ObjectiveTo investigate the feasibility, safety, cost, and patient satisfaction of ambulatory laparo-scopic cholecystectomy(ALC). MethodsThe clinical data of patients who divided into ALC group(678 cases) and in-patient laparoscopic cholecystectomy(IPLC) group(1 534 cases) in our hospital from April 2011 to December 2012 were retrospectively analyzed. The operative time, conversion rate, complication rate, hospitalization time, cost of hospi-talization, rehospitalization rate, and patient satisfaction were analyzed and evaluated. ResultsThere were no significant differences of the operative time, postoperative complication rate, and rehospitalization rate between the 2 groups(P > 0.05). The conversion rate(0.44%), and hospitalization time[(1.2±0.5)d] of the ALC group were significantly lower or shorter than those of IPLC group[3.19%, (4.8±1.3) d], P < 0.05. The direct, indirect health care costs, and the total costs of the ALC group were (6 555.6±738.7), (230.0±48.0), and (8 856.0±636.0) yuan, respec-tively; and lower than those of the IPLC group[(7 863.71, 014.6), (973.0±136.5), and(8 856.0±636.0)yuan], P < 0.05. ConclusionALC is safe and feasible, and could shorten the hospitalization time, lower the medical cost, speed up the bed turnover, and increase the efficiency in the use of health resource.
Objective To explore the effects of bile from patients with cholecystolithiasis on the growth of human gallbladder carcinoma cells GBC-SD and the potential correlation between cholecystolithiasis and gallbladder carcinoma. Methods Cholecystolithiasis bile (CB) and normal bile (NB) specimens were used for this study. The proliferative effects of bile were measured by methabenzthiazuron (MTT) assay and cell cycle and apoptosis were analyzed by flow cytometry. Results CB can significantly promote the proliferation of GBC-SD cells, GBC-SD proliferative index increased significantly after treated with 1% CB for 48 h （P＜0.05）.The Sphase fraction of CB 〔（49.26±8.07）%〕 increased remarkably (P＜0.05) compared with that of NB 〔（25.54±6.57）%〕, and the CB percentage of G0/G1 phase 〔（40.59±9.12）%〕 decreased remarkably (P＜0.05) compared with NB 〔(60.64±13.42）〕%. Conclusion CB can promote the proliferation of human gallbladder carcinoma GBC-SD cells.
Objective To evaluate the use of fast track surgery （FTS） in the treatment for cholecystolithiasis combined with calculus of common bile duct （CBD） by combination of laparoscope and duodenoscope. Methods One hundred and twenty patients with cholecystolithiasis combined with calculus of CBD underwent laparoscopic cholecyst-ectomy （LC） and endoscopic retrograde cholangiopancreatography （ERCP） were divided into FTS group （n=55） and conventional group （n=65），which were accepted the perioperative therapy of FTS or conventional therapy，respectively. After operation，the incision pain，nausea and vomiting，infusion time，loss of body weight，out-of-bed time，dieting time，postoperative hospitalization，hospital costs，and complications were compared in two groups. Results Compared with the conventional group，the postoperative infusion time，dieting time，out-of-bed time，and postoperative hospitali-zation were shorter，the incidence rates of pulmonary infection，and urinary systems infection，pancreatitis，nausea and vomiting， and incision pain were lower，the loss of body weight was lower in the FTS group （P＜0.05），but the differences of WBC and serum amylase at 24 h after operation were not significant between the FTS group and conventional group（P＞0.05）. Conclusion The FTS is safe，economic，and effective in the treatment for cholecystolithiasis combined with calculus of CBD by combination of laparoscope and duodenoscope.
Objectiveofthisstudyistoprognosethepossibilityofdevelopinggallstoneinsubjectswiththedyslipidemiaandobesity.Themultivariablelogisticregressionmodelwasusedtoevaluatetheoddsratio(OR)ofthedyslipidemiaandobesitytoinducetheformationofgallstone.ORgt;1indicatesdangerousfactor,ORlt;1protectivefactor,andOR=1nosignificance.Theresultsshowedthatiftriglyceride(TG)andverylowdensitylipoproteincholesterol(VLDLC)increasedanaveragelevelofnormalrespectively,andtherewouldbeORofTG2.43(Plt;0.05)andORofVLDLC6.09(Plt;0.05),thehighlevelsofTGandVLDLCwerethefactorsoflithogenesis.Highdensitylipoproteincholesterols(HDL1C,HDL2C,HDL3C),withORlessthanone,werethefactorsofprotectingagainsttheformationofgallstone.ORoflowdensitylipoproteincholesterol(LDLC)andORoftotalcholesterol(TC)werealsolessthanone,butpresentresearchindicatedthattheymaybeawayoflipidmetabolismnottobeaprotectivefactor.ORofBMIinmalesubjectswas1.16(Pgt;0.05),andinfemale1.38(Plt;0.05).Thesesuggestthatbothcorrectionofthemetabolismofdyslipidemiaandreductionofbodyweightareimportanttodecreasethemorbidityofcholecystolithiasis.
