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Objective To explore the feasibility and safety of laparoscopic transcystic common bile duct stone extraction and cholecystectomy in pregnant patients with choledocholithiasis.Methods A retrospective analysis of 4 pregnant patients with choledocholithiasis was performed.The clinicoradiologic,perioperative and follow up data were analyzed.Results The 4 patients were admitted for acute cholangitis at their second trimester of pregnancy.Preoperative MRCP demonstrated that the diameter of the common bile duct stone was less than that of the cystic duct.Laparoscopic transcystic common bile duct stone extraction and cholecystectomy were successfully conducted.Plasma shock wave lithotripsy was applied in one patient with impacted gallstone,intraoperative cholangiography was conducted in one patient with suspected residual stone.There was not major post-op complications nor stone recurrence in the follow up postoperatively.They all delivered a healthy baby on the expected date of childbirth.Conclusions Simutaneously laparoscopic transcystic common bile duct stone extraction and cholecystectomy in pregnant patients with choledocholithiasis is feasible and safe.
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Objective@#To explore the feasibility of laparoscopic treatment for incidental gallbladder cancer(IGBCA) and analyze the factors influencing prognosis.@*Methods@#A retrospective study of 71 patients with IGBCA received laparoscopic treatment at Department of General Surgery, Peking University Third Hospital from January 2007 to December 2016 was conducted,the clinicopathological data and prognosis were analyzed. There were 18 males and 53 females,aged 23 to 81 years. They were divided into two groups based on the presence of intraluminal mass in the gallbladder. Sixty-five of the 71 patients received laparoscopic radical resection, the prognosis of them were compared with 14 patients with open radical resection.@*Results@#Among the 71 patients,65 patients received radical resection,3 patients simple gallbaldder resection and 3 patients palliative resection. Postoperative complications occurred in 6 patients. IGBCA were detected by frozen section in 57 patients,with the accuracy of 96.5%,while the accuracy of T stage is 43.8% in the 48 patients received T stage evaluation during frozen section examination. The T stages based on final pathology were Tis(n=6),T1a(n=5),T1b(n=10),T2(n=46),and T3(n=4).The number of harvested lymph node was 4.7±2.9(range:2-12).There are 14 patients with lymph node metastasis. The 50 patients with intraluminal gallbladder mass include 21 patients with ≤T1b stage and 29 patients with ≥T2 stage, while the 21 patients without intraluminal gallbladder mass are all with ≥T2 stage. The median survival time of the 71 patients was 33 months, with the 5-year cumulative survival rate 67.3%. The 5-year cumulative survival rate is 78.5% for the 65 patients who received radical resection,comparable with those who received open radical resection(P=0.485).Univariate analysis demonstrated that T stage, lymph node metastasis, G grade, lymphovascular invasion, neural invasion, acute cholecystectomy, bile spillage, gallbladder mass and preoperative CA19-9/CEA were the most important prognostic factors(P<0.05).@*Conclusions@#Laparoscopic treatment for IGBCA is feasible, especially for those with intraluminal gallbladder mass. The accuracy of frozen section examination in evaluating T stage is low.
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Objective To evaluate laparoscopic radical cholecystectomy for T2 gallbladder cancers.Methods A retrospective analysis was made on 44 patients with pathology confirmed T2 gallbladder cancer undergoing laparoscopic vs open radical cholecystectomy.The clinicopathological and follow-up data were compared.Results Laparoscopic cholecystectomy was performed in 32 patients,the implantation metastasis rate of this approach has no statistical differences compared with the open cholecystectomy (P =1.000).26 patients underwent laparoscopic radical resection and the remaining 18 patients underwent open radical resection.There was no statistical difference in operation time (P =0.953),blood loss (P =0.193)and postoperative complications (P =1.000),but the laparoscopic radical resection group is superior to the open group on postoperative pain grading (P =0.022),ambulation time (P =0.000),nothing per mouth time (P =0.000) and length of hospital stay (P =0.048).The mean number of lymph nodes retrieved was 5 ±4 (range 1-12) in the laparoscopic radical group and 6 ± 3 (range 1-12) in the open group (P =0.983);the 1,3,5 year survival rates was 92.3％,70.3％,61.5％ and 92.3％,76.3％,69.3％,respectively(P =0.473).Conclusions Initial laparoscopic cholecystectomy does not increase the rate of seeding metastasis in the context of intact gallbladder carcinoma.Totall laparoscopic radical resection is feasible in selected T2 gallbladder cancer patients.
