Objective To evaluate the efficacy of laparoscope, choledochoscope and duodenoscope in the treatment of extrahepatic bile duct stones. Methods The clinical data of 610 patients with extrahepatic bile duct stones who had received the treatment with laparoscope, choledochoscope and duodenoscope in our hospital from September 1997 to January 2007 were retrospectively analyzed. Patients with bile duct stones received ERCP or EST, and patients with cholecystolithiasis + choledocholithiasis underwent the treatment with laparoscope+ duodenoscope, or laparoscope + choledochoscope, or laparoscope + duodenoscope + choledochoscope. Results The operation was successful in 589 patients, with the successful rate of 96.6%. The duration of hospital stay was 7-28 days (mean, 13 days). No severe complications such as bile leakage, duodenal leakage, duodenal papilla bleeding, acute cholangitis occurred. Four hundred and eleven patients had been followed up for 1 to 3 years (mean, 13 months), and no bile duct stone recurrence or other complications occurred. Conclusions For patients with bile duct stones, the treatment with ERCP or EST is appropriate. Laparoscope + endoscopes in the treatment of cholecystolithiasis combined with choledocholithiasis is safe and effective.

Objective To explore the protective effect of portal vein administration of propofol on hepatic ischemia reperfusion injury(HIRI) and its mechanism.Methods Thirty-two male rabbits were randomly allocated into four groups:Group A(sham operation group),the abdomen was only opened and closed;group B,the hepatic inflow was occluded for 30 min,and reperfused for 60 min;group C,the same managment as group B + propofol injected through jugular vein;group D,the treatment same as group B + propofol injected through portal vein.Drug injection was completed 20 min before hepatic inflow occlusion.Serum ALT and AST,and endothelin-1(ET-1) and nitric oxide(NO)in the hepatic tissue and blood,and the content of ATP in hepatic tissue were determined.Results The level of ET-1 in plasma and hepatic tissue was significantly increased in group B compared to group C and D(P

Objective To analyze the risk factors of bile duct injuries in laparoscopic cholecystectomy.Methods The clinical data of 11 243 patients who underwent laparoscopic cholecystectomy between October 1992 and December 2013 in the Xianyang Center Hospital were studied retrospectively.The risk factors of bile duct injuries were analyzed using the Chi-square test to determine the independent risk factors of bile duct injuries.Results Univariate analysis showed that bile duct injuries were associated with male,age ≥65 years,BMI ≥25 kg/m2,staging of inflammation,gallbladder atrophy on ultrasonography,thickness of gallbladder wall on ultrasonography,anatomy of Calot 's triangle and operator's experience (all P ＜ 0.05).Multi-factor and non conditional Logistic regression analyses showed that the independent risk factors of bile duct injury were old men,gallbladder atrophy,anatomy of Calot's triangle and operator's experience (All P ＜ 0.05).Conclusion Old men,gallbladder atrophy,anatomy of Calot's triangle and operator's experience were independent risk factors of bile duct injuries.

Objective To explore the curative effect and prevention of complications of emergency laparoscopic cholecystectomy(LC) for acute cholecystitis.Methods The clinical data of 1 278 patients with acute cholecystitis who were treated with emergency laparoscopic cholecystectomy from July 2004 to July 2010 in our haspital were collected and analyzed retrospectively.Among these patients,471 cases had mild acute cholecystitis,720 cases had acute suppurative cholecystitis and 87 cases had acute gangrenous cholecystitis.The impaction of stones in the neck of gallbladder was present in 823 cases.The impaction of stones in the cystic duct was present in 157 cases.In 96 cases emergency operation was performed within 48 hours after the synptoms occurred,in 799 cases operation was performed from 48 to 72 hours,and in 383 cases operation was undertaken after 72 hours.Results The mean operation time was 40min(20-90 min) and the mean blood loss was 80ml(20-300 mL).Early postoperative fever(38.0～39.5℃) developed in 375 cases.Temporary jaundice was found in 108 cases.Bile leakage occurred in 17 cases.No LC cases were converted to open cholecystectomy.No cases were complicated with bile duct injury and there was no mortality.Conclusions Emergency laparoscopic cholecystectomy for acute cholecystitis is difficult.The probable complication rate is quite high.Severe complications can be avoided with skillful surgical technique and rich operative experience.Acute cholecystitis is not a contraindication for emergency laparoscopic cholecystectomy.

Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2％).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.