Objective To evaluate the clinical application value of the tauro ursodeoxycholic acid (TUDCA) for preventing the relapse of lithiasis after the gallbladder-protected lithotomy. Methods Totally 80 cholecyslithiasis patients in Chengdu General Military Hospital who met the demand of lithotomy in protecting gallbladder were divided into two groups by random permutations, with 40 patients in each. The calculus was removed by using the percutaneous ultrasonic lithotripsy in order to preserve the well-functioning gallbladder. The patients in the trial group were given TUDCA after surgery for two years, whereas the patients in the control group received the same nursing and diet therapies without medication. The thickness of gallbladder wall and the contraction function of gallbladder were checked two years after surgery, the statistics of the recurrence rate of liary calculus symptoms and cholecyslithiasis were conducted, and the comparison between those two groups was performed. Results All the operations of gallbladder-protected lithotomy were successful. There was significant difference between those two groups two years after surgery in terms of the thickness of gallbladder wall and the contraction function of gallbladder (Plt;0.05). The relapse of lithiasis was remarkably decreased in the trial group (Plt;0.05). Conclusion The application of TUDCA for patients with gallbladder-protected lithotomy can prevent the relapse of cholecyslithiasis.
Objective To evaluate the diagnostic value of analyzing the pattern of gallbladder wall enhancement on MDCT to identify the different causes of acute cholecystitis. Methods In January 2009 to December 2012， 169 patients diagnosed with acute cholecystitis caused by various pathologic conditions were performed MDCT scans， the images of portal venous phase and clinical data were retrospectively reviewed by two blinded radiologists. There were 146 cases in non-hepatopathy cholecystitis group and 23 cases in hepatopathy cholecystitis group. The other 5 normal gallbladder cases diagnosed by MDCT scans were retrospectively reviewed as contrast group. Using five patterns according to the enhancement pattern of flat gallbladder wall thickening on MDCT. The study cases were then divided into five patterns and the thickness of the mucous membrane were measured. The occurrence rate of each pattern and the thickness of the mucous membrane between the groups were compared respectively. Results In the non-hepatopathy cholecystitis group， there were typeⅡin 102 cases （69.9%）， typeⅢin 5 cases （3.4%）， typeⅣ in 30 cases （20.5%）， and typeⅤ in 9 cases （6.2%）. In the hepatopathy cholecystitis group， there were typeⅡin 2 cases （8.7%）， typeⅢ in 11 cases （47.9%）， typeⅣin 5 cases （21.7%）， and typeⅤin 5 cases （21.7%）. The occurrence rate of typeⅡin the non-hepatopathy cholecystitis group was significialtly higher than that in the hepatopathy cholecystitis group （P＜0.005）. The occurrence rate of typeⅢ and typeⅤ in the hepatopathy cholecystitis group were significialtly higher than those in the non-hepatopathy cholecystitis group（P＜0.005， P＜0.05）. The occurrence rate of type Ⅳ between the two groups had no significant difference （P＞0.05）. TypeⅠonly present in the contrast group. The non-hepatopathy group’s mean mucous membrane thickness was （2.61±1.30） mm ， which was thicker than the hepatopathy group’s （2.02±0.52） mm（t=2.22， P＜0.05）. Conclusion Analyzing the enhancement pattern of a thickened gallbladder wall on MDCT is helpful in identifying the causes of acute cholecystitis， and the gallbladder perforation or not.
