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1.
Article in Chinese | WPRIM | ID: wpr-910586

ABSTRACT

Objective:To evaluate the clinical application efficacy of four-stitch cholangiojejunostomy.Methods:Of 38 patients who received four-needle biliary and enterointestinal anastomosis in the Department of Hepatobiliary Surgery, Yuebei People's Hospital Affiliated to Shantou University Medical College from November 2016 to April 2020 were included, and the diseases, surgical methods and postoperative complications of four-needle biliary and enterointestinal anastomosis were analyzed.Results:There were 26 males and 12 females with an average of 57.3(44-77) years. Among 38 patients, there were 12 hilar cholangiocarcinoma patients, 10 pancreatic head cancer, 9 duodenal papillary cancer, 4 intrahepatic and extrahepatic bile duct stones, 1 pancreatic cystic adenoma, 1 gastric cancer invading pancreatic head and 1 gallbladder carcinoma. The procedure included pancreatoduodenectomy in 20, radical resection of hilar cholangiocarcinoma in 12, hepatectomy with biliary-enteric anastomosis in 4, radical resection of gastric cancer combined with pancreaticoduodenectomy in 1, radical resection of gallbladder carcinoma in 1. One, two and three ductal openings were anastomosed in 27, 7 and 4 patients, respectively. 10 patients have bile duct diameter <6 mm. Postoperative anastomotic leakage occurred in 1, and all patients were received followed-up visit for 2 months to 4 years without anastomotic stenosis.Conclusion:Four-stitch cholangiojejunostomy is simple, safe, effective, and convenient for small biliary ductal surgeries.

2.
Chinese Journal of Surgery ; (12): 412-417, 2019.
Article in Chinese | WPRIM | ID: wpr-810654

ABSTRACT

In order to facilitate the treatment strategies for biliary tract injury, hilar cholangiocarcinoma, bile duct tumor thrombus, cholangiocellular carcinoma and bile duct cystic dilatation, many classifications have been made, even more than 10 types for one disease. Each type is represented by numbers or English alphabet, which are not only confusing but also difficult to remember. The Academician Mengchao Wu divided the liver into five sections and four segments base on its anatomy, this classification is very direct and visual, thus had been using till now. In order to overcome those complicated problems, it is considered to develop a new classification based on actual anatomic location similar to that for liver cancer, which is easy to remember and to directly determine the treatment strategy. All kinds of classifications have their own characteristics and advantages and disadvantages. This practical classifications avoid the complexity and may be useful for clinicians.

3.
Article in Chinese | WPRIM | ID: wpr-734390

ABSTRACT

Surgical resection is the only effectively curative option for patients with colorectal liver metastases (CRLM).However,fewer than 20% of those patients are deemed eligible for surgery when they were initially diagnosed.Conversion therapy,mainly used by chemotherapy,increases the opportunities of surgical treatment for patients with initially unresectable CRLM.Notably,sufficient future liver remnant (FLR)is a key factor for liver resection.The deficiency of FLR could lead to serious complications including postoperative liver failure.Surgical methods,represented by portal vein embolization (PVE),portal vein ligation (PVL) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS),could increase FLR and subsequently further increase the surgical security for CRLM patients.Most CRLM patients accept systemic chemotherapy before surgery.With extensive research has revealed the chemotherapy-induced liver injury,more attention has been shifted to explore the influence of different chemotherapy regimens,chemotherapy cycles and timing of surgery on the volume of FLR.With this review,we overview the research status of conversion therapy for initial unresectable CELM and the influence of chemotherapy on the volume of FLR.

