The results of surgical treatment in 100 patients with intrahepatic gallstones are reported including follow-up on 61 patients who survived more than three years. Nine patients died in the follow-up period, and of the remainder, 44 showed complete rehabilitation (72%). The results of follow-up examinations were best shown by improvement in the tests of hepatic function when compared with the values at the time of discharge. However, in those patients with a long duration of illness, or with residual stones or with impairment of liver function, many claimed persistent complaints and showed abnormal late values of hepatic function. Patients with intrahepatic gallstones are best managed: 1) removal of all gallstones as thoroughly as possible, 2) additional procedures to eliminate bile stasis and permit residual stones to enter the intestinal tract and 3) irrigation of the biliary ducts to remove remaining stones.
The present authors have made it a rule to use a modified Mellet-Guy's method for measuring pressure in the bile duct. The determined manometric pressure expressed in curve has been classified into (a) basal pressure, (b) rising time, (c) perfusion pressure, (d) dumping time and (e) residual pressure. The basal pressure (a) represents a static pressure free from any load in the bile duct. The rising time (b) varies with factors including the measuring apparatus, duetal elasticity and capacity, resistance at the choledochal terminal, and the volume of physiological saline infused. The perfusion pressure (c) is likely to undergo interference of a variety of factors such as the duetal diameter, mural elasticity and thickness, resistance at the choledochal terminal, along with the measuring apparatus. The dumping time (d), free from the influence of the measuring apparatus, is considered to be an important guide for us to guess the condition of choledochal terminal. The residual pressure (e) and the trend of manometric pressure curve help us to surmise the choledochal terminal resistance and the presence of duetal abnormalities. After all, among the above factors, the dumping time and the residual pressure are apparently available for objective evaluation of bile duct pressure. biliary pressure; cholelithiasis; bile duct; papilla of Vater In the biliary tract surgery, it is important to ascertain abnormalities, either functional or organic, in the terminal portion of the common bile duct. Bile duct pressure, one of the essential factors with relation to the condition of the biliary tract, is usually determined during and after operation. The intraoperative measurement is made in an effort to confirm the presence or absence of stenosis at the choledochal terminal and to determine the indication for transduodenal sphincteroplasty, while the postoperative determination via a T-tube is made to judge an adequate time for withdrawing the T-tube inserted into the common bile duct. In search of a reliable technique for identifying disorder in the terminal portion of the bile duct along with the development of intraoperative cholangiography, radioman.ometry was devised by Caroli (1942) and Mallet-Guy (1952) to observe abnormal conditions of that region. Their original methods have since been improved remarkably. In this paper, we report the details of our perfusion method and its clinical significance.
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