To study the red cell′s deformation and the immune adhesion functions to tumor cell in patients with primary gallbladder carcinoma (PGC)， twenty-seven patients with PGC and twenty normal persons were investigated by means of BL88B type laser diffraction RBC deformation instrument and agglutinate method of tumor cell. The result showed that the RBC deformation index was lower in patients with PGC than that in the normal persons (Ｐ＜0.01). Also was the enhance factor of RBC immune adherent functions lower than that in the normal persons. While the inhibitory factor was higher than that in the normal persons. The result suggests that the decrease of RBC immune function be related with change of serum modulating factors in patient with PGC.
Objective To study the relationship between the expression of apoptosisrelated gene bclx,bax and estrogen receptor (ER) in primary gallbladder carcinoma (PGC) and its clinical significance. MethodsImmunohistochemistry of labeled dextran polymer (LDP) with EnvisionTM system was used to detect ER and gene bclx and bax. ResultsThe positive rate of bclx,bax and ER were 72.3%,66.0% and 59.6% in 47 cases with primary gallbladder carcinoma and 40.0%,93.3% and 93.3% in 6 cases with gallbladder adenomahyperplastic. The expression of bax and ER in PGC was significantly lower than that in gallbladder adenomahyperplastic (P＜0.05),the expression of bclx was significantly higher in PGC than that in the latter (P＜0.05).The expression of bclx and ER in well differentiated PGC was significantly higher than that in moderately, poorly differentiated PGC (P＜0.05); bax expression in well differentiated PGC was lower. ER and bax expression in male PGC was significantly lower than that in female PGC （P＜0.01）, the expression of bclx in male PGC was higher (P＜0.05).ER was more highly expressed in smaller PGC than in larger one (P＜0.05). ER and bax, bclx were not different between various clinical stages and ages (P＞0.05,respectively). Conclusion The expression ER, apoptosisrelated gene bclx and bax have correlation with differentiation and sex in PGC, their levels shows significance in the prognosis of PGC.
ObjectiveTo investigate the value of single incision laparoscopic cholecystectomy in the operation of benign diseases of the gallbladder in day surgery.MethodThe clinical data of 105 patients underwent the single incision laparoscopic cholecystectomy in the Day Operation Center of Zhengzhou Central Hospital of Zhengzhou University from March 2017 to December 2018 were retrospectively analyzed.ResultsThe single incision laparoscopic cholecystectomies were successfully performed in 105 patients with benign gallbladder diseases, including 65 cases of gallbladder stones, 26 cases of gallbladder polyps, 14 cases of gallbladder adenomyosis; 45 cases of men and 60 cases of women. In all cases, no incision was increased or no case was converted to laparotomy. No bile duct injury and intra-abdominal bleeding happened during the operation. All patients were discharged overnight (no more than 24 h) after the surgery and without delayed discharge and re-admission. The intraoperative blood loss was (10.3±3.5) mL, and the operation time was (55.0±25.5) min (from laparoscopy to gallbladder removal). The postoperative pain score was 1–2 and 0–1 on day 1 and on day 3 after the surgery, respectively. The postoperative incision cosmetic satisfaction score on month 6 after the operation was 4.5±0.5.ConclusionSingle incision laparoscopic cholecystectomy is safe and feasible for benign gallbladder disease during day surgery.
We reviewed the clinical studies on drug therapy for gallbladder cancer and expounded on the current situation of conversion therapy for gallbladder cancer. Gallbladder cancer was usually diagnosed late, with high malignancy, low surgical resection rate, and poor prognosis. With the development of conversion therapy, systemic therapy combined with radical resection had effectively improved the surgical resection rate and prognosis of gallbladder cancer patients. At present, most of the published conversion therapies for gallbladder cancer were mainly retrospective researches, lacking large multicenter prospective research, and the treatment plan was still based on chemotherapy, lacking the research of targeted therapy in combination with immunotherapy. It is expected that more high-quality clinical trials can be made first-line recommendations for the conversion therapy of gallbladder cancer.
ObjectiveTo study the efficacy and safety of early laparoscopic cholecystectomy with percutaneous transhepatic gallbladder drainage (PTGBD) in the treatment of elderly patients with high risk moderate acute cholecystitis.MethodsThe clinical data of 218 elderly patients with high risk moderate acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to October 2019 were retrospectively analyzed, including 112 cases in the PTGBD combined with early LC sequential treatment group (sequential treatment group) and 106 cases in the emergency LC group. In the sequential treatment group, PTGBD was performed first, and LC was performed 3–5 days later. The emergency LC group was treated with anti infection, antispasmodic, analgesia, and basic disease control immediately after admission, and LC was performed within 24 hours. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative catheter retention time, postoperative anal exhaust time, postoperative hospitalization time, hospitalization cost, incidence of incision infection, and incidence of complications above Dindo-Clavien level 2 were compared between the two groups to evaluate their clinical efficacy and safety.ResultsAll patients in the sequential treatment group were successfully treated with PTGBD, and the symptoms were significantly relieved within 72 hours. There were significant differences in the operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative tube retention time, postoperative anal exhaust time, postoperative hospitalization time, incidence of incision infection, and the incidence of complications above Dindo-Clavien level 2 between the two groups (P<0.05), which were all better in the sequential treatment group, but the hospitalization cost of the sequential treatment group was higher than that of the emergency LC group (P<0.05). There were no cases of secondary operation and death in the 2 groups. After symptomatic treatment, the symptoms of all patients were relieved, without severe complications such as biliary injury and obstructive jaundice. All the 218 patients were followed up for 4–61 months, with an average of 35 months. During follow-up period, 7 patients in the sequential treatment group had postoperative complications, and complications were occurred in 13 patients in the emergency LC group.ConclusionPTGBD is the first choice for elderly high risk moderate acute cholecystitis patients with poor systemic condition and high risk of emergency surgery, but it has the disadvantage of relatively high medical cost.