4.
Chinese Journal of Surgery ; (12): 269-273, 2018.
Article in Chinese | WPRIM | ID: wpr-809903

ABSTRACT

Objective@#To evaluate the role of anatomical hepatectomy in the treatment of intrahepatic cholangiocarcinoma.@*Methods@#The cases of intrahepatic cholangiocarcinoma who received curative surgery in two hospitals from 2010 to 2015 were analyzed retrospectively. Among the 98 patients enrolled in this study, 55 were male and 43 were female. The median age was 61 years. According to receiving anatomical hepatectomy or not, the 98 cases were divided into two groups: non-anatomical hepatectomy(n=30) and anatomical hepatectomy(n=68). The surgical results were compared between the two groups.Survival curves were plotted by the Kaplan-Meier method and compared by the log-rank test. The influence of each prognostic factor identified by univariate analysis was multivariate analysis by Cox′s proportional hazard regression.@*Results@#The duration of surgery was significantly prolonged in the anatomical hepatectomy group((196.4±94.9)minutes vs. (166.2±65.7)minutes, P=0.027), while there was no significant difference in terms of other surgical results such as intraoperative blood transfusion, postoperative morbidity and mortality rate. Compared to non-anatomical hepatectomy, anatomical hepatectomy significantly improved long-term survival results(14 months vs. 11 months)(χ2=4.641, P=0.031). Single variable analysis indicated that tumor differentiation, tumor numbers, T stage, N stage, anatomical hepatectomy and adjuvant therapy significantly affected overall survival. Multivariate analysis demonstrated that tumor numbers(HR=0.522, 95% CI: 0.259-0.974, P=0.042) and anatomical hepatectomy(HR=1.858, 95%CI: 1.092-3.161, P=0.022) were two independent prognostic factors for overall survival.@*Conclusion@#Compared to non-anatomical hepatectomy, anatomical hepatectomy performed for intrahepatic cholangiocarcinoma is not only safe but also beneficial for long-term survival.

5.
Article in Chinese | WPRIM | ID: wpr-620987

ABSTRACT

Lymph node dissection was the key procedure of pancreatic surgery.The majority of guidelines indicated that extended lymph node dissection was helpless for improving survival rate.However,there were still quite a few researches which demonstrated that the extended dissection was a valuable procedure.It was still a controversial topic considering lymph node dissection.To review the shortcomings of previous randomized controlled trials (RCT),this article combined the experience of new techniques in pancreatic surgery,which are developing rapidly in recent years,and our theory and practice of radical resection of retroperitoneal lipo-lymphatic layer (RRRLLL).Therefore,the controversy and update of extended lymph node dissection for pancreatic head carcinoma were discussed,which could provide references for standardizing the treatment of extended lymph node dissection in clinical practice.

6.
Chinese Journal of Surgery ; (12): 655-660, 2017.
Article in Chinese | WPRIM | ID: wpr-809238

ABSTRACT

Objective@#To analyze the efficacy of branches portal vein embolization (TBPVE) combined with transcatheter arterial chemoembolization (TACE) on liver neoplasms.@*Methods@#From August 2016 to May 2017, there were 13 patients including 11 males and 2 females with primary hepatocellular carcinoma who underwent TBPVE+ TACE , among whom there were 11 cases with a history of HBV infection.Average age of the 13 patients was (60.8±6.2)years. The live function of all patients were Child-Pugh A classification.The CT or MRI images of each patient was reconstructed and the standard liver volume(SLV) before TBPVE+ TACE was (1 181.2±49.3)ml, estimated future liver remnant(FLR) was (326.1±72.1)ml and FLR/SLV was (27.6±6.0)%.The puncture site for TBPVE was determined by the three-dimensional reconstruction of portal vein.CT scan or MRI, AFP and liver function test were repeated after one and two weeks after TBPVE+ TACE.FLR and FLR/SLV were calculated respectively.Hepatectomy would be performed if the patients agreed.The postoperative complications were analyzed.@*Results@#On the 7thday after TBPVE+ TACE, the FLR/SLV was(42.6±8.0)% and the FLR increasement was(56.0±24.6)%.The level of AFP decreased from(87.9±81.8)μg/L to (29.7±20.9)μg/L.On the 14thday after TBPVE+ TACE, the FLR/SLV was(45.8±6.2)% and the FLR increasement was(71.8±29.0)%.Four patients underwent surgery which including 2 right hepatectomies and 2 right trisegmentectomies in 2 weeks after TBPVE+ TACE.Nine patients were performed with targeting intratumoral lactic acidosis TACE (TILA-TACE). No severe complication occurred in all patients.@*Conclusions@#TBPVE could induce a rapid growth of the liver remnant but still with the concern of inducing the growth of neoplasms at the same time.To combine TACE in TBPVE therapy not also can the growth of neoplasms be prevented but also inducing its shrinking.This method might be a new mode for the treatment of hepatocellular carcinoma.

