Objective To summary clinical experience of laparoscopic treatment of cholecystitis with cholecystolithiasis complicated,in order to provide reference for clinical difficult laparosco-pic resection of gallbladder.Methods Reviewing the operation treatment of laparoscopic cholecystectomy on 94 complex cases of resection during January 2008 to December 2014.Results The 94 patients included 17 cases with severe adhesion around gallbladder,9 cases with gallbladder atrophy,39 cases with gallbladder ampulla and cystic duct stone incarceration,11 cases with acute gangrenous cholecystitis with gallbladder stones,14 cases with gallbladder triangle anatomy is not clearing and 19 cases with gallbladder stones with schistosomial cirrhosis or liver volume variation.Some cases were with the two or more kinds gallbladder stone.There were 91 cases with successful implementation of the laparoscopic cholecystectomy,4 of 91 cases were treated with subtotal cholecystectomy,and 3 cases were converted to open cholecystectomy.There were no cases with serious complications or even deaths.Conclusion Regarding of the complex gallbladder stones appear different situation in operation,we can complete the operation by using different operation method and treatment method in laparoscopic.

Objective To investigate the reasons for and preventing measures of iatrogenic traumatic pancreatitis after epigastric operations and ERCP.Methods The clinic data of 18 cases of iatrogenie traumatic pancreatitis treated in our hospital from January 1992 to December 2006 were retrospectively analyzed.Results The disease occurred 12 cases after operation and in 6 after ERCP.The iatrogenic traumatic pancreatitis after epigastric operations or ERCP mostly occurred in 1-4 d after the operation.Twelve patients underwent conservative therapy(66.7%)and 6 reoperation(33.3%).Sixteen patients were cured and 2 died of the multiple organ failure after reoperation.Conclusion This complication iS related to the operative skill and expertise.The preventing measures include suitable operative handling,proficiency in technique and drug lessening excretion of pancreatic juice.Conservative therapy is of the first choice unless there is a state of illness alteration.

Objective To investigate the cause, prevention and treatment of biliary fistula after biliary tract operation.Methods Biliary fistula developed postoperatively in 27 out of 3*!786 patients undergoing bile duct surgery from 1991 to 2000. Results Injury of liver bed cholangiole or tiny accessory hepatict duct occured in 8 cases, 1 developed after incision and exploration of CBD in biliary duct cancer, stump leakage of cystic duct in 7, early T tube inadvertent sliding off or after T tube removement in 10. 21 patients underwent conservative therapy (78%), 6 reoperation (22%). Fistula was cured in 26 cases, the remaining one who suffering from late staged bile duct cancer died. Conclusions Biliary fistula often occurs after cholecystectomy, and after the removal of a T tube. Conservative therapy is often successful unless there is a frank peritonitis, biliary tract obstruction, or improper peritoneal drainage.

Objective To explore the diagnosis and treatment of acute biliary pancreatitis (ABP) and when to operate. Methods 126 cases of ABP from Jan. 2005 to Dec. 2009 in our hospital were analyzed retrospectively. Results The cases number of the mild non-obstructive type, mild obstructive type, severe non-obstructive type, and severe obstructive type was 54, 33, 15, 24 respectively. 43 patients underwent early operation, 80 patients underwent postponed operation and three patients died preoperatively as a consequence of fulminat severe pancreatitis. 117 cases ( 92.86% ) were cured and 9 cases ( 7. 14% ) with severe acute pancreatitis died. Conclusion ABP should be treated according to its type. The key to reduce the complications and increase the cure rate is to determine the proper operation time according to the condition of individual patient.

Objective To explore the etiological factors,clinical characteristic and diagnosis of nonacute biliary pancreatitis (NABP) and acute biliary pancreatitis (ABP).Methods The Clinical data of 152 patients with NABP and 206 patients with ABP from January 2004 to December 2014 in the Hepatobiliary Surgery Department of Jinshan Branch of the Sixth People's Hospital of Shanghai were analyzed retrospectively.Results There were no statistically significant differences in terms of the Ranson score,blood amylase and C reactive protein (CRP) between two groups (P ＞ 0.05).The incidences rate of hepatic insufficiency,renal insufficiency and encephalopathy were 35.5％ (54/152),25.6％ (39/152) and 8.5％ (13/152) in the NABP group,and 25.7％(53/206),12.1％(25/206) and 3.3％(7/206) in the ABP group,with significant difference between the two groups (x2 =4.01,10.89,4.41;P ＜ 0.05).Conclusion The key to reduce the complications and improve the cure rate is to make clear the etiology of NABP and ABP and to take active and effective treatment for the cause of the disease.

