Biomedical subjects

C G Ker

Publications and source records attributed to C G Ker.

76 records · Page 5Linked to original sources

PubMedDate not supplied

Subcutaneous implantation of KMC tube for removal of recurrent intrahepatic stones without laparotomy.

About half of 361 patients with intrahepatic stones had recurrent stone(s) requiring additional surgery in the past 10 years. In order to cope with this problem, a new tube referred to as the KMC (Kaohsiung Medical College) tube was developed to allow the removal of stones without additional surgery. This tube was implanted subcutaneously between the common bile duct and the abdominal wall after successful extrication of intra- or extra-hepatic stones. Thirty-nine patients with intrahepatic stones were accepted for this new trial. The surgical procedure consisted of first removing the biliary drainage tube followed by insertion of the KMC tube. The KMC tube was introduced through a small skin incision under local anesthesia and the KMC tube fixed with abdominal fascia. The benefit of this procedure is that the contrast medium could be percutaneously injected into the tube for follow-up cholangiographic study when necessary. The procedure for removal of recurrent stones included removing the KMC tube under local anesthesia, then inserting the choledochofiberscope through the original sinus tract to engage the stone(s) without laparotomy. This procedure had been performed on 4 patients with successful removal of their recurrent stones after 6 to 24 months without the necessity for abdominal surgery.

Aged↗

PubMedDate not supplied

Evaluation of choledochojejunostomy with subcutaneous jejunostomy for treatment of intrahepatic stones.

Twenty-nine patients, 16 males and 13 females, with intrahepatic stones were treated by choledochojejunostomy with subcutaneous jejunostomy after choledocholithotomy in cases where the common bile duct was dilated more than 2 cm in diameter. This surgical technique consists of putting a segment of jejunum in the subcutaneous area with a jejunostomy after finishing the choledochojejunostomy. If the stone recurs years later, this loop of jejunum will offer a route for inserting the scope while producing the fistulotomy under local anesthesia. These patients became symptomless soon after removal of the residual stone by postoperative choledochoscope. After more than five years of follow-up study, seven cases (24.1%) had reflux cholangitis and among them, four patients had recurrent stones. Reopening of the fistulotomy was carried out under local anesthesia, and the choledochoscope was inserted into the bile duct through the jejunum for removal of those recurrent stones. We believe that this surgical technique is very effective for the treatment of patients with recurrent intrahepatic stones without the necessity of major laparotomy.

Adult↗

PubMedDate not supplied

Conservative hepatic resection for hepatocellular carcinoma of cirrhotic patients.

We evaluated in retrospect the applicability of conservative hepatic resection for hepatocellular carcinoma (HCC) of cirrhotic patients. Eighty (14.6%) of 548 patients with HCC underwent liver resection over a period of 10 years in this hospital. They were divided into two groups according to surgical procedures. In group I, 22 patients underwent major hepatic resection, and in group II, 58 patients underwent conservative liver resection. The operative mortality for patients in group I was 13.6% while it was 3.5% for those in group II. The difference was significant (p<0.05). The five-year survival rate was 22% for patients in group I, while it was 21% for group II patients. The rate of HCC recurrence was 47.4% for group I patients while it was 57.1% for group II patients. The difference was not significant. The tumor-free survival rates at 6-, 12-, 24- and 36-months were 80%, 75%, 55% and 55% respectively for patients in group I, while they were 50%, 42.5%, 42.5% and 42.5% for patients in group II. It suggested that conservative liver resection was associated with early recurrence of HCC. But the difference of mean tumor-free survival time is not significant (35.82+/-5.47 vs 38.63+/-8.05 months, p>0.05). Using Cox's regression analysis, the presence of Child's B was identified as an independent adverse prognostic factor (p=0.000) for long-term survival. The factors associated with poor tumor-free survival rate were Child's classification (p=0.008), metastasis (p=0.021), liver cirrhosis (p=0.039) and tumor size (p=0.054). By evaluating the operative mortality, long-term survival rate, prognostic factors for cumulative survival time and tumor-free survival time, it suggests that conservative liver resection can be selectively used to treat HCC associated with liver cirrhosis.

Adult↗

PubMedDate not supplied

Morphology of intrahepatic duct in surgical treatment of hepatolithiasis.

BACKGROUND/AIMS: Surgery is the usual treatment for hepatolithiasis. However, the method of choice is based on intrahepatic duct morphology. MATERIAL AND METHODS: Six hundred sixty-two patients with hepatolithiasis were operated on in the period between 1980-1994. Hepatolithiasis was clinically classified into primary (75.8%) and secondary (24.2%) types. RESULTS: Patients treated between 1990-1994 (35.9%), liver resection was performed in 71 patients (69 of left and 2 of the right liver). However, liver resection was chosen only in 6.7% (11/163) during the 1970s. Candidacy for liver resection increased recently due to the increase in primary type. According to the morphology of intrahepatic ducts, the location of stricture was classified into: Central type (n = 59, 30%), Segmental type (n = 101, 51%), and Subsegmental type (n = 21, 10.6%), and unclassified (n = 17, 8.4%). Liver resection was recommended for patients of segmental or subsegmental type. Choledocho-lithotomy with T-tube drainage was indicated in two third of the patients with hepatolithiasis. However, the incidence of post-operative retained stones was very high, and post-operative choledochoscopic lithotripsy was used to treat these post-operative problems easily. The mortality of this disease was 1% (2/198) in the 1990s compared with that of 4.1% (19/464) in 1980s and 10.1% (15/148) in 1970s. CONCLUSION: We strongly recommend that liver resection for patients with adequate indications will have good results. In addition, one should pay attention to the abnormal pattern of intrahepatic ducts that are commonly found in patients with hepatolithiasis during liver resection. Liver resection is an ideal surgical method for the eradication of diseased lesions and to prevent malignant changes from bile duct with stones. Concise information concerning the anatomic structure was found to be important in determining post-operative results in the management of hepatolithiasis.

Bile Duct Diseases↗