ObjectiveTo summarize the clinical experience on primary suture after common bile duct exploration and to investigate its clinical indications and curative effects. MethodsThe clinical data of 137 patients underwent primary closure of common bile duct between February 2006 and June 2010 were analyzed retrospectively. ResultsAll operations were successful. The operative time ranged from 65-213 min (mean 129 min) and the blood loss ranged from 50-350 ml with an average of 148 ml. One hundred and twenty-four patients (90.5%) were discharged from hospital without complications within 7 d after operation. Postoperative bile leakage occurred in 13 patients (9.5%) consisted of 10 early stage cases (18.5%, 10/54) and 3 later stage cases (3.6%, 3/83), which were discharged with improvement by conservative treatment within 3 weeks after operation. Totally 113 patients (82.5%) were followed up for 2-54 months with a median time of 14 months, no residual or retained stone and biliary duct stricture occurred. ConclusionOnly with the strict indication and proficient surgical technology, primary suture after common bile duct exploration is a safe and effective way to choledocholithiasis.
【Abstract】ObjectiveTo investigate the effects of cholecystokinin （CCK） on diabetes mellitus with cholecystolithiasis. MethodsRelevant literatures of recent years were reviewed. ResultsCCK exists widely in human body．On the one hand, CCK enhances cholecystolithiasis by causing diabetes. On the other hand, its pathological changes can also lead to cholecystolithiasis. Besides, it is possibility that the CCKrelated gene abnormality is the common cause of diabetes and cholecystolithiasis. ConclusionCCK plays an important role in diabetes mellitus complicated with cholecystolithiasis. However, there is much yet to be known about CCK．
The present study was designed to elucidate the role of apoE polymorphism in the lithogenesis of cholecystolithiasis and to explore the hereditary pathogenesis of the disease. Polymerase Chain Reaction (PRC) was used as researching apoE phenotypes and allele frequencies in patients with gallstones (n=87) and in controls (n=50), and the fasting serum lipids of subjects were also measured. The characteristics of lipid variants were analysed among the patients with different apoE phenotypes. The results showed that the levels of TG (1.43mmol/L), VLDL-C(0.68mmol/L) in E2/3 patients were greatly higher than those in E2/3 controls (1.06mmol/L, Ｐ＜0.05 and 0.48mmol/L, Ｐ＜0.05), and LDL-C (1.41mmol/L) was markably lower in E2/3 patients than that in controls (2.04mmol/L, Ｐ＜0.05). The levels of serum lipids decreased significantly in E3/3 patients with HDL-C (0.89mmol/L), HDL2-C (0.49mmol/L), HDL3-C (0.39mmol/L), and compared with those in E3/3 controls (1.28mmol/L Ｐ＜0.05, 0.73mmol/L Ｐ＜0.001 and 0.55mmol/L Ｐ＜0.001). In E3/4 patients there were only slight changes of VLDL-C, LDL-C level. The results suggest that the average level of serum lipids in the same apoE phenotype patients with gallstones is higher than that in controls, and the different apoE phenotypes patients with gallstones have different characteristics of dyslipidemia. ε2 allele is probably one of the dangerous factor in the lithogenesis of cholecystolithiasis.
