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Reoperation for benign biliary tract diseases in 149 cases: causes and prevention

Hepatobiliary & Pancreatic diseases International 2004年第2期3卷 265-269页

作者： Qing-Guang Liu, Zhi-Min Geng, Sheng-Li Wu, Ying-Min Yao, Hao Sun and Cheng-En Pan Xi’an, China Department of Hepatobiliary Surgery, First Hospital of Xi’ an Jiaotong University, Xi’an 710061, China Department of Hepatobiliary Surgery First Hospital Xi'an Jiaotong University Xi'an 710061 China. zhimin@***

BACKGROUND: Failure to diagnose and treat benign bi- liary tract disease relatively common surgical disease may cause serious consequences. Since the introduction of B- mode ultrasonography, CT, or MRI early and accurate diagnosis of the disease has been possible. In clinical prac- tice, however, these methods have not been adequately used. Inappropriate surgical procedures can also lead to bile duct injury or stenosis after injury, residual cholecystitis, stenosis after cholangiojejunostomy, or stenosis of the Od- di' s sphincter. But improvement of the diagnosis and treat- ment of benign biliary tract disease remains a great chal- lenge to clinicians. METHODS: A total of 149 patients with benign biliary tract disease who had received reoperation from June 1988 to June 2001 were analyzed retrospectively. Among them 95 patients (63.76%) received operation twice and 38 (25.5%) underwent 3 operations. Sixteen patients (10.74%) needed 4 or more operations. The procedures for the first opera- tion included cholecystectomy (71 patients, 47.65%), cho- lecystectomy with exploration of the common bile duct (42, 28.19%), cholangiojejunostomy (21, 14.1%), and la- paroscopic cholecystectomy (15, 10.06%). RESULTS: The causes for reoperation included residual and recurrent bile duct stones in 53 patients (35.57%), bile duct injury or stenosis after injury in 41 (27.52%), residual cho- lecystitis with or without stones in 28 (18.8%), stenosis af- ter cholangiojejunostomy in 17 (11.41%), stenosis of the Oddi's sphincter in 5 (5.35%), and others in 5 (5.35%). Four patients (2.68%) died after operation. CONCLUSIONS: To prevent reoperation for benign biliary tract diseases, the following measures should be taken to in- crease preoperative diagnostic rate, to understand condi- tions of the biliary tract by using imaging techniques and cholangiography, to examine comprehensively and careful- ly with choledochoscopy, cholangiography and B-mode ul-trasonography intraoperatively, to choos

关键词： biliary tract disease benign reoperation

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Pyogenic liver abscess caused by Klebsiella pneumoniae:analysis of the clinical characteristics and outcomes of 84 patients

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Chinese Medical Journal 2007年第2期120卷 136-139页

作者： CHAN Khee-siang YU Wen-liang TSAI Chi-lun CHENG Kuo-chen HOU Ching-cheng LEE Meng-chih TAN Che-kim Department of Intensive Care Medicine Chi Mei Medical Center Tainan Taiwan 710 China Institute of Medicine Chung Shan Medical University Taichung Taiwan 400 China

Background The increased incidence of pyogenic liver abscess caused by Klebsiella pneumoniae （***） was reported in the recent literature. This study was conducted retrospectively to investigate the clinical characteristics and outcomes of these patients. Methods Microbiological and medical databases of a medical center were searched from January 2000 to June 2003. Eighty-four patients with liver abscess caused by K. pneumoniae were analyzed. Results In the 84 patients, 52 men and 32 women aged （58.2±13.3） years on average, 64.4% had concomitant diabetes mellitus and 23.8% had biliary disease. The most common clinical symptoms were fever （98.8%）, chills （69.0%） and abdominal pain （58.3%）. 85.7% of the 84 patients received catheter drainage for the abscess. The length of hospital stay was （17.4 ±8.7） days. The mortality rate was 7.1%. Older age and presence of biliary disease were associated with mortality. Conclusions The low mortality of our patients was probably related to the high proportion of patients who received catheter drainage. Older age and presence of biliary disease were associated with the mortality.

