ObjectiveTo summarize the clinical experience on primary suture after common bile duct exploration and to investigate its clinical indications and curative effects. MethodsThe clinical data of 137 patients underwent primary closure of common bile duct between February 2006 and June 2010 were analyzed retrospectively. ResultsAll operations were successful. The operative time ranged from 65-213 min (mean 129 min) and the blood loss ranged from 50-350 ml with an average of 148 ml. One hundred and twenty-four patients (90.5%) were discharged from hospital without complications within 7 d after operation. Postoperative bile leakage occurred in 13 patients (9.5%) consisted of 10 early stage cases (18.5%, 10/54) and 3 later stage cases (3.6%, 3/83), which were discharged with improvement by conservative treatment within 3 weeks after operation. Totally 113 patients (82.5%) were followed up for 2-54 months with a median time of 14 months, no residual or retained stone and biliary duct stricture occurred. ConclusionOnly with the strict indication and proficient surgical technology, primary suture after common bile duct exploration is a safe and effective way to choledocholithiasis.
ObjectiveTo investigate the application of fast track surgery (FTS) in hepatobiliary surgery, and discuss the postoperative stress response and its efficacy and safety assessment. MethodsA total of 171 patients undergoing different hepatobiliary operations in our ward from August 2008 to Jule 2011 were randomly divided into control group (n=89) and FTS group (n=82). Patients in the FTS group received the improved methods while those in the control group received traditional care. A series of indicators such as hospital stay, hospital expense, duration of intravenous infusion, postoperative complications, and the C-reaction protein (CRP) and interleukin-6 (IL-6) levels in serum were observed postoperatively. ResultsFor the FTS and control group, the first exhaust time was respectively (2.4±0.3) and (3.3±0.6) days, postoperative hospital stay was (9.1±2.7) and (14.1±4.1) days, hospitalization expense was (16 432±3 012) and (21 612±1 724) yuan, all of which had significant differences (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, IL-6 serum level for the FTS group was respectively (8.57±2.58), (30.21±12.44), (17.41±11.73), (11.14±7.12), and (10.50±5.19) ng/L, and for the control group was respectively (9.13±2.99), (51.31±19.50), (36.82±12.33), (28.23±9.18), and (15.44±4.33) ng/L. There was no significant difference in the preoperative IL-6 level between the two groups (P>0.05), while IL-6 level was significantly lower in the FTS group than the control group after surgery (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, CRP serum level for the FTS group was respectively (18.41±4.01), (69.74±26.03), (45.52±20.50), (39.14±11.23), and (29.03±6.47) μg/L, and for the control group was respectively (17.74±2.11), (99.23±23.50), (86.81±17.34), (68.22±15.60), and (37.70±9.55) μg/L. There was no significant difference in the preoperative CRP level between the two groups (P>0.05), while CRP level was significantly lower in the FTS group than the control group after surgery (P<0.05). Postoperative complication rate after surgery was not significantly different between the two groups (P>0.05). ConclusionThe application of FTS in some hepatobiliary operations is effective and safe by decreasing the stress response.
目的 探討射頻消融術在無法實施手術的原發性肝癌患者中的臨床應用效果。方法 回顧性分析2007年9月至2011年3月期間我院收治的58例由于各種原因無法手術治療的大肝癌（＞5cm）并接受射頻消融治療患者的臨床資料，射頻消融前后結合超聲造影的方法，術后隨訪并定期復查血清甲胎蛋白水平和超聲造影或者肝臟增強CT。結果 58例中無一例發生與射頻消融相關的死亡，22例達到完全消融（37.9%，22/58）。共51例（87.9%，51/58）獲得隨訪，隨訪至2012年5月，隨訪時間（12.6±6.4）個月（2～21個月），隨訪12個月以上患者有20例（39.2%，20/51），有10例（19.6%，10/51）無腫瘤復發或者轉移的跡象。22例達到完全消融的患者無瘤生存時間為（13.6±10.4）個月（3～21個月）；36例未能達到完全消融的患者中，有19例隨訪期間死亡，生存時間（8.3±6.1）個月（4～16個月）。結論 由于各種原因不能接受手術的大肝癌患者，射頻消融作為一種有效、安全治療方法，部分能達到完全消融的效果，而部分作為姑息性治療手段，能一定程度上減輕患者的疼痛，達到提高生活質量的目的。