Objective To discuss the therapeutic effect and safety of laparoscopic cholecystectomy plus laparoscopiccommon bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincte-rotomy plus LC （ERCP/EST＋LC） for cholecystolithiasis with choledocholithiasis patients with obstructive jaundice. Methods The clinical data of cholecystolithiasis with choledocholithiasis patients with obstructive jaundice from January2011 to June 2012 were analyzed retrospectively. During this period， 48 patients were treated by LC＋LCBDE （LC＋LCBDE group）， and 76 patients by ERCP/EST＋LC （ERCP/EST＋LC group）. Results ①There were no statistical significances in the age， gender， preoperative total bilirubin， alanine aminotransferase， number and maximum diameter of common bile duct stone， and internal diameter of common bile duct in two groups （P＞0.05）. ②No perioperative mortality occurred and no significant differences were observed in terms of stone clearance from the common bile duct， postoperative morbidity， and conversion to open surgery in two groups （P＞0.05）. However， the operative time and post-operative hospital stay in the LC＋LCBDE group were shorter than those in the ERCP/EST＋LC group （P＜0.05）. In addi-tion， the costs of surgical procedure and hospitalization charges in the LC＋LCBDE group were less than those in the ERCP/EST＋LC group （P＜0.05）. Conclusions Both LC＋LCBDE and ERCP/EST＋LC are safe and effective therapies forcholecystolithiasis with choledocholithiasis patients with obstructive jaundice. However， LC＋LCBDE is better for pati-ents’ recovery and cost effective. Especially for patients with common bile duct＞1.0cm in diameter or with multiple common bile duct stones， LC＋LCBDE is the best choice. To sum up， the choice of minimally invasive treatment must be individualized according to the patient’s condition and the availability of local resources.
Objective To evaluate the clinical effectiveness of laparoscopic cholecystectomy and laparoscopic common bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincterectomy with LC（ERCP/EST＋LC） in treatment for cholecystolithiasis with choledocholithiasis. Methods From January 2008 to July 2011， 127 patients suffered from cholecystolithiasis with choledocholithiasis underwent either LC＋LCBDE（85 cases， LC＋LCBDE group） or ERCP/EST＋LC（42 cases， ERCP/EST＋LC group） were collected retrospectively. The clearance rate of calculus， hospital stay， hospitalization expenses， and the rate of postoperative complications were compared between two groups. Results Eighty-five patients were performed successfully in the LC＋LCBDE group， out of which 54 patients had primary closure of common bile duct （LC＋LCBDE primary closure group）， whereas in 28 patients common bile ducts were closed over T tube （LC＋LCBDE＋T tube group）. Forty-two patients were performed successfully in the ERCP/EST＋LC group. There were no differences in the clearance rate of calculus〔100%（82/82） versus 97.37%（37/38）， P=0.317〕 and postoperative complications rate 〔（4.71% （4/85） versus 4.76%（2/42）， P=1.000〕 between the LC＋LCBDE group and ERCP/EST＋LC group. The median （quartile） hospital stay in the LC＋LCBDE group was shorter than that in the ERCP/EST＋LC group 〔12 （6） d versus 17（9） d， P＜0.001〕. In the LC＋LCBDE primary closure group， both median （quartile）?hospital stay and median（quartile） hospitalization expenses were less than those of ERCP/EST＋LC〔hospital stay：11（5） d versus 17（9） d， P＜0.001；hospitalization expenses：27 054（8 452） yuan versus 31 595（11 743） yuan， P=0.005〕 . Conclusions In the management of patients suffered from cholecystolithiasis with choledocholithiasis， both LC＋LCBDE and ERCP/EST＋LC are safe and effective. LC＋LCBDE， especially primary closure after LCBDE， is associated with significantly less costs as compared with ERCP/EST＋LC. Moreover， patients can be cured by LC＋LCBDE through one-stage treatment with the protection of the papilla function and no limits to the amount or size of the choledocholithiasis. The LC＋LCBDE is a preferable choice for the appropriate cases of cholecystolithiasis with choledocholithiasis.
63 normal human gallbladders (non-stone group) and 47 inflammed cholesterol stone gallbladders(stone group) were assayed for the amount of macrophages(ΜΦ),the levels of tumor necro-sis factor (TNF) and interleukin 1(1L-1).It was found that in stone group,the amount of ΜΦ was significantly higher than in non-stone group(ΜΦ4101.90±295.72 vs 572.13±30.07AU,Plt;0.01).The levels of TNF and 1L-1 released mainly from the MΦ in stone group were also significantly increased in comparison with those in non-stone group(TNF 18.12±2.03 vs 4.45±0.39ng/mg,Plt;0.001;1L-1 102.42±7.84 vs 66.75±9.50u/mg protein,Plt;0.05).These results suggest that the activited ΜΦ and increases of TNF,1L-1 may be closely related to the inflammatory reaction in gallbladders and the formation of cholesterol gallstones.