from 46 patients undergoing reoperation for bile duct diseases in our hospital from January 2003 to December 2012 were investigated retrospectively.Results The operating time was 2.1-6.0 h(mean 4.2 ± 2.2 h).Six cases had blood transfusion during the operation,and the blood volume was 200-800 ml(mean 500 ± 100 ml).The hospital delay was 12-38 days(mean 21.0-5.0 days).There was no death during perioperative period and no serious complications.Conclusion The main cause of biliary duct reoperation after biliary duct multiple operations was bile duct stricture.For those complicated cases,preoperative evaluation of patient's condition was accurately done by imaging examination,optimal choice of surgical procedures,excellent surgical skills and meticulous perioperative period management were keys to a successful operation.
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