Objective To explore the origin of chronic subdural heamatoma.Methods Follow-up 92 patients of acute subdural haematoma(ASDH)and 207 patients of traumatic subdural effusion(TSE)S by CT or MRI.Results None of ASDHs developed into CSDHs directly,but ASDHs could become to CSDHs via TSEs;67 cases of TSE was proved becoming to CSDHs by CT scanning or operation.Conclusions Origin of CSDH is TSE.

Objective To probe the prevention and management of complications after laparoscopic cholecystectomy (LC). Methods Retrospective study was performed on 13 000 patients, who underwent LCs from September 1991 to February 2005 at our department. Results The complication rate was 1. 66% (216 patients) including intraabdominal hemorrhage in 21 patients (0. 16%),bile duct injury in 11 (0. 08% ),gastrointestinal perforation in 7(0. 05% ) , bile leakage in 26(0. 20% ) , retained abdominal tumor in 10(0. 08% ) , retained common bile duct stones in 47(0. 36% ) , intraabdominal abscess in 4(0. 03% ) , upper gastrointestinal hemorrhage in 2(0. 02% ) , extensive subcutaneous emphysema in 32 (0. 25% ) , port wound infection in 46(0. 35% ) , incisional hernia in 1 (0. 01% ) and deep vein thrombosis in 9 (0.07%). Six patients died postoperatively. Conclusions LC is a safe technique when up-to-date equipment and meticulous dissection techniques are employed. With the routine procedure, LC can be performed more safely.

Objective To report a randomized trial in comparing the clinical outcomes of three-port LC versus standard four-port LC. Methods From March 2001 to August 2004, four hundred consecutive patients who underwent elective LC were randomized to receive either the three-port or the four-port technique. All patients were blinded to the type of operation they underwent. Postoperative overall pain and incisional pain at different sites were assessed on the first day after surgery using the Prince-Henry scale. Other outcome measures included length and success of the operation, analgesia requirements, postoperative complications, postoperative stay, and the cosmetic results. Results There was no difference between the two groups in age, sex, weight or other diseases. In terms of outcome, patients in the three-port group had less pain at individual subcostal port sites and better cosmetic results. Success rate, mean operative time, complications, subxiphoid port and overall pain score, analgesia requirements, and postoperative hospital stay were similar between these two groups. Conclusion Three-port LC resulted in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port LC. The three-port technique is as safe as the standard four-port procedure for LC. Thus, it can be recommended as a routine procedure in elective LC.

OBJECTIVETo evaluate the role of laparoscopic ultrasonography(LUS) in prevention of bile duct injury(BDI) and residual common bile duct (CBD) calculi during complicated laparoscopic cholecystectomy (LC).

METHODSOne hundred and four cases of LC were defined complicated because of anatomic aberrance of the extrahepatic biliary system, unconfirmed exposed cystic duct, suspected CBD calculi or BDI, adhesion or inflammation in the Calot's triangle, acute cholecystitis, and atrophic gallbladder. LUS was performed to scan the extrahepatic bile duct. LC was carried out with assistance of the LUS.

RESULTSAssisted with the LUS demonstrated anatomic relationship between the extrahepatic bile duct and cystic infundibulum or cystic duct, 85 cases of LC were accomplished successfully. 19 were converted to open cholecystectomy because of LUS-indicated potential risk of BDI, CBD calculi, and suspected BDI.

CONCLUSIONSWith the extrahepatic bile duct visualized by LUS and contrast of the cystic infundibulum and cystic duct, operators can precisely identify the anatomic relationships between the cystic infundibulum, cystic duct and extrahepatic bile duct. Preoperatively unpredicted choledocholithiasis may be recognized.

Adult ; Aged ; Aged, 80 and over ; Bile Ducts, Extrahepatic ; diagnostic imaging ; Cholecystectomy, Laparoscopic ; adverse effects ; methods ; Cystic Duct ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Ultrasonography