关键词： Klebsiella pneumoniae liver abscess biliary tract disease

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Endoscopic bilateral stent-in-stent placement for malignant hilar obstruction using a large cell type stent

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Hepatobiliary & Pancreatic diseases International 2016年第6期15卷 633-639页

作者： Jin Myung Park Sang Hyub Lee Kwang Hyun Chung Dong Kee Jang Ji Kon Ryu Yong-Tae Kim Jae Min Lee Woo Hyun Paik Department of Internal Medicine and Liver Research Institute Seoul National University HospitalSeoul National University College of Medicine Department of Internal Medicine Kangwon National University HospitalKangwon National University School of Medicine Department of Internal Medicine Gyeongsang National University HospitalGyeongsang National University College of Medicine Department of Internal Medicine Inje University Ilsan Paik Hospital

BACKGROUND： Bilateral stent-in-stent （SIS） self-expandable metal stent placement is technically chghallenging for palliation of unresectable malignant hilar obstruction. In the SIS technique, the uniform large cell type biliary stent facilitates contralateral stent deployment through the mesh of the first metallic stent. This study aimed to assess the technical success and clinical effectiveness of this technique with a uniform large cell type biliary stent. METHODS： Thirty-one patients who underwentlbilateral SIS placement using a large cell type stent were reviewed retrospectively. All patients showed malignant hilarl obstruction （Bismuth types Ⅱ, Ⅲ, Ⅳ） with different etiologies. RESULTS： Sixteen （51.6%） patients were male. The mean age of the patients was 67.0±14.0 years. Most patients were diagnosed as having hilar cholangiocarcinoma （58.1%） and gallbladder cancer （29.0%）. Technical success rate was 83.9%. Success was achieved more frequently in patients without masses obstructing the biliary confluence （MOC） than those with MOC （95.2% vs 60.0%, P=0.03）. Functional success rate was 77.4%. Complications occurred in 29.0% of the patients. These tended to occur more frequently in patients with MOC （50.0% vs 19.0%, P=0.11）. Median time to recurrent biliary obstruction was 188 days and median survival was 175 days. CONCLUSIONS： The large cell type stent can be used efficiently for bilateral SIS placement in malignant hilar obstruction. However, the risk of technical failure increases in patients with MOC, and caution is needed to prevent complications for these patients.

关键词： biliary tract disease cholangiocarcinoma endoscopic biliary drainage stent insertion

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CA19-9 antigen levels can distinguish between benign and malignant pancreaticobiliary disease

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Hepatobiliary & Pancreatic diseases International 2009年第6期8卷 620-626页

作者： Gareth Morris-Stiff Mary Teli Nicky Jardine Malcolm CA Puntis Department of Surgery University Hospital of Wales

BACKGROUND:CA19-9 is a carbohydrate tumor-associated antigen which is frequently upregulated in pancreatobiliary ***,it may also be elevated in patients with jaundice in the absence of a tumor due to biliary obstruction,and in other non-hepato-pancreatico-biliary *** study aimed to evaluate whether CA19-9 levels could accurately differentiate between benign and malignant pancreatobiliary ***:All patients referred to a single surgeon for investigation of pancreaticobiliary disease in 2003 in whom a firm diagnosis had been established were *** malignant disease,a histological diagnosis was required but for benign disease a firm radiological diagnosis was deemed *** patients were divided into 4 categories:pancreatic adenocarcinoma(PCa);cholangiocarcinoma(CCa);chronic pancreatitis(CP)and biliary calculous disease(Calc).Bilirubin and alkaline phosphatase levels corresponding to the point of assessment of CA19-9 were also ***:Final diagnoses were made of pancreatic adenocarcinoma(PCa,n=73),cholangiocarcinoma(CCa,n=19),ampullary carcinoma(Amp,n=7),neuroendocrine carcinoma(Neu,n=4),duodenal carcinoma(Duo,n=3),chronic pancreatitis(CP,n=115),and biliary calculous disease(Calc,n=27).Median CA19-9 levels(U/ml)were:PCa,653;CCa,408;Duo,403;Calc,27;CP,19;Neu,10.5;Amp,8(reference range:0-37).The CA19-9 levels were significantly greater for malignant than for benign disease,could differentiate PCa from CCa/Duo,and were significantly higher in unresectable than in resectable *** sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)for CA19-9 were 84.9%,69.7%,67.7%and 86.1%,respectively.A ROC analysis provided an area under the curve for CA19-9 of 0.871(0.820-0.922),giving an optimal CA19-9 of 70.5 U/ml for differentiating benign from malignant *** this cut-off,the sensitivity was 82.1%,while specificity,PPV and NPV improved to 85.9%,81.3%and 86.5%,*** sta

