目的 探讨胰管结石慢性胰腺炎的诊断和治疗。方法 收集我院1993年3月至2003年9月经手术治疗的胰管结石慢性胰腺炎患者34例的临床资料并进行回顾性分析。结果 全组病例均经B超和CT检查确诊，均经手术治疗。手术方式： 胰十二指肠切除术5例； 胰管切开取石、胰空肠Roux-Y吻合术27例，其中同时行胆囊切除术6例，Oddi扩约肌切开、T管引流术4例，胆肠Roux-Y吻合术2例； 胃空肠、胆肠吻合加活检术2例。治愈31例，缓解2例，死亡1例。结论 影像学检查是诊断本病的重要手段，准确率高。根据合并症和胰管扩张程度选择合适的手术方式，可取得良好治疗效果。
目的 探讨胆道再次手术的原因和对策。 方法 对1997年12月至2003年12月206例胆道再次手术的原因和术式进行回顾性分析。结果 172例（83.5%）因结石复发和（或）残留主要行胆总管切开取石术、肝叶切除术、胆总管空肠Roux-Y吻合术及胆道镜取石术； 9例（4.4%）胆道恶性肿瘤主要行根治性切除术、内外引流术； 5例（2.4%)胆管损伤及3例（1.5%）十二指肠损伤主要行胆总管断端吻合术、T管引流术、胆肠吻合术、十二指肠修补及造瘘术； 17例（8.3%）因其他原因再手术者主要行胆总管囊肿切除+胆肠吻合术、腹腔引流术、腹腔探查、止血术等。结论 ①胆道再手术主要原因是残留结石和（或）复发； ②为降低胆道再手术率，应强调术前诊断明确、选择正确术式和审慎操作。
目的 总结糖尿病患者胆道疾病围手术期处理体会。方法 对40例合并糖尿病的胆道疾病患者的血糖进行回顾性分析。结果 本组中行急诊手术23例，择期手术17例，治愈38例，死于败血症2例； 其中14例糖尿病患者在术前未被确诊，占35%。血糖控制在5.5～8.9 mmol/L,尿糖为（-）～（+）及尿酮体阴性，是手术的最佳时机。结论 控制血糖和感染是糖尿病患者胆道围手术期处理的关键。
Platelet aggregation test (PAgT), platelet adhesion test (PAdT), thromboplastic activity of factor Ⅷ (FⅧ∶c), antithrombin Ⅲ activity (AT-Ⅲ∶a), antithrombin Ⅲ antigen (AT-Ⅲ∶Ag), von willebrand factor (vWF) and fibrinogen (Fg) were measured in 33 patients with biliary tract diseases and 24 normal individuals. The results showed that there was no significant difference in PAgT, PAdT, AT-Ⅲ∶a and AT-Ⅲ∶Ag between the two groups (Ｐ＞0.05). Fg increased more significantly in biliary tract disease than in the controls (Ｐ＜0.01). FⅧ∶c increased more significantly in patients with obstructive jaundice than in that of nonjaundiced and the controls (Ｐ＜0.01). The levels of vWF increased higher and higher in the sequence of patients with no jaundice, obstructive jaundice due to benign diseases and obstructive jaundice due to malignancy(Ｐ＜0.01). In conclusion, Fg, FⅧ∶c and vWF increased in patients with biliary tract disease.
Objective To investigate the clinical significance of routine application of choledochoscope during operation of biliary duct. Methods The clinical data of 136 patients with the routine application of intraoperative choledochoscope dealing with bile duct diseases in this hospital from October 2003 to July 2009 were analyzed and summarized. Results Intraoperative choledochoscope inspection, taking stones and targeted surgery were performed in 116 cases with extrahepatic and (or) intrahepatic bile duct stones. The taking out rate of extrahepatic bile duct stones was 100% (85/85), the residual stone rates of extrahepatic and intrahepatic bile duct were 0 (0/85) and 22.6% (7/31), respectively, with the total residual stone rate was 6.0% (7/116). By using intraoperative choledochoscope, benign intrahepatic bile duct stricture was found in 13 cases, malignant extrahepatic and intrahepatic bile duct stricture in 8 cases. Four cases of hilar cholangiocarcinoma and 4 cases of common bile duct cancer, 2 cases of lower segment of common bile duct polyp, 3 cases of hepatolithiasis with the left hepatic bile duct carcinoma were diagnosed by biopsy via choledochoscope. Causes were confirmed by applying choledochoscope in 16 patients with obstructive jaundice. The use of choledochoscope with surgical treatment enabled benign and malignant bile duct stricture to achieve good results, without serious complications such as bile duct dilaceration, subphrenic abscess or acute cholangitis. Conclusions Using choledochoscope can tremendously reduce the residual rate of stone in biliary duct surgery, increase the definite diagnosis rate of biliary duct diseases and play a role of reasonable instruction in its treatment options. It has unique advantages in identifying causes of jaundice. It is remarkable that the role of applying choledochoscope to diagnose and cure biliary duct diseases. It should be widely used.
目的 总结高龄胆道疾病患者的治疗经验。方法 对近2年来我科收治的60岁以上因胆道疾病入院的急、择期手术患者的临床资料进行了回顾性分析。结果 本组235例中行急诊手术78例(33.2%)，择期手术167例(71.1%)； 合并各种内科疾病者147例，占62.6%，其中以心血管疾病最多，71例(48.3%)，其次为呼吸系统疾病，54例(36.7%)； 术后并发症发生率为23.0%(54/235)，在并发症中以肺部感染发生率最高，占42.6%(23/54)，其次为泌尿道感染，占33.3%(18/54)，再其次为切口感染，占29.6%(16/54)； 全组术后近期死亡7例，占3.0%，其中死于肝、肾功能衰竭4例，呼吸衰竭2例，心衰1例。结论 高龄胆道疾病患者合并疾病多，手术风险性增加，术后并发症发生率较高，因此应加强围手术期的监护与处理，确保患者平安度过手术期。