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.
Objective To investigate the recurrence of intrahepatic bile duct stones and study the relations to the primary intrahepatic stones.Methods One hundred and twenty nine patients who experienced complete lithotomy were followed up for 2-10 years. Results Thirty five cases had the recurrence of intrahepatic stones at 49 sites (27.13%). The recurrent stones were found at following sites: 13 at left duct, 12 right duct , 8 left medial segment, 6 right anterior segment, 4 right posterior segment, 3 left lateral segment, 3 caudate. Nine cases were asymptomic, 16 cases had slight symptoms and 10 cases suffered from the serious attacks of stones. The time of recurrence was from 2 to 9 years (5.49±2.25 years) after surgery. The recurrent rate was 27.13% in our group. Conclusion The recurrence of intrahepatic stones also developed at several sites in the liver. The recurrence of intrahepatic stones had a tendency to develop at the primary sites. The recurrence of intrahepatic stones may be asymptomic and most patients suffered from slight attack. Liver resection is the best way to prevent the recurrence from intrahepatic stones.
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.
目的 减少肝内胆管结石术后的残留。方法 回顾性分析近5年我科收治的50例肝内胆管结石病例行病灶肝切除并结合术中、术后胆道镜应用的近期疗效及术后残石率。结果 术后近期并发症发生率为8%，无胆漏、肝衰及手术死亡发生，术后B超、逆行T管造影及术后胆道镜检查证实的即期残石率仅4%（2例）。结论 减少肝内胆管结石术后结石残留的关键是术中术后胆道镜的使用，肝内及肝门胆管狭窄的彻底处理； 依据狭窄胆管所引流区域行“根治性”的肝组织切除是取尽结石，清除病灶的合理方法。
Objective To determine whether local delivery of c-myc shRNA could inhibit hyperplasia and lithogenic potentiality in a rat model of chronic proliferative cholangitis (CPC) via specific blockade of the c-myc expression. Methods The CPC animal model (CPC group) was established via retrograde insertion of a 5-0 nylon thread into the common bile duct through Vater’s papilla. Three kinds of c-myc shRNAs were then respectively injected in c-myc shRNA group, which were included shRNA-1, shRNA-2, and shRNA-3, respectively. Negative control group and sham operation group were established for comparison. Subsequently, histopathological changes of bile duct wall were observed by HE, Massion, and PAS/AB staining; c-myc protein was detected by immunohistochemistry method; 5-bromodeoxyuridine (BrdU) protein was tested by immumofluorescence method; c-myc, Mucin 3, and Procollagen Ⅰ mRNAs were detected by real time PCR; Ki-67 protein was determined by Western blot; Activity of β-glucuronidase was measured by modified Fisherman method. Results ①Compared with the CPC and negative control groups, biliary tract mucosa epithelium (HE staining), submucosal acid mucinous gland (mid-blue staining, PAS/AB staining), and degree of over-hyperplasia of collagen fiber in bile duct wall (blue staining, Massion staining) were weaker in the c-myc shRNA group. ②The expressions of c-myc mRNA, Mucin 3 mRNA, Procollagen Ⅰ mRNA, Ki-67 protein, and β-G activity in the c-myc shRNA group were lower than those of the CPC and negative control groups (Plt;0.05), but higher than those of the sham operation group (Plt;0.05). Conclusion c-myc shRNA treatment could effectively inhibit the hyperplastic behavior and lithogenic potential of CPC, which might help to prevent the biliary restenosis and stone recurrence.