7.
Chinese Journal of Surgery ; (12): 136-140, 2017.
Article in Chinese | WPRIM | ID: wpr-808138

ABSTRACT

Objective@#To investigate the role of "Hong′s single-stitch duct to mucosa pancreaticojejunostomy(HSDMP)" in laparoscopic pancreaticoduodenectomy (LPD).@*Methods@#The clinical data including perioperative and short-term outcomes of 51 cases of LPD with HSDMP which performed in Zhejiang Provincial People′s Hospital(33 cases) and Frist Clinical Hospital of Jilin University(18 cases) between April and October 2016 were reviewed retrospectively. There were 31 male patients and 20 female patients. The mean age was(59±11)years. Body mass index (BMI) was 18 to 28 kg/m2 and the average BMI was (23.2±4.4)kg/m2. Preoperative diagnosis: 18 cases with pancreatic mass, 26 cases with peri-ampullary tumor, 3 cases with intra-ductal papillary mucinous neoplasms, 2 cases with duodenal carcinoma, 2 cases with serous cystadenoma.@*Results@#Fifty-one patients accepted LPD using HSDMP. One patient underwent LPD combined with resection of superior mesentery vein. The mean operation time was (307±69)minutes, the mean diameter of pancreatic duct for reconstruction was (3.1±1.1)mm.The mean operation time for HSDMP was (34±5) minutes, the estimated blood loss was (170±127)ml. Twelve cases(23.5%) had pancreatic fistula according to International Study Group definition, including 9 cases(17.6%) of grade A and 3 cases (5.9%) of grade B. Five cases(9.8%) had delayed gastric empty, 5 cases(9.8%) had bile leakage and 2 cases(3.9%) had pulmonary infection postoperative.All these complications were treated by non-surgical strategies. One patient(2.0%) suffered from postoperative intra-abdominal bleeding and recovered after reoperation. Pathologic results showed pancreatic ductal adenocarcinomas in 20 cases(39.2%), non-pancreatic original peri-ampullary tumors in 23 cases(45.1%), intra-ductal papillary mucinous neoplasms in 3 cases(5.9%), duodenal carcinoma in 2 cases(3.9%), serous cystadenoma in 2 cases(3.9%) and neuroendocrine tumors in one case(2.0%).@*Conclusions@#HSDMP could not only reduce the incidence of clinical pancreatic fistula, but also save operation time. It is a feasible and safe method for pancreaticojejunostomy.

8.
Article in Chinese | WPRIM | ID: wpr-447037

ABSTRACT

Objective To evaluate the concept of artery first and total mesopancreatic excision in radical resection of pancreatic head carcinoma through both anterior and posterior approaches.Method The anterior approach was to identify the superior mesenteric artery (SMA) and the posterior approach to confirm the possibility of negative margin at the origin of SMA,on the posterio-lateral vascular wall of superior mesenteric vein (SMV) and the supposed posterior of the mesopancreas.The resection scope were with the celiac trunk and common hepatic artery as the upper boarder,the SMA as the left boarder,the inferior mesenteric vein (IMA) level as the lower boarder,to achieve a complete mesopancreatic excision,namely the en bloc resection of all the involved nerve,the lymph tissue and vascular tissue along the right side of the axial composed by SMA and celiac trunk.Results Of the 15 patients,11 had radical Whipple procedure,among which 2 had a combining SMV resection and reconstruction.1 case suffered from delayed gastric emptying and 2 cases from bile leakage.There was no mortality.The postoperative pathology reported carcinoma in all 11 cases,with duodenum and low bile duct involved in 4 cases,with the duodenum involved in 6 cases,no surrounding tissue involvement was identified in 1 case.Nerve involvement was found in 7 (7/11),vascular involvement in 10 (10/11),and lymphnode metastasis was (2.5 ± 3.8/12.9 ± 4.9).Conclusions The radical resection of pancreatic head carcinoma using the concept of artery first and the total mesopancreatic excision is helpful for an early evaluation of the possibility of radical resection and guarantees negative margins.

9.
Article in Chinese | WPRIM | ID: wpr-239387

ABSTRACT

Pancreatic enteric anastomosis is an important step during pancreaticoduodenectomy. Based on the anastomosis site, pancreatic enteric anastomosis is classified as pancreaticojejunostomy anastomosis and pancreaticogastrostomy. Depending on the jejunum site, reconstruction can be perform as end-to-end or end-to-side anastomosis. Previous randomized clinical trials, showed no significant differences between pancreaticojejunostomy and pancreaticogastrostomy. Binding pancreaticojejunostomy and binding pancreaticogastrostomy are easy to perform. The rate of pancreatic leakage is related to the texture of the pancreas and the size of the pancreatic duct. It is helpful to reduce pancreatic leakage by placing a pancreatic duct stent. The simple and effective pancreatic enteric reconstruction is the future direction for minimizing leakage.


Subject(s)
Humans , Pancreatic Fistula , Pancreaticoduodenectomy , Pancreaticojejunostomy , Methods
10.
Article in Chinese | WPRIM | ID: wpr-420450

ABSTRACT

Iatrogenic bile duct injuries (BDIs) and subsequent benign biliary stricture is a medical catastrophe which is associated with significant perioperative morbidity and mortality,reduced long-term survival rate and poor quality of life.For most major BDIs (Strasberg classification E1-E4),the recommended method of repair is hepaticojejunostomy (HJ).We conducted a retrospective review aiming to examine the surgical technique of high HJ at our institution.This review highlights 4 aspects in the operation which include the hepatoduodenal ligament exposure,hepatic artery and its branches protection,exposing the intrahepatic bile duct above the stricture plane,and HJ techniques.Overall,the optimal long-term result of surgical management depends on the availability of experienced hepatobiliary surgeons and a considerable large HJ anastomosis above the stricture.

11.
Article in Chinese | WPRIM | ID: wpr-414585

ABSTRACT

Radical resection is still the only possible cure for gallbladder cancer nowadays. Rational procedures vary according to different TNM stages, locations and biological behavior of tumor. Diagnostic laparoscopic exploration offers the opportunity to identify peritoneal metastasis which may be negative on preoperative radiological findings. Besides, this can also minimize trauma to abdomen. Therefore, laparoscopic exploration is suggested in cases highly suspected of peritoneal metastasis. For incidental gallbladder cancer, radical surgery should be performed because of positive margin of cystic duct, inadequate trocar management or advanced tumor stages. Timing for reoperation is still controversial. Most scholars recommended that it should be proceed within two months after the first surgery.

12.
Article in Chinese | WPRIM | ID: wpr-390016

ABSTRACT

Hilar cholangiocarcinoma remains a formi-dable challenge to hepatopancreatobiliary surgeons since the reported resection of a primary cancer originating at the hepatic duct confluence by Brown and Myers in 1954. Emerging evidence has indicated that aggressive surgery with a curative resection offers a better option for long-term survival compared with conservative therapy. Liver transplantation has also been considered as a management opportunity for the treatment of cholangiocarcinoma. However, the survival rate has been poor due to the high proportion of disease recurrence. This review highlights recent techniques in hilar cholangiocarcinoma resec-tion, with special attention to the management of the resection margin, clinical skills of liver resection, lymph node clearance, and portal vein or hepatic artery resection or reconstruction. In addition, technical advances have been proposed in hepatopan-creatoduodenectomy and liver transplantation for hilar cholangio-carcinoma treatment. In the current hepatic procedures, promis-ing survival outcomes have been obtained in patients with hilar cholangiocarcinoma, exhibiting a decreased operative mortality and a steady improvement in long-term survival. Overall, the correct clinical strategy and appropriate surgical techniques may provide an increased chance to cure patients with hilar cholan-giocarcinoma.

13.
Article in Chinese | WPRIM | ID: wpr-396811

ABSTRACT

Objective Through constructing prokaryotic expression vector pET-30a-GPI-B7-1, to gain purified GPI-B7-1 fusion protein so as to confirm the tumor immune effect. Methods The DNA fragment encoding the signal for GPI-anchor attachment of hPLAP-1 and the cDNA encoding the human costimulatory molecule CD80 ( BT-1 ) were cloned from fresh placenta and human peripheral blood monocytes (PBMC) respectively. The two fragment were annealed to form a fusion gene (GPI-BT-1) by PCR. Then the fusion gene was inserted into the prokaryotic expression vector pET-30a, resulting in pET-30a-GPI-BT-1. Transfer to E. coli BL21, purified fusion protein were analysed by SDS-PAGE and Western blot. Results Agarose gel electrophoresis map of GPI and BT-1 PCR products show that GPI goal gene strap was seen at 133bp region and BT-1 goal gene strap at 792 region. Identification of recombinant pET-30a-GPI-B7-1 by restriction enzyme and PCR illustrate two goal fragment for 5000 bp and 900 bp, to realize the expression of fusion gene ( GPI-B7-1 ) at the E. coli BL21. The fusion protein was successfully produced in the pET expression system induced by IPTG and purified by Ni2 + -NTA agarose column. By SDS-PAGE and Western blot analysis, the observed molecular weight of the fusion protein was 38 kDa. Conclusion The purified GPI-B7-1 fusion protein can be obtained from E. coli BL21 transfered by prokaryotic expression vector pET-30a-GPI-B7-1, which will prove useful tool for the study of tumor immune therapy.