关键词： CA19-9 antigen pancreatic disease biliary tract disease malignant benign

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Clinical features and treatment of sump syndrome following hepaticojejunostomy

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Hepatobiliary & Pancreatic diseases International 2011年第3期10卷 261-264页

作者： Gabriele Marangoni Amir Ali Walid Faraj Nigel Heaton Mohamed Rela King's College London School of Medicine at King's College Hospital Institute of Liver StudiesDenmark Hill

BACKGROUND:Cholangitis after Roux-en-Y hepaticojejunostomy is usually caused by anastomotic stricture.A small number of cases present without evidence of obstruction and are ascribed to reflux of gastro-intestinal content into the biliary tree above the anastomosis (sump syndrome).Despite prophylactic rotating antibiotic therapy,the cholangitic episode may be severe and ***:From 2001 to 2006,six patients who had undergone an end-to-side hepaticojejunostomy presented to our institution with recurrent episodes of biliary *** stricture was excluded by liver MRI/MRCP and percutaneous transhepatic cholangiogram (PTC).Barium meal showed reflux of contrast into the biliary tree in all *** patients had a short jejunal Roux limb (less than 50 cm) on pre-operative ***:Five patients underwent surgery and two of them had two *** patient had a Tsuchida antireflux valve and subsequently underwent lengthening of the Roux *** patients had lengthening of the Roux loop;one underwent re-do hepaticojejunostomy and one had concomitant revision of the hepaticojejunostomy and lengthening of the Roux *** latter underwent further lengthening of the Roux *** patients are cholangitis-free 6,36 and 60 months after surgery;two still experience mild episodes of ***:An adequate length of the Roux loop is important to prevent ***,Roux loop lengthening to 70 cm or more does not always resolve the problem and cholangitis,although generally less frequent and severe,may recur despite appropriate reconstructive or antireflux *** these cases,life-long rotating antibiotics is the only available measure.

关键词： biliary tract surgical procedures biliary tract disease septicemia

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disease spectrum and use of cholecystolithotomy in gallstone ileus

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Hepatobiliary & Pancreatic diseases International 2012年第5期11卷 553-557页

作者： Nicholas E Williams Justin S Gundara Sophia Roser Jaswinder S Samra Upper Gastrointestinal Surgical Unit Royal North Shore HospitalUniversity of SydneySt.LeonardsSydneyNSW 2065Australia

BACKGROUND: Gallstone ileus is a heterogeneous and highly morbid condition that suffers from a lack of consensus regarding the timing and approach to management of the biliary tree and associated fistula. METHODS: We report three cases that demonstrate the spectrum of gallstone ileus with classical examples of both Barnard’s and Bouveret’s syndromes. Clinical presentation diagnostic imaging, surgical technique and outcome are discussed. RESULTS: One patient with Barnard’s syndrome presented with recurrent gallstone ileus. To minimize the risks of complex, definitive biliary surgery and avoid further recurrent episodes, a cholecystolithotomy was performed with effect Two cases of Bouveret’s syndrome were successfully managed with enterolithotomy/cholecystectomy and multivisceral resection respectively, thus highlighting the diverse nature of this disease and management options. CONCLUSIONS: Following enterolithotomy, potentially morbid definitive one-stage surgery in typically compromised, elderly patients needs to be weighed against the risk of recurrence and ongoing biliary pathology. We suggest the use of open cholecystolithotomy for the removal of residual gallstones when the patient is not suitable for definitive biliary surgery.