The morbidity and mortality of gallbladder cancer were rising. At present, there was no effective chemotherapy regimen, so it was of great practical significance to explore new therapy target. Ferroptosis is a non-apoptotic form of cell death characterized by iron-dependent lipid peroxidation and metabolic constraints. In recent years, it had become a research hotspot. Many studies had been carried out on the relevant biological mechanisms such as liver cancer, breast cancer, pancreatic cancer, and other cancer. At present, there are still few studies on ferroptosis in gallbladder cancer, and its relevant mechanisms need further in-depth analysis, which opens up a new research direction for exploring the treatment of gallbladder cancer.
Objective To study the association and the effect of the expression of p16 and p53 protein on the occurence and development of gallbladder carcinoma. Methods The expression of p16 and p53 protein were detected in 40 cases of gallbladder carcinoma with immunohistochemical method. Results The expressions of p16 and p53 protein were closely correlated to the tumor pathological grade, lymph mode metastasis and prognosis. p16 protein was correlated to the Nevin classifications. Conclusion The results indicate that the low expression rate of p16 protein occurred in the advanced stage of gallbladder carcinoma. The expression of p16 and p53 protein are helpful in judging the malignant degree and prognosis of primary gallbladder cancer.
Gallbladder polypoid lesion (GPL) is a common gallbladder disease, mainly including tumor lesions such as gallbladder cancer and gallbladder adenoma and non-tumor lesions such as cholesterol polyps and gallbladder adenomyomatosis. Contrast-enhanced ultrasound (CEUS) can improve the diagnostic accuracy of GPL. This paper reviews the application progress of CEUS in the diagnosis of gallbladder cancer, gallbladder adenoma, gallbladder cholesterol polyps and gallbladder adenomyosis, and the limitations of CEUS in the diagnosis of GPL.
Objective To observe the expression of Ezrin protein in primary carcinoma of gallbladder tissue and the levels of CEA and CA19-9 in serum of patients with primary carcinoma of gallbladder, and to explore the relationship between the expressions of these measurements and clinicopathologic characteristics. Methods Immunohistochemistry was applied to analyze the expression of Ezrin protein in primary carcinoma of gallbladder and chronic cholecystitis tissue. The levels of CEA and CA19-9 in serum and clinicopathologic characteristics of all including patients were detected with clinical measurement. All data were analyzed statistically. Results ①The positive rates of Ezrin protein in primary carcinoma of gallbladder and chronic cholecystitis tissue were 66.7% （40/60） and 30.8%（4/13）, respectively (χ2=5.57, Plt;0.05). ②There was no difference between the expression of Ezrin protein in primary carcinoma of gallbladder tissue and age or gender (Pgt;0.05). However, difference was significant between the Ezrin expression and degree of difference, pNevin stages, pTNM stages, lymph node metastasis or distant metastasis (Plt;0.05). ③There were no differences between the positive rates of CEA and CA19-9 in primary carcinoma of gallbladder and age or gender (Pgt;0.05). However, differences were significant between the positive rates of CEA and CA19-9 and pNevin stages, pTNM stages, degree of difference, lymph node metastasis or distant metastasis (Plt;0.05). ④There was some relationship between the expression of Ezrin protein and the positive rate of CEA (rs=0.213, Plt;0.05), but not with the positive rate of CA19-9 (rs=0.081, Pgt;0.05). Conclusions The high expression of Ezrin protein may promote the invasion and metastasis in primary carcinoma of gallbladder. It could be possible to decide the outcome of primary carcinoma of gallbladder through the combined analysis on the expression of Ezrin protein and the serum levels of CEA and CA19-9.
ObjectiveTo review the latest advances in diagnosis and treatment of gallbladder carcinoma.MethodsThe recent literatures on diagnosis and treatment of gallbladder carcinoma at home and abroad were reviewed, and the diagnosis, staging and treatment progress of gallbladder carcinoma were systematically reviewed.ResultsThere are many methods to diagnose gallbladder carcinoma, among which imaging methods are commonly used, as well as various tumor markers and gallbladder carcinoma-related genes. Surgical resection is still the only possible cure for gallbladder carcinoma, but the scope and timing of surgical resection are still controversial. Radiotherapy, chemotherapy and gene therapy also play an important role in the treatment of gallbladder carcinoma.ConclusionsImaging examination is still the first choice for the diagnosis of gallbladder carcinoma. The tumor markers and gene diagnosis has broad prospects. Gallbladder carcinoma is mainly treated by surgery. Gene intervention and precise targeted therapy are the future development direction.