14.
Article in Chinese | WPRIM | ID: wpr-398217

ABSTRACT

Objective To study the clinical features and postoperative complications for gastric carcinoma in the patients older than 65 years. Methods From January 2005 to January 2007, 65 elderly gastric carcinoma cases underwent surgical resection, the age related preoperative and postoperative complications were analyzed. Result The incidence of preoperative complications in elderly gastriccarc inoma patients is 83%, compared with younger group of 59%; Preoperatively, 52% elderly cases presented with two or more complications. The incidence of hypertension was the highest (40%), the radical curative rate for the elderly group was 86% as compared with younger group of 93%. The postoperative complications in elderly group was 37%. In elderly cases, postoperative complications were common in those suffering from preoperative complications such as hypertension, diabetes, respiratory diseases, anaemia, hypoalbuminemia. Conclusion The age itself is not a single influential factors indicating postoperative complications. There was no significant difference in the morbidity and mortality between elderly and younger gastric carcinoma cases undergoing a surgery.

15.
Article in Chinese | WPRIM | ID: wpr-306737

ABSTRACT

<p><b>OBJECTIVE</b>To summarize the experience in applying acupunctural anesthesia (AA) with new combination principle (NCP) of acupoints in supratentorial craniocerebral operation of tumor in functional area or deep site of brain.</p><p><b>METHODS</b>With the acupoints selection of AA changed from the previous combination principle of near segmental and peri-operational region to the NCP of near-remote along corresponding meridian, craniotomy was carried out under AA in 23 patients.</p><p><b>RESULTS</b>Operation was performed successfully in all the patients, 82.6% of them with the effectiveness reaching I A grade. In those operated on the vital functional area, such as central anterior/posterior gyrus and language center, the accidental functional injury could be well prevented.</p><p><b>CONCLUSION</b>AA with NCP of acupoints has satisfactory effect in supratentorial craniocerebral operation of functional area or deep site of brain, it is especially valuable in monitoring the effect of operation on function of around normal cerebral area to avoid accident injury.</p>


Subject(s)
Acupuncture Analgesia , Methods , Acupuncture Points , Adolescent , Adult , Electroacupuncture , Female , Glioma , General Surgery , Humans , Male , Middle Aged , Supratentorial Neoplasms , General Surgery
16.
Chinese Journal of Traumatology ; (6): 180-185, 2002.
Article in English | WPRIM | ID: wpr-332971

ABSTRACT

<p><b>OBJECTIVE</b>To find out the optimal concentration, infusion rate and dosage of saline for resuscitation.</p><p><b>METHODS</b>Forty-five dogs were used to establish hypovolemic shock models. The dogs were resuscitated with saline of different concentrations and different dosages under different infusion rates, and the resuscitation results were compared.</p><p><b>RESULTS</b>The best concentration was 7.5%, the best rate of infusion 20 ml/min (a volume equivalent to 15% of the shed blood) and the best dosage 5.71 ml/kg. The method was effective for resuscitation, the mean arterial pressure (MAP) could be elevated to 89% of the baseline, and this MAP could be kept for more than one hour.</p><p><b>CONCLUSIONS</b>Using 7.5% sodium chloride solution equivalent to 15% of the shed blood at an infusion rate of 20 ml/min can achieve a best resuscitation result.</p>


Subject(s)
Animals , Blood Pressure , Blood Volume , Body Weight , Dogs , Electrolytes , Blood , Female , Male , Resuscitation , Saline Solution, Hypertonic , Shock, Hemorrhagic , Therapeutics
17.
Article in Chinese | WPRIM | ID: wpr-528406