关键词： cholecystectomy biliary tract disease gallstone ileus biliary tract surgery

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biliary-colonic fistula caused by cholecystectomy bile duct injury

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Hepatobiliary & Pancreatic diseases International 2013年第4期12卷 443-445页

作者： Francisco Igor B Macedo Victor J Casillas James S Davis Joe U Levi Danny Sleeman Dewitt Daughtry Family Department of Surgery University of Miami Miller School of Medicine and Ryder Trauma Center/Jackson Memorial HospitalMiami Florida USA Department of Radiology University of Miami Miller School of Medicine and Ryder Trauma Center/Jackson Memorial HospitalMiami Florida USA

biliary-colonic fistula is a rare complication after laparoscopic cholecystectomy. We present a case of post-cholecystectomy iatrogenic biliary injury that resulted in a fistula between the common hepatic duct and large bowel. Magnetic resonance cholangiopancreatography provided good visualization of injury even with concurrent normal level of alkaline phosphatase. Radiologic findings and surgical management of this condition are discussed in detail.

关键词： cholecystectomy magnetic resonance imaging biliary tract disease

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biliary endoscopy in the management of primary sclerosing cholangitis and its complications

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Liver Research 2019年第2期3卷 106-117页

作者： Brian M.Fung James H.Tabibian University of California Los Angeles-Olive View Internal Medicine Residency Program SylmarCAUSA Division of Gastroenterology Department of MedicineOlive View-University of California Los Angeles Medical CenterSylmarCAUSA

Primary sclerosing cholangitis(PSC)is a chronic,idiopathic,cholestatic liver disease characterized by inflammation and fibrosis of the intrahepatic and/or extrahepatic bile *** can affect individuals of all age groups and gender,has no established pharmacotherapy,and is associated with a variety of neoplastic(***)and non-neoplastic(*** strictures)hepatobiliary *** these considerations,endoscopy plays a major role in the care of patients with *** this review,we discuss and provide updates regarding endoscopic considerations in the management of hepatobiliary manifestations and complications of *** evidence is limited,we suggest pragmatic approaches based on currently available data and expert opinion.

关键词： Primary sclerosing cholangitis(PSC) biliary tract disease Balloon dilation Cholangioscopy Dominant stricture Cholangiocarcinoma(CCA) Endoscopic retrograde cholangiopancreatography(ERCP)

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Pathogenesis of Fibrosing Cholestatic Hepatitis B Post-Liver Transplantation

Pathogenesis of Fibrosing Cholestatic Hepatitis B Post-Liver...

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第二届全国病毒性肝炎慢性化重症化基础与临床研究进展学术...

作者： Xian-li Chen Yu-Ming Wang Institute for Infectious diseases Southwest HospitalThird Military Medical University

Aim:Fibrosing cholestatic hepatitis(FCH) is a particular type of liver failure that was first reported in patients with recurrent HBV after liver transplantation(LT) and termed in the Journal of Hepatology by Susan *** et *** *** has also been reported in other cases,such as HCV-related liver *** development of FCH was associated with a rapidly progressive graft rejection,and the prognosis was usually very *** it has been 20 years since the disease was first described,the pathogenesis is still not clear and the therapeutic effects for this disease have not yet *** hope to identify cases of FCH to better characterize its clinical features and pathogenesis. Methods:From November 1999 to December 2007,303 LTs completed due to hepatitis B virus(HBV)-related end-stage liver disease or liver cancers were investigated *** December 1998 to January 2010,63 renal transplantations(RTs) with HBV were conducted in our *** the pathology database,44 LT cases and 1 RT case were identified with a provisional diagnosis of *** was diagnosed histologically by cholestasis accompanied by thin periportal fibrous septa,a ductular reaction and mild *** expression of hepatitis B viral antigens was quantified using immunohistochemistry and confocal uorescence microscopy in the liver tissue of ten transplant recipients with fibrosing cholestatic hepatitis and compared to patients with recurrent HBV without *** pictures of HBV-related FCH with biliary tract diseases were also compared with other HBV-free patients with biliary tract diseases after liver transplantation. Results:Twenty-one LT cases were *** these patients,biopsy slides of seven(from the early period of our program) were unavailable for review,10 did not meet the histological criteria for FCH and four had missing clinical ***-seven LT recipients had confirmed FCH, which was determined by reviewing the his

关键词： cholestatic liver transplantation recurrent hepatitis B hepatocellular cytopathic effect biliary tract disease

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