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[Summary] The controversy remains on whether the Oddi sphincter function should be preserved or deprived in the treatment of hepatolithiasis .The surgical approaches achieving both hepatobiliary lesions clearance and Oddi sphincter preservation have been widely accepted .The biliary-enterostomy is suspected to increase the risk of reflux cholangitis and cholangiocarcinoma due to iatrogenic Oddi sphincter deprivation.Endoscopic sphincterotomy (EST) as a minimally invasive method still needs further research to determine its role in hepatolithiasis management .
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SUMMARY To investigate the effect and feasibility of total laparoscopy to treat hepatolithiasis using gall-bladder-hepatic duct subcutaneous tunnel.Retrospective analysis was conducted of the case data of 11 pa-tients with hepatolithiasis who underwent total laparoscopic treatment using gallbladder-hepatic duct sub-cutaneous tunnel from January 2010 to October 2014.The operation time,blood loss,postoperative com-plications and recurrence of stones were recorded.All the cases completed the operation.The average hos-pital-stay was 9.2 days (range:3 -29 d).The average operation time was 298 min (range:225 -480 min).The average blood loss was 253 mL (range:50 -700 mL),and the average blood loss of liver re-section groups was 325 mL (range:200 -700 mL).The average discharge time was 3.3 days (range:3 -5 d).The rate of postoperative residual stones was 36.4% (4 /11).We extracted stones with chole-dochofiberscope via T-tube sinus six weeks after operation.One case developed biliary leakage,and healed through adequate drainage and the T-tube was pulled out after one month.There was no periopera-tive mortality.All the cases were followed up and the mean follow-up was 22 months (range:2 -51 months).The anastomotic stenosis of gallbladder-hepatic duct was found in one case.But we got a good therapeutic result with performed gallbladder chemical ablation with 95% ethanol.No recurrence of hepa-tolithiasis was found.As a choice for minimally invasive method to hepatolithiasis using gallbladder-he-patic duct subcutaneous tunnel,total laparoscopy is a safe and feasible procedure.
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Objective To summarize the clinical features,diagnosis,treatment and prognosis of hepatolithiasis complicating cholangiocarcinoma. Methods From June 1958 to March 2011,709 cases of hepatolithiasis were admitted to Department of General Surgery,Peking University Third Hospital.The cases concomitant with cholangiocarcinoma were reviewed. Results 20 of 709 (2.8％ ) hepatolithiasis cases developed cholangiocarcinoma.17 cases (85％,17/20) were followed-up for 2 years (0 - 15 years).The hepatolithiasis course before the malignant diagnosis was 15 ± 1 1 years (3 -38 years).14 cases had frequent episodes of cholangitis,15 cases had liver cirrhosis.Preoperative diagnosis was established by CT,MRCP,B-ultrasound and tumor markers in 55％ (11/20) cases.4 cases underwent radical resection,7 received palliative resection,9 cases received conservative treatment.In radical resection,one lost to follow-up,one survived one year,two for 5 years.In palliative resection,2 lost to follow-up,two survived one year,one survived 3 years, one for 5 years. None in conservative group survived more than one year.Conclusions Cholangiocarcinoma developed from hepatolithiasis with a long history,frequent cholangitis,liver cirrhosis,especially in cases with imige showing thickness of bile duct or mass and rising tumor markers (CA19-9,CA125,CEA).The cases undergoing radical resection may have a favorable prognosis.
