RÉSUMÉ
Hilar cholangiocarcinoma is a common bile duct cancer.The radical resection rate of end-stage malignancies reported in literature is about 20％.Half of the patients have lost the chance of operation at the time of care,while the average survival time in the patients who can not be operated is about six months.Therefore,for most patients,looking for a palliative treatment which can prolong the survival time is particularly important.From June 2013 to June 2014,our hospital applied iodine-125 brachytherapy,to treat 7 patients with unresectable hilar cholangio carcinoma.All the patients are still alive,the average survival time of 7 patients is 5.2 months up to now,with median survival time being 7.8 months,and longest survival time being 12 months.With good outcomes,few complications,as well as significantly prolonged survival time,iodine125 brachytherapy is regarded with broad clinical applications.
RÉSUMÉ
Objective To explore the feasibility and clinical value of the trans-umbilical single-port laparoscopic operation with routine apparatus in treatment of hepatobiliary diseases. Methods From Mar 2010 to Sep 2012, 415 patients with hepatobiliary disease, splenic disease, abdominal cavity disease or combine hysteromyoma were performed by trans-umbilical single-port laparoscopic operation with routine apparatus. The clinical data of 415 cases were analyzed respectively.Result All patients except one patients who was added one port for hysterectomy, were performed successfully trans-umbilical single-port laparoscopic operation with routine apparatus without conversion to laparotomy or conventional laparoscopic surgery. Conclusions The trans-umbilical single-port laparoscopic operation with routine apparatus is safe and effective in treatment of hepatobiliary diseases. Limited by the anatomy position, the trans-umbilical single-port laparoscopic operation with routine apparatus can cure most hepatobiliary diseases. So the operator must have the experience both in single-port laparoscopic operation and traditional laparoscopic operation. With the improvement of rotatable equipment, the practical procedure is expected to be generalized in the future.
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Objective To investigate the differences in the safety of the operation of different hepatic vascular exclusion for liver surgery. Methods Sixty patients with liver resection were grouped by different hepatic blood flow blocking methods, and given pre-operative assessment prior to surgery. Results On the first day after surgery, the average levels of ALT and AST were (395.0 ± 220.2) U/L and (415.3±311.0) U/L in patients who received Pringle’s method (110.2±53.0) U/L and (125.6±78.5) U/L in patients who received regional hepatic vascular exclusion, (98.9±32.2) U/L and (96.2 ±66.5) U/L in patients who didn't receive hepatic vascular exclusion, respectively. Postoperative liver function damage was more serious in patients who received Pringle's method than patients who received regional hepatic vascular exclusion or patients who didn't receive hepatic vascular exclusion, the difference was statistically significant (P<0.05) .Conclusion Regional hepatic vascular exclusion or not can not only reduce the incidence of postoperative complications, but also expand the indications for liver resection.
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Objective To study donor liver repair in modified piggyback liver transplantation and its ~relationship to postoperative complications. Methods The relationship between donor liver repair and ~development of complications of 14 cases of modified piggyback liver transplantation,which among 17 cases of orthotopic piggyback liver allotransplantation performed in our hospital,were analyzed retrospectively.In the 14 cases,abnormal hepatic artery was repaired in 2 cases,portal vein interposition shunt was done in 1 case;~repaired ligaments were sutured in 10 of 14 cases,and not sutured in 4 cases.Results None of the 14 ~patients died in the perioperative period. The success rate of the operation was 100%. 3 patients had ~intra-abdominal bleeding,postoperatively,and in 2 cases the bleeding was related to donor liver repair. ~Postoperatively ,there was no thrombosis of hepatic artery or portal vein, and no bile duct necrosis, no hepatic outflow tract occlusion. Conclusions Donor liver repair is an important procedure in liver tramsplantation.The quality of donor liver repair is directly related to the difficulty of operative technique during liver ~transplantation ,and to the development of postoperative complications.In donor liver repair during piggyback liver transplantation,reconstruction of the retrohepatic vera cava is very important.The constructed stoma must be compatible with the donor hepatic vein outflow stoma and be able to effectively prevent the formation of eddy blood flow,ensure patency of the outflow tract and effectively prevent thrombus formation.
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Objective To explore the pathological characteristics, diagnosis and operative treatment of Mirizzi Syndrome(MS). Methods The clinical data of 95 cases of Mirizzi Syndrome admitted to our hospital in recent 12 years were reviewed retrospectively. Results All of the 95 cases underwent operative therapy. In the 95 patients, simple cholecystectomy was performed in 2 patients, cholecystectomy and choledochotomy with T tube drainage in 58 patients, cholecystectomy and choledoscopic bile duct examination via cystic duct in 15 patients, partial cholecystectomy plus repair of choledochal fistula in 18 patients, and cholecystectomy plus repair of the injured choledochus in 2 patients. 65 cases were folloned up for 1-5 years, and all of them have been in good health. Conclusions Mirizzi Syndrome consists of varied pathology. The selection of rational operation for different types of Mirizzi Syndrome can give satisfactory results.