ObjectiveTo summarize the research progress of tissue-engineered bile duct in recent years. MethodsThe related literatures about the tissue-engineered bile duct were reviewed. ResultsIn recent years, the research of tissue-engineered bile duct has made a breakthrough in scaffold materials, seed cells, growth factors etc. However, the tissue-engineered bile duct is still in the research stage of animal experiments, which can not be directly applied to clinical practice. ConclusionsThe research of tissue-engineered bile duct becomes popular at present. With the rapid development of materials science and cell biology, the basic research and clinical application of tissue-engineered duct will be more in-depth research and extension, which might bring new ideas and therapeutic measures for patients with biliary defect or stenosis.
目的 探讨胆源性肝脓肿的诊治方法。方法 对我院2000~2004年期间收治并确诊为胆源性肝脓肿的12例患者进行分析，在应用抗生素和全身支持的前提下，再依据其病变发生、发展的不同阶段采用不同手段治疗。结果 4例急性期患者中2例行急诊胆道引流手术后治愈，另2例转为亚急性期（脓肿融合期）； 6例亚急性期患者均经B超导向下行脓肿穿刺抽脓后注入抗生素治疗后治愈； 4例慢性期患者行脓肿切开引流后治愈。结论 本病在应用广谱抗生素（二联抗生素）和全身支持治疗的前提下，再根据病变不同时期采用不同方法治疗，可获得良好效果。
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.
【Abstract】Objective To analysis the clinical characteristics, pathogenesis, diagnosis and treatment of acute acalculous cholecystitis.Methods Seventy-nine cases of acute acalculous cholecystitis from January 1996 to January 2003 were retrospectively reviewed.Results Of those 79 cases, 13 cases were treated nonoperatively and 66 cases were treated operatively. Twentythree cases were suppurative, 43 cases were gangrenous with perforation in 18 cases，which were proved by postoperative pathology. Seventysix cases were cured and 3 cases were dead. Conclusion Keeping vigilant alert, observing dynamically as well as appropriate operative intervention are effective to improve the prognosis of acute acalculous cholecystitis.
Objective To study the clinical diagnosis and treatment of juxtapapillary duodenal diverticula with biliary deseases.Methods Eighteen duodenal diverticulum treated in our department in recent 5 years were retrospectivly analyzed, especially investigated the postcholecystectomy cases whose symptoms were continuing existence after operatoins. Articles about the surgical treatment were reviewed. Results The total of 18 duodenal diverticulum with 17 cases of juxtapapillary duodenal diverticulum were included in this study. The ages of 12 cases were over 50 years old. Sixteen cases(88.89%) presented biliary stones. Seven cases once had performed cholecystectomy or cholecystectomy plus choledochotomy,but symptoms persisted after operations. The duodenal diverticulum were found by endoscopic retrograde cholangiopancreatography (ERCP) and hypotonic duodenography. Sixteen patients underwent surgical treatment with good effect. Conclusion The juxtapapillary duodenal diveticula has the close relationship with biliary stones. ERCP and hypotonic duodenogrphy are the most reliable methods to get the correct diagnosis. In case of recurrent common bile duct stones after operations or persisting billiary symptoms after cholecystectomy, the coexistence of juxtapapillary duodenal diverticulum should be ruled out. The surgical treatment is only considered for the duodenal diverticulum with complication.
ObjectiveTo explore the clinicopathological characteristics of combined hepatocellular and cholangiocarcinoma (cHCC-CC), and the prognostic factors associated with survival. MethodesThe clinical features of 31 patients with cHCC-CC from 1995 to 2010 in West China Hospital of Sichuan University underwent liver resection were analyzed retrospectively. The prognostic factors were analyzed by using univariate and multivariate analysis. ResultsOf these 31 patients, 25 men and 6 women, with a median age of 58 years, underwent liver resection for cHCC-CC. Twentythree cases (74.2%) showed positive of hepatitis B surface antigen (HBsAg), 13 cases (41.9%) had elevated AFP≥20μg/L, 18 cases (58.1%) with liver cirrhosis, 8 cases (25.8%) showed presence of lymph node metastases. The 1-, 3-, and 5-year overall survival rates of these patients were 61.3%, 32.3%, and 12.9%, respectively. Univariate analysis showed that invasion of portal vein, microscopic tumor thrombi, positive resection margins, and lymph node involvement were significant prognostic factors. Multiple analysis revealed the positive resection margins and lymph node involvement were independent prognostic factors for overall survival. ConclusionsThe prognosis of patients with cHCC-CC is poor. R0 resection is the only available treatment in curing these patients.