Objective To study the expression of p16 and Rb gene in primary gallbladder carcinoma (PGC). MethodsFiftysix cases of PGC and 26 of gallbladder benign lesions were observed by immunohistochemistry (SP). ResultsThe positive rates of p16 and Rb protein in PGC were 46.3% and 71.4% respectively. No association of Rb expression with histological grade, histological type, invasion, metastasis and prognosis was found. There were close correlation between p16 expression and invasion, metastasis as well as prognosis. The inverse correlation of p16 and Rb gene expression in PGC was confirmed. Conclusion The loss of p16 or Rb gene protein is an important molecular event in PGC,and closely related to the block in the negative regulatory pathway of all cell cycle. The detection of p16 protein may be useful in evaluating biological characteristics and prognosis in PGC.
Objective To study the relation between retinoblastoma (Rb) gene expression and biological characteristics of gallbladder carcinoma. Methods The expression of Rb protein in tissues of 41 cases of gallbladder carcinoma, 7 cases of gallbladder papilloma, and 14 cases of cholecystitis were detected by immunohistochemical staining of SP with polyclonal antibody. Results The rate of positive staining was 58.7% in gallbladder carcinoma which was significantly lower than that in cholecystitis and gallbladder papilloma (100%). There was a significant difference of Rb protein expression among the low, moderate and high differentiations and so was between S5, S4, S1, S2 and S3 stage (Ｐ＜0.05). Conclusion It sugests that expression or non-expression of Rb gene is closely related to the malignant potential invasiveness and prognosis of gallbladder carcinoma.
Objective To investigate the method of single umbilical port laparoscopic cholecystectomy and its feasibility. Methods The clinical data of 46 patients receiving single port umbilical laparoscopic cholecystectomy in this hospital from December 2008 to February 2009 were analyzed retrospectively. Results Fourty-six cases were operated successfully with ordinary laparoscopic instruments by single umbilical port laparoscopic cholecystectomy, all without drainage placed. Operative time was from 40 to 130 min, average 52.3 min; bleeding was from 10 to 150 ml, average 40.6 ml. No complications, such as biliary leakage, hemorrhage, umbilical hernia and infection of incisional wound happened. Postoperative abdominal wall scar was not obvious, 1-4 d hospitalization, from 2 weeks to 3 months following-up without disconnecting of incision. Conclusions The single umbilical port laparoscopic cholecystectomy is safe and feasible, with little abdominal wall scar, but difficult to perform, so it can be applied in hospitals with related conditions as improvements of laparoscopic cholecystectomy.
The quantitative studies of secretory granules andand lysosomes in gallbladder epithelium and gallbladder bile glycoprotein were performed in 20 gallstone patients and 15 gallstone-free subjects. The results showed that the number, the volume density and the total secrectory granules were significantly increased in gallstone patients compared with gallstone-free controls. The gallstone patients had a markedly reduced number,volume destiny and total lysosome area compared with gallstone-free subjects. The glycoprotein concenrtation in gallblader bile was increased up to 21.04±4.92g/L in gallstone paients,as compare with 13.02±5.72g/L(Plt;0.05)in the stone-free controls. The qualitity of secretory granules and lysosomes was directly proprtational to that of bile glycproteins. Evidence and secrectory granules and lysosomes was directly proporional to taht of bile glycoproteins. Evidence and argument are presentded suggesting that gallblader epithelium secrectory granules affect the concentration of bile glycoprotein and lysosomemay be related to the intracellular degradation of secretory granules.
【Abstract】ObjectiveTo explore the relationship between anomalous pancreaticobiliