Twenty-eight cases of hepatocellular carcinoma(HCC)involving bile duct and causing obstructive jaudice in this hospital between 1987-1994 were studied.In this series cancerous cast formation in bile duct was found in 13 cases and cancerous thrombus in 15 cases which accounts for 5.7% of 487 HCC patients admitted to this hospital in the same period.According to the operative and pathological findings,characteristics of cancerous cast type are:①direct connection of cancerous cast with the primary tumor as a dumb bell-shped,②no adhesion between the cast and the thin wall of bile duct,③central location of the primary tumor in liver near the larger bile duct and ④HCC tissues seen in pathologic section of the cast.Characteristics of cancerous thrombus type are:①no connection between intraductal thrombus and the primary tumor,②segmental stenosis or obstruction of the bile duct,③adherence of cancerous thrombus to the thick ductal wall,④peripheral location of the primary tumor and⑤HCC cells scattered in the thrombus.
Objective To introduce the total mesorectal excision (TME)under the laparoscope and with the ultrosonic scalpel. Methods Under the laparoscope and with the ultrosonic scalpel, total mesorectal excision in 3 patients was performed. In operation, alone the parietal layer of pelvic fascia and inside the automatic nerve trunk, the mesorectum was excised with the ultrasonic scalpel. Results Three patients got final recovery, no damage to the viscera in operation occurred. Average hemorrhage amount was about 100ml. Intestinal function recovered within 24 hours, average in hospital time was 10.3 days. After 4 months, 3 patients got good living quality without recurrence and metastasis.Conclusion TME under the laparoscope is a new progress of less damageable operation. Compared with the traditional open laparotomy,it has some advantage. But it requires high technology and expensive equipments, and the case is still very limited in use.
目的 观察内镜治疗急性胆源性胰腺炎（ABP）的疗效及其并发症。方法 30例ABP患者在抗炎、抑酶等综合治疗基础上，经内镜（1～3 d 内）逆行胰胆管造影（ERCP）及经内镜十二指肠乳头括约肌切开（EST）或鼻胆管引流（ENBD）等治疗。结果 内镜治疗后22 例（73.3%）轻症急性胆源性胰腺炎（MABP）患者3～5 d 体温恢复正常； 8例（26.7%） 重症急性胆源性胰腺炎（SABP）患者3～8 d 腹部体征好转，血常规、淀粉酶及血生化1~2周内基本恢复，平均住院18.7 d，3例死亡（10.0%）。内镜治疗过程中5例出现十二指肠乳头括约肌切口少量出血，经简单治疗止血，未再出现其他并发症。与同期开腹手术治疗相比较，症状体征缓解、血常规、淀粉酶、血生化恢复正常及住院的时间更短，死亡率无明显差异。结论 ABP早期ERCP 及内镜治疗安全有效。
Objective To investigate the method of the treatment on cholecystolithiasis combined with calculus of common bile duct (CBD) by laparoscopy with combination of choledochoscope and duodenoscope and its significances. Methods Forty-two patients with cholecystolithiasis combined with calculus of CBD were treated by laparoscopy with combination of choledochoscope and duodenoscope from Jan. 2007 to Dec. 2008 in this hospital. Under general anesthesia, laparoscopic cholecystectomy was performed first, then the anterior wall of CBD was opened, calculus of CBD was treated by choledochoscope and duodenoscope intraoperatively. Then primary suture of the CBD was performed under laparoscope and nasobiliary drainage duct was placed. Results One case was converted to laparotomy, 41 cases succeeded and left hospital after being taken off the nasobiliary drainage duct in 5-7 d. No case died, no bile leakage, no bleeding or perforation of upper digestive tract, and no acute pancreatitis happened after operation. Conclusion Laparoscopy with combination of choledochoscope and duodenoscope treating cholecystolithiasis combined with calculus of CBD is a safe, effective and quickly recovering method with less sufferings and trauma.
Objective To evaluate the efficacy of multiple minimally invasive therapy and individualized treatments combination in severe acute pancreatitis. Methods The data of sixty-seven patients with severe acute pancreatitis between September 1998 and October 2008 undergoing multiple minimally invasive therapy and individualized treatments were analyzed retrospectively. The changes of APACHE Ⅱ score, CT score, WBC count, total bilirubin, AST, blood glucose, amylase, lypase, C-reactive protein, tumor necrosis factor-α, blood urea nitrogen, creatinine, and oxygenation index (PaO2/FiO2) were observed and compared between before and after treatment. Time of abdominal pain relieved, laparotomy rate, mortality rate, recovery rate, hospital stay, and cost of hospitalization were also observed. Results All the detected indexes improved significantly after treatments compared with those before treatments （Plt;0.001）. Time of abdominal pain relieved was (20.17±14.16) h. Laparotomy rate was 6.0% （4/67）. Mortality rate was 7.5% （5/67）. Recovery rate was 92.5% （62/67）. Hospital stay was (30.85±28.37) d and cost of hospitalization was (59 295.78±34 564.44) yuan. Conclusions Multiple minimally invasive therapy and individualized treatments for cases of severe acute pancreatitis with different causes, course, severity of disease, and complications, could significantly improve the clinical indexes and recovery rate of severe acute pancreatitis.
Objective To explore the value of CT guided percutaneous puncture, aspiration and drainage on diagnosis and treatment of local complications of severe acute pancreatitis (SAP). Methods Forty-three cases of SAP combined with pancreatic necrosis, peripancreatic hydrops, pseudocyst and abscess were analyzed, all of them underwent CT guided percutaneous puncture, aspiration and drainage. Results The punctures were performed on 43 SAP patients for sixty-four times, the success rate was 100%, and in 24 cases of them puncture were performed for diagnosis, the positive rate of fluid absorption by puncture was 100%. Forty-one of 43 cases (95%) received puncture and tube drainage, open operation was performed in one patient, one patient was automatically discharged. The remission rate of abdominal distension was 93% (40/43) and 16 of 43 cases (37%) were turned to open operation. The effective rate of drainage was 61% (25/41). Conclusion The puncture, aspiration and drainage guided by CT is an effective method in diagnosis and treatment of local complications in part of SAP cases.
Objective To evaluate the efficacy and mechanism of early repeated intermittent veno-venous hemofiltration (RIVVH) in treatment of severe acute pancreatitis (SAP). Methods Sixty-five patients were randomly divided into RIVVH group (35 cases) and control group (30 cases). Symptoms, physical signs, serum concentration of BUN, Cr, AST, ALT, AMS were observed and compared between two groups. The changes of C-reactive protein (CRP) and result of bacteria culture, APACHEⅡ grades and Balthazar CT grades, open-belly surgery rate, complications, mortality rate, average hospital stay and costs were compared between these two groups. Results Two patients died of multiple organ failure in the RIVVH group, with 5.7% mortality rate, which was significantly lower than that in the control group (26.7%, 8/30), P＜0.05. Twenty-four hours after treatment, symptoms and signs were alleviated more in RIVVH group; blood biochemical indicator, oxygenation index and CRP level improved significantly in RIVVH group compared with those in control group （P＜0.05，P＜0.01）. Balthazar CT grades and APACHEⅡ grades decreased significantly after treatment in patients of RIVVH group （P=0.002, P＜0.001）. The hospital stay, costs, open-belly surgery rate, complications rate and infection rate were also significantly lower in RIVVH group comparing with those in control group （P＜0.05, P＜0.001）. Conclusion RIVVH can decrease the mortality rate of SAP with high recovery rate, less cost and shorter hospital stay.
ObjectiveTo evaluate the therapic efficacy for severe acute pancreatitis (SAP) during different periods. MethodsAccording to internalized standard, 234 patients with SAP admitted to this hospital from January 1986 to October 2009 were included, which were divided into two stages based on the time of admitting to this hospital. The first stage named prior operation group was from January 1986 to August 1998 (n=117), the second stage named individual treatment group was from September 1998 to October 2009 (n=117). There was comparability in demography and clinic between two groups. The prior operation group primarily underwent laparotomy and medication, and the individual treatment group underwent multiple combined therapies. These indexes were compared between two groups: hospital stay, cure rate, and mortality; the incidences of pancreatic pseudocyst, pancreatic and peripancreatic abscess, pancreatic encephalopathy, cardiac insufficiency, acute renal failure (ARF), acute respiratory distress syndrome (ARDS), and shock. The efficacies for early treatment, ascites, biliary pancreatitis, and pancreatic and peripancreatic complications were compared two groups by stratified analysis. ResultsCompared with the prior operation group, the hospital stay was shorter (Plt;0.05), cure rate was higher (Plt;0.001), and mortality was lower in the individual treatment group (Plt;0.001). During the treatments, the incidences of pancreatic pseudocyst, pancreatic and peripancreatic abscess, pancreatic encephalopathy, cardiac insufficiency, ARF, ARDS, and shock in the individual treatment group were lower than those in the prior operation group (Plt;0.05). According to the stratified analysis, the efficacies for early treatment, ascites, biliary pancreatitis, and pancreatic and peripancreatic complications in the individual treatment group were better than those in the prior operation group (Plt;0.001). ConclusionIn recent years, the change of therapeutic mode significantly improves the treatment efficacy for SAP.