ObjectiveTo investigate clinical value of magnetic resonance imaging (MRI) in differentiating xanthogranulomatous cholecystitis (XGC) with gallbladder cancer (GBC). MethodsMRI data of 7 patients with XGC and 13 patients with GBC proved by surgery and pathology were analyzed retrospectively. The main contents of the observation included:①Maximum thickness of gallbladder wall; ②Diffuse thickening or localized thickening of gallbladder wall; ③Enhancement pattern (uniform or nonuniform) of gallbladder wall; ④Gallbladder wall sandwiches enhancement; ⑤Gallbladder wall nodules; ⑥Completeness of gallbladder mucosa lines; ⑦Obstruction of biliary tract; ⑧Calculus in gallbladder or bile duct; ⑨Involvement of adjacent liver; ⑩Definition of surrounding fat layer; Lymphadenopathy. ResultsIn above 11 MRI comparing features, these features such as the gallbladder wall sandwiches enhancement, the gallbladder wall nodules, the completeness of gallbladder mucosa lines, the biliary obstruction, and the lymphadenopathy were statistically significant between the XGC and the GBC (P < 0.05), while the rest features such as the maximum thickness of gallbladder wall, the type of gallbladder wall thickening, the gallbladder wall enhancement pattern, the calculus in gallbladder or bile duct, the involvement of adjacent liver, and the definition of surrounding fat layer were not statistically significant between the XGC and the GBC (P > 0.05). ConclusionMRI has important values in differentiating XGC with GBC.
Objective To explore the operative managements of ectopic gallbladder during laparoscopic cholecystectomy (LC).Methods Twenty one cases of ectopic gallbladder undergone LC in this hospital were analyzed regarding the perioperative management, principle, and technique of operation.Results There were 2 cases of situs transversus, 1 case with gallbladder under right posterior lobe of liver, 2 under left lateral lobe of liver and 16 in the liver. All 21 cases of ectopic gallbladder had undergone LC successfully, and no complications were found during and after operation. Conclusion Anatomic ectopia of gallbladder tosses a challenging problem to laparoscopic surgeon. It is safe for surgeons to recognise actual anatomical anomaly and to manage them appropriately.
The expression of p21, p53, bcl-2 oncoprotein was evaluated using immunohistochemistry in 40 patients with gallbladder carcinoma and 8 patients with gallbladder adenomous polyp. In the study, the positive rate of expression of p21, p53 and bcl-2 oncoprotein was 52.5%, 52.5% and 70.0% respectively in gallbladder carcinoma, while, in gallbladder polyp, they were 0%, 0% and 100% respectively. The positive rate of expression of p53 oncoprotein was significantly higher in poor-differentiated adenocarcinomas than in well-differentiated ones (Ｐ＜0.05). The converse was true for bcl-2 oncoprotein. The positive rate of expression of p21 and p53 oncoprotein was significantly higher in metastatic group than in non-metastatic one. These results suggest that the patients with the expression of p21, p53 might be of poor-prognosis.
ObjectiveTo investigate the prevalence of gallbladder stone in dialysis patients, determine whether it is higher than that in the general population, find out the difference of prevalence between hemodialysis and peritoneal dialysis patients, and analyzes the possible causes. MethodsWe analyzed the prevalence of gallbladder stone in 358 dialysis patients (126 cases of hemodialysis and 232 cases of peritoneal dialysis) followed up in our hospital from January 2009 to October 2012. And we compared it with 376 patients diagnosed with chronic kidney disease stage 5 (CKD5) and the general population. ResultsThe prevalence of gallbladder stone in dialysis patients followed up in our hospital was 23.5%, which was higher than CKD5 patients (P=0.002). The prevalence was significantly greater in dialysis patients than that in the general population (P<0.000 5). In the dialysis patients who were younger than sixty years old, the prevalence of gallbladder stone in peritoneal dialysis patients was obviously higher than that in the hemodialysis patients (P<0.05). The albumin level was significantly lower in peritoneal dialysis patients than in the hemodialysis patients. At the same time, cholesterol, low density lipoprotein, and the ratio of low density lipoprotein to high density lipoprotein were much higher with statistical significance. Logistic regression analysis showed that increasing age (OR=2.581, P=0.001), female (OR=2.554, P=0.000), the primary disease (diabetes mellitus) (OR=1.947, P=0.044) and dialysis period (OR=1.000, P=0.006) were risk factors for gallbladder stone in dialysis patients. ConclusionThe prevalence of gallbladder stone in dialysis patients is higher than that in the general population. Peritoneal dialysis patients have more risk factors to get gallbladder stone than hemodialysis patients. Risk factors for gallbladder stone in dialysis patients are increasing age, female, primary disease (diabetes mellitus), dyslipidemia, hypoalbuminemia, long dialysis period and so on.
Objective To discuss the relationship between motilin, vasoactive intestinal peptide and the gallstone formation. Methods The level of motilin, vasoactive intestinal peptide in plasma, bile and gallbladder tissue of 48 cases of chololithiasis before operation and the first, third, seventh day after cholecystectomy were mesured by radioimmunoassay. Results The level of motilin in plasma was markedly increased in patients with chololithiasis before cholecystectomy and the first day after cholecystectomy. The level of motilin, vasoactive intestinal peptide in bile and gallbladder tissue were significantly increased in patients and motilin was positively correlated with vasoactive intestinal peptide in the gallbladder tissue. Conclusion Motilin, vasoactive intestinal peptide might affect the gallstone formation by affecting the motility of gallbladder.
Objective To evaluate the expression of cyclin E and p27kip1 protein and their significance in gallbladder carcinoma. Methods SP immunohistochemistry was used to detect the expression of cyclin E and p27kip1 protein in 41 cases gallbladder carcinomas,15 cases chronic cholecystitis tissues. Results The positive rate of cyclin E in gallbladder carcinoma was 61.0%（25/41）,which was significantly higher than that in chronic cholecystitis (20.0%，3/15)，P＜0.05; The expression of cyclin E positively correlated with tumor TNM staging (r=0.314,P＜0.05). The positive rate of p27kip1 in gallbladder carcinoma was 53.7%(22/41),which was lower than that in chronic cholecystitis (100%). The positive rate of p27kip1 was decreased with the poor differentiation and progression of TNM staging. There was negative correlation between cyclin E and p27kip1 expression (r=-0.342,P＜0.05). Conclusion The high expression of cyclin E and the decreased expression of p27kip1 result in abnomal regulation of cell cycle,which may be associated with gallbladder carcinogenesis and progression.
【Abstract】ObjectiveTo study the apoptosis of gallbladder carcinoma cell line GBCSD induced by antisense oligodeoxynucleotide (ASODN) targeting survivin. MethodsASODN targeting survivin was transfected into GBCSD cells mediated by lipofectin. Cultured cells were divided into 3 groups: control group,sense oligonucleotide (SODN) group and ASODN group. After transfected for 16 h, the cultured cells were harvested and the following texts were carried out. The expression of survivin mRNA was detected by RTPCR. Flow cytometer were used to detect apoptosis. Morphological changes were observed by electron microscopy. ResultsThe expression of survivin mRNA was decreased 47.83% in ASODN group while apoptosis was increased from (0.50±0.23)% to (26.28±3.91)%. Abnormal morphological changes of cells were observed in ASODN group and apoptosis bodies were found in some gallbladder carcinoma cells. ConclusionThe expression of survivin may be decreased in GBCSD cells after ASODN transfection.ASODN targeting survivin could induce gallbladder carcinoma cells apoptosis effectively.
ObjectiveTo discuss the clinical effects of T-tube with side holes in the gallbladder-common hepatic duct anastomosis. MethodsThe clinical data of 60 cases that performed gallbladder-common hepatic duct anastomosis from Jul. 2009 to Jul. 2012 were retrospectively analyzed. The contractile functions and mucosal recovery of gallbladder were compared between the conventional T-tube and T-tube with side holes. ResultsTwenty-four cases of gallbladder-common hepatic duct anastomosis used conventional T-tube, the gallbladder were not developing in 6-8 weeks after operation by T-tube cholangiography, the gallbladder mucosa of 17 cases were normal without edema, congestion and edema were observed in 6 cases, and the normal gallbladder mucosa structure disappeared in 1 case. The gallbladder were developing in 6-8 weeks after operation by T-tube cholangiography in 36 cases that used T-tube with side holes, the gallbladder mucosa structure had not congestion, edema, and erosion. The gallbladder contractile function were normal. ConclusionsThe floc, blood clots, and inflammatory substances in gallbladder can be discharged into the intestine or drainage in vitro, and the bile can go into gallbladder and can be concentrated through the T-tube with side holes. Physiological flow of bile can return to normal and the function of gallbladder can recover early.