Objective To investigate feasibility and curative effect of ultrasound-guided percutaneous transhepatic cholangioscopy in treatment of complicated hepatolithiasis. Methods The data of 42 patients with complicated hepatolithiasis from June 2012 to June 2017 in the Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed. All the patients were treated with ultrasound-guided percutaneous transhepatic cholangioscopy, including the first stage of dilation and drainage and the second stage choledochoscopy. Results The operations of the 42 patients were successfully performed. No case was converted to the conventional laparotomy. The puncture sites of 10 cases were at the right intrahepatic bile duct, 25 cases were at the left intrahepatic bile duct, and 7 cases were at the bilateral intrahepatic bile duct. The residual stones were removed by two stage choledochoscopy in the 31 patients, 11 patients had the residual stones. After the first stage, there were 4 cases of the bile duct hemorrhage, 8 cases of the cholangitis, 1 case of the pleural effusion and 1 case of the infection, 2 cases of the postoperative drainage tube shedding. After the second stage, there were 3 cases of the cholangitis and 3 cases of the postoperative drainage tube shedding. The stones of the 10/31 patients with stone removal occurred and the diseases of 9/11 patients with stone residual were stable during the following-up of (18.6±7.8) months. Conclusion Ultrasound-guided percutaneous transhepatic cholangioscopy including the first stage of dilation and drainage plus the second stage choledochoscopy is safe and effective in treatment of complex intrahepatic bile duct stones, it is an effective supplement to traditional surgery.
Objective To explore risk factors and treatment strategies of liver resection surface infection following laparoscopic hepatolithiectomy for patient with complicated intrahepatic bile duct stones. Methods The clinical data of 45 patients with complicated intrahepatic bile duct stone underwent laparoscopic hepatectomy from January 2014 to April 2017 in this hospital were analyzed. The liver resection surface infection rate, pathogenic bacteria distribution, factors of operation, antibiotic use time, volume of drainage, and drainage tube placement time were analyzed. Results A total of 13 cases of liver resection surface infection occurred following the laparoscopic hepatolithiectomy in the 45 cases, the infection rate was 28.89%. Totally 24 strains of pathogens were isolated from the infected patients, including 9 strains of gram-positive bacteria and 15 strains of gram-negative bacteria. The mainly postoperative complications included 16 cases of the biliary leakage, 5 cases of the effusion and empyema, the average drainage volume was about 200 mL after the surgery. The double pipes were placed in the 10 patients in the operation. The drainage tubes were placed in the 23 patients under the ultrasound or CT intervention after the surgery, the average time of drainage tube placement was 8 d. The results of univariate analysis showed that the past biliary surgery history, combined with liver cirrhosis, double pipe drainage, operation time, and postoperative biliary leakage were associated with the liver section surface infection following the laparoscopic hepatolithiectomy (P<0.050). The results of multivariate analysis identified that the past biliary surgery history and postoperative biliary leakage were the risk factors (P<0.050), while the double pipe drainage was the protective factor (P<0.050) for liver resection surface infection following the laparoscopic hepatolithiectomy. Conclusions Prophylactic treatment such as perfect preoperative management and careful intraoperation should be taken for risk factors of liver section surface infection following laparoscopic hepatolithiectomy. Actively effective treatment strategies should be given if postoperative liver section surface infection existence.
ObjectiveTo evaluate the feasibility and effect of treatment of bile duct exploration though hepatic sections instead of spliting common bile duct, cured for hepatolithiasis with bile duct stones. MethodsClinical data of 122 cases of our hospital were retrospectively reviewed, these patients with left intrahepatic bile duct stone and common bile duct calculi. As control group, during the period from June 2007 to June 2010, in which 64 patients underwent left hepatic lobectomy, common bile duct exploration and T tube drainage. In observation group, 58 patients from June 2011 to December 2013, underwent left hepatic resection combined biliary duct exploration by the liver section stump bile duct. The operative time, intraoperative bleeding volume, postoperative hospitalization time, and incidence of complications between the 2 groups were compared. ResultsCompared with the control group, the postoperative hospitalization time was shortened obviously in observation group patients(P < 0.05), there were no significant difference in operative time and bleeding during operation of 2 groups(P > 0.05), The incidence of postoperative complications in the observation group was significantly lower than the control group(P < 0.05). In 122 patients, 105 cases were followed-up(86.1%), the follow-up time was 2 years. Two groups of patients had no stone residual and recurrence. ConclusionsBile duct exploration by intraoperative liver section is an effective method to treat left hepatolithiasis, it can simplified procedures, shortening the postoperative hospitalization time, and effectively avoid complications caused by common bile duct incision and T tubedrainage.