ABSTRACT

Objective To evaluate concomitant anatomical hepatectomy and inferior vena cava (IVC) reconstruction for hepatic cancer. Methods Between Aug 2004 and Jul 2005, three patients with intrahepatic cholangiocarcinoma and two patients with hepatocellular carcinoma suspected to invade the wall of IVC underwent concomitant hepatectomy, IVC resection and reconstruction under portal triad clamping (PTC), total vascular exclusion(HVE) without venovenous bypass. The retrohepatic IVC was repaired by primary suture (n = 2), a Gore-Tex patch (n = 1), and a ringed ePTFE graft ( n = 1). Results Surgery was successful in all cases without operative death. The mean operative time was 345 min (range 300 ~ 450 min) ,and the mean intraoperative blood loss was 1375 ml (range 1200 ~ 1800 ml). The cumulated mean PTC and HVE times were 19 min and 21.2 min respectively. Postoperative complications included pleural effusion in one needing thoracentesis, bile leakage and ascites in one each. During the follow-up, one patient died at 9 months due to recurrence, and the remaining 4 patients were alive at the follow-up of 4 to 15 months. Conclusions Concomitant hepatectomy with IVC resection offers hope for patients with hepatic tumors involving the IVC, who would otherwise have a dismal prognosis.

18.
Article in Chinese | WPRIM | ID: wpr-518213

ABSTRACT

Objective To investigate the extent and the relevant factors for local lymph node metastasis of gallbladder carcinoma. Methods Clinicopathologic features of 34 patients with gallbladder carcinoma who underwent radical resection were analyzed retrospectively. Results The overall lymph node metastasis rate was 68%(23/34), with 0(0/3) in T 1 stage, 43%(3/7) in T 2, 85%(11/13) in T 3, and 82%(9/11) in T 4. The metastasis rate was 29%(10/34) in gallbladder lymph nodes, 44%(15/34) in pericholedochal, 18%(6/34) in hepatic hilum, 24%(8/34) alongside proper hepatic artery, 21%(7/34) in periportal vein, 38%(13/34) in retropancreaticoduodenal, and 4/6 in paraaortic region. Conclusions Lymph node metastasis was determined by the depth of invasion of the primary tumor. The extent of surgical dissection was made according to the exploration and result of intraoperative biopsy.

19.
Article in Chinese | WPRIM | ID: wpr-411973

ABSTRACT

Objective To evaluate the methods for the diagnosis and treatment of biliary malignant tumor(BMT) so as to achieve improvement. Methods Various methods of diagnosis and treatment of BMT were comprehensively analysed and evaluated. Results and Conclusion The present laboratory examinations do not show obvious help for the early diagnosis of BMT. Both bile cytology and neoplasm histology may define the character of tumor but the positive rate is low. Although imaging examinations have difficulty in finding early tumor, it may help to define the position, size, infiltration and metastasis of the neoplasm. To diagnose the tumor in its early stage, the monitor and management of some diseases related to BMT should be enhanced, and tumor markers with high susceptibility and specificity should be explored. Operation is the major choice treatment. For advanced neoplasm patients, radical operation or extented radical operation can bring great help for some cases. Palliative surgery may be performed on the patients unable to accept radical operation, and biliary drainage may be performed on the unresectable tumor. The application of special surgery apparatus, such as Peng's Multifunctional Operative Dissector(PMOD), may increase the resection rate of tumor and lymph nodules. Radiotherapy and chemotherapy need further exploration. Gene therapy may likely bring about new hope for the treatment of BMT in the future.

20.
Article in Chinese | WPRIM | ID: wpr-411389

ABSTRACT

Objective To investigate the cause,prevention and treatment of bile leakage. MethodsThe clinical data of 22 cases with bile leakage treated from Jan.1993 to Dec.1998 were reviewed retrospectively. Results Of the 19 cases treated with nonoperative therapy,1 patient died,3 patients were transferred to be operated later, and the other 15 cases were cured. The cure rate of nonoperation was 79%(15/19). 3 patients were cured with emergent operation at the beginning of bile leakage. Of the 3 cases who were transferred to be operated later,2 cases were finally cured by operation while the other 1 patient was not cured.The total cure rate was 91%(20/22). ConclusionBile leakage often oocurs in cholecystectomy procedure and after removal of a T tube, which is mainly related to inflammation, adhesion, abnormality of anatomy and incorrect manipulation. In order to prevent it,surgeons should pay more attention to the 3 links of prirnary procedure, including preoperative preparation,operative management and postoperative treatment. Different treatments are optional according to the degree of leakage and the condition of patients.

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