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Objective To explorethe clinical features of adenosquamous carcinoma,squamous cell carcinoma and adenocarcinoma of the gallbladder. Methods A retrospective analysis of 112 patients with gallbladder carcinoma was performed.The clinical features and outcomes of 11 patients with either adenosquamous or squamous cell carcinoma were compared with the other 101 patients of adenocarcinoma.Results The rate of tumor with T3 or T4 stage in adenosquamous/squamous cell carcinoma group and adenocarcinoma groupwere 100%and 53%(X2=7.013,P=0.008).The rate of distant metastasis in adenosquamous/squamous cell carcinoma group and edenocarcinoma at advanced stage(T3 or T4 stage)group were 0 and 35%(X2=3.900,P=0.048).The rate of lymph node invasion were 82% and 87%(X2=0.000,P=1.000).The rate of gastrointestinal tract invasion in adenosquamous/squamous cell carcinoma group and adenocarcinoma at advanced stage(T3 or T4 stage)group were 45% and 15%(X2=3.618,P=0.054).The median survival time for the two groups were 5 months and 4 months respectively(X2=0.359,P=0.549).Condusiom Adenosquamous/squamous cell carcinoma of the gallbladder had high local invasion capacity and usually were diagnosed at an advanced stage.The distant metastasis rate of adenosquamous/squamous cell carcinoma of the gallbladder was lower compared with adenocarcinoma.The lymph node invasion mte of adenosquamous/squamoua cell carcinoma was similar to adenocarcinoma.
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Objective To explore rational and effective treatment strategies by comparing long-term effects of different treatment methods for hepatolithiasis. Methods One hundred and fifty-nine cases of hepatolithiasis treated in this hospital from January 1993 to December 2002 were analyzed retrospectively.Five treatment methods: conservative treatment,choledocholithotomy followed by choledochostomy,hepatolobectomy,hepaticojejunostomy,and hepaticoplasty with the conservation of the Oddi's sphincter,were compared in respect of postoperative complications and long-term outcomes.Results Out of the 159 cases,follow-up was completed in 146 cases(91.8%,146/159) for 2~12 years(median,7 years).Of 16 cases of conservative treatment,15 were followed.Cholangitis occurred in all the 15 cases,with 1 fatal case.Of 47 cases of extrahepatic surgical exploration,the incidence of residual stones was 100%.Follow-up in 43 cases found 32 cases of cholangitis(74.4%) with 7 fatal cases.Of 16 cases of hepatolobectomy,residual stones were noted in 3 cases(12.5%).Follow-up in 15 cases found 4 cases of cholangitis(26.7%) with 1 fatal case.Of 32 cases of hepaticojejunostomy,residual stones were found in 11 cases(34.4%).Follow-up in 29 cases found 14 cases of cholangitis(48.3%) with 3 fatal cases.Of 48 cases of sphincter-sparing operation,residual stones were found in 8 cases(16.7%).Follow-up in 44 cases found 7 cases of cholangitis(15.9%).The incidence of residual stones was significantly higher in cases of extrahepatic surgical exploration than in cases of other treatment(P=0.000).The recurrence rate of cholangitis was significantly higher in cases of conservative treatment and extrahepatic surgical exploration than in cases of other treatment(P
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0.05). Conclusions The upstream lesions of biliary tract must be dealt with thoroughly in the treatment of hepatolithiasis. EST should not be the first choice for hepatolithiasis preparatory to determining whether or not lesions like stricture are present in intrahepatic ducts.
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Objective To explore the relationship between surgical procedure and prognosis of gallbladder carcinama invading the whole layer without extension beyond serosa. Methods A retrospective analysis on 24 patients with pathologic stage T2 gallbladder carcinoma invading the whole layer without extension beyond serosa was performed. Kaplan-Meier method was used to analyze the survival rate and disease-free survival rate between the patients undergoing radical resection ( n = 14) and the patients undergoing simple cholecystectomy (re = 10). Results The 1,3 and 5-year survival rates for patients undergoing radical resection were 100%、71% and 54% respectively, whereas the rates that for patients undergoing simple cholecystectomy were 70%、30% and 20% respectively. There was significant difference between the survival time of these two groups ( X2 =4. 659, P = 0. 031). The median clinical tumor-free survival time in radical resection group and simple cholecystectomy group were 45 months and 13.5 months respectively. There was significant difference between the clinical tumor-free survival time of these two groups ( X2 = 3. 854, P = 0. 049 ). Conclusions A radical resection is indicated for patients with pathologic stage T2 gallbladder carcinoma. Radical resection is an effective method to improve the survival rate for pathologic stage T2 gallbladder carcinoma.