Objective To explore and analyse the causes of reoperation after biliary duct operation, so as to decrease the reoperation rate of biliary tract. Methods Clinical data of 71 patients who underwent reoperation of biliary duct diseases in our hospital between January 2005 to September 2010 were analysed,and the causes of biliary duct reoperation were summarized and analysed. Results The main cause of reoperation was recurrent or retained bile stone (76.1%,54/71), noncalculous stenosis of biliary tract ( 15.5 %, 11/71 ),biliary tract obstruction due to tumor (4.2%,3/71), and other factors (4.2%,3/71).Conclusion Recurrent or retained bile duct stone were the main cause for biliary reoperation, but noncalculous stenosis of biliary tract and biliary tract obstruction due to tumor could not be ignored. The initial rational operative method, approporiate operation time and the thoroughness of operation are the key factors to decrease bile duct reoperations.

Objective To explore etiological factors, clinical characteristic and diagnosis of acute recurrent pancreatitis (ARP). Methods Clinical data of 68 patients with ARP from Jan. 2003 to Dec. 2009 were reviewed retrospectively. Results Among 532 acute pancreatitis (AP) cases, 68 were diagnosed as ARP ( 12.8% ). The majority of ARP patients were male, amounting 76.5% of the total. The average age of ARP patients was 45.6 years. Cholelithiasis, hyperlipemia and alcohol were the most frequent factors causing ARP. Among the 68 ARP cases, 58 cases were mild (85.3%) and 10 cases were severe ( 14. 7% ). 54 cases underwent surgery or endoscopic treatment (79.4%) while 14 cases underwent non-operative treatment (20.6%). As a result, 66 cases were cured or improved and 2 cases with severe ARP died. Conclusion The key to reduce recurrent rate of ARP is to find out the causes of recurrence and then treat the diseases accordingly.

Objective To explore the clinical characteristic and diagnosis and treatment of HLAP.Methods The clinical data of 38 patients with HLAP were reviewed retrospectively.Results 38 cases were diagnosed as HLAP(10.7%),that included 29 cases with mild acute panereatitis(76.3%) and 9 cases with severe acute panereatitis(23.7%).34 patients were treated by nonsurgical methods(89.5% ),4 by surgery(10.5%),As a result,36 cases were cured and 2 cases with severe acute pancreatitis died.Conclusions HLAP are common,and have particular clinical manifestations.Treatment for HLAP is mainly by nonoperative management.Reducing the blood triglyceride could quickly alleviate symptoms.Surgical treatment should be adopted according to the severity of panereatitis.

Objective To study the etiological factors,clinical characteristics and diagnosis of acute pancreatitis (AP).Methods The clinical data of 217 patients with AP treated from January 2005to December 2010 in our hospital were studied retrospectively.Results The majority of patients were male (60.4％).The average age was 52.5 years.Cholelithiasiss,hyperlipidemia and trauma were the most frequent etiologic causes of AP.There were 164 patients with mild (75.6％) and 53 patients with severe (24.4％) AP.151 patients underwent surgical or endoscopical treatment (69.6 ％) while 66 patients underwent non-operative treatment (30.4 ％).14 of 53 patients with severe AP died.Conclusions AP should be treated according to the cause and the type.The key to reduce complications and increase cure rate is to find the cause of AP and then treat the underlying disease.

Objective To investigate the distribution of biliary bacteriology and their sensitivity to antibiotics in patients with biliary tract infection in Jinshan area in recent 3 years.Methods Bile specimens collected from 367 patients with cholelithiasis between June 2006 and June 2009 were cultured and tested for drug sensitivity to aerobic bacteria.The results were statistically analyzed.Results One hundred and fifty-six bacterial strains were found in 142 (38.7%) bile specimens including gram negative strains (97,62.2%),gram positive strains (51,32.7% ),and fungal strains (8,5.1%).Enterococcus (17.9%) was major pathogen and follwed by Escherichia coli (12.8%),staphylococcus (11.5%),Klebsiella pneumoniae (8.3%),Pseudomonas aeruginosa (7.7%).Whereas the mixed infection was found in 26 (18.3%) specimens.The positive rate of bacterial infection was 53.1% in patients over 60 years of age (X2=8.36,P<0.01 ) and 47.1% in patients with acute biliary infection(X2=4.68,P<0.05).The drug susceptibility revealed that gram negative strains had low resistance to Meropenem (7.5 %),and followed by Imipenem (8.8 %),Cefoperazone +Sulbactam (19.7%),Amikacin (21.9%) and Tazobactam+Piperacillin (TZP,25.3%),but they were highly resistant to Ampicillin,Quinolones and some third generation of Cephalosporins (>50% ).In gram positive strains,none was resistant to Vancomycin,11.3% to fosfomycin and 11.6% to chloromycetin.They were highly resistant to Penicillins,Ampicillin and Cefazollin (>40%).ConclusionsEnterococcus,Escherichia coli,Sstaphylococcus and Klebsiella pneumoniae are commonly seen pathogens in biliary tract infection in Jinshan area.Use of Sulperazone or TZP plus Amikacin and metronidazole is recommended.Imipenem and Vancomycins may be second choice in treatment of severe biliary infection and refractory infection.