A total of 1,867 patients were admitted or readmitted to this department in the period from January 1976 to November 1982 and 1,081 of them underwent certain biliary surgery for the treatment of biliary lithiasis. The operations of 702 cases out of the 1,081 were performed on the biliary duct, either exlrahepatic or intrahepatic. In 333 cases out of the 702 who received extrahspatic biliary surgery, 20 cases were found to have postoperative residual biliary stones (6%); while in 369 cases out of the 702 who underwent intrahepatic biliary operations, 136 cases were found to have residual stones (36.85%). Altogether 156 cases out of the 702 operated cases suffered from postoperative residual biliary stones and the overall incidence was 22%.The predisposing, causes of the occurrence of residual stones were discussed-In order to prevent or reduce the occurrence of residual stones, the key, as suggested by the authors, is to perform every emergency or selected operation very carefully without leaving any hidden trouble.

Objective To investigate the causes of intractable abdominalgia after simple choleystectomy and analyse the therapeutic effect of endoscopic sphincterotomy (EST).Methods 84 patients undergoing EST were retrospectively viewed from 1987 to 1998. Results Sixty five out of 84 patients were followed up, in which the clinical signs disappeared completely in 51 cases (78%), and there were 6 cases with relapsing symptom(9%),3 cases with intermittent relapsing symptom (4%). Therapy was ineffective in 5 cases. The intractable abdominalgia is a specific sign of postcholecystectomy syndrome. EST is effective in removing the nervous structure in duodenal papilla submucosa and sphincter muscle layer responsible for abdominal pain, therefore eliminated or relived the pain.Conclusion EST has a significant effect on intractable abdominalgia after simple cholecystectomy in the majority of patients.

Objective To evaluate the safety,clinical and financial aspects of laparoscopic cholecystectomy(LC).Methods 278 cases undergone LC and 234 cases undergone open cholecystectomy(OC)were compared in retrospective study.Results LC was as safe as OC.In favour of LC,significant differences were observed regarding the time of severe pain,hospitalization and recovery.The total occurences of postoperative complications were low in all the patients undergone LC or OC,and its significantly lower in patients undergone LC than that in those undergone OC.Furthermore,the total charges for LC were significantly lower than that for OC.Conclusions LC is as safe as OC and has clan obvious advantage over OC in clinical,social and financial aspects.

Objective To explore the diagnosis and surgical management of juxtapapillary choledochoduodenal fistula and to evaluate endoscopic retrograde cholangiopancreatography(ERCP) in the diagnosis of juxtapapillary choledochoduodenal fistula. Methods A retrospective clinical analysis was made in reference to the diagnosis and operative intervention for a total of 47 cases of juxtapapillary choledochoduodenal fistula.Results Forty seven fistula cases were diagnosed among 3*!800 patients undergoing ERCP. Thirty four cases were complicated with cholelithiasis and 19 bile duct pneumatosis. Thirty eight patients were operated on including choledocholithotomy in 7 cases and hepatojejunostomy in 31 cases, in which hilar choledochoplasty was added in 4 cases, and 5 cases underwent concomitant hepatic segmentectomy. Conclusion ERCP is the most valuable method in diagnosing and guiding surgical management in juxtapapillary choledochoduodenal fistula.

Internal drainage of the biliary tract such as choledocho-duodenostomy or Roux-en-y choledocho-jejunostomy is a common operation for the treatment of primary choledocholithiasis and biliary stricture. Though these operations can creat a good drainage, serious reflux cholangitis is frequently resulted. In order to prevent this tiresome complication, the authors have designed a new operative procedure: a loop of jejunum is isolated and an artificial papilla is made on its distal end, then its proximal end is joined to the bile duct and its distal end with the artificial papilla is inserted into the duodenum and the two parts are sutured up.This paper is to report this operative method in detail and our experience with 11 cases. After operation, no reflux of the intestinal content into the interposed jejunal loop was found and barium meal could demonstrate reflux of the contrast medium only in one case out of the 11. Ten cases were followed up from 4 to 18 months and excellent results were observed. It proves that this operative procedure can prevent the reflux of chyme into the biliary tract.Interposed jejunal loop with an artificial papilla is more physiological than Roux-en-y choledochojejunostomy since bile can flow through the interposed jejunum loop into duodenum to mix with the pancreatic fluid and the chyme, which is helpful to better digestion.

Objective To investigate the value of endoscopic papillosphincterotomy (EST) in the management of common bile duct stone and constrictive papillitis. MethodsFrom July 1987 to May 2001 746 cases treated with EST were analyzed retrospectively. ResultsThe rates of success in constrictive papillitis and functional disturbance of Oddi′s sphincter were 94.8% and 94.1% respectively. Forty patients (88.9%) with chronic obstructive pancreatitis caused by constrictive papillitis were alleviated and common bile duct stone were removed in 538(94.1%) out of 572 patients after EST. The incidence of complications (severe pancreatitis and hemorrhage) after EST was 2.2% and the mortality was nil. ConclusionEndoscopy is effective and minimally invasive treatment for common bile duct stone and constrictive papillitis.

Bile duct injury caused by abdominal trauma, usually accompanied with injuries of other abdominal organs, is rarely seen. For the reason of its complexity and often delayed diagnosis and treatment, bile duct injury usually leads to severe complications such as abdominal infection. This paper reports a group of 10 cases of bile duct injury treated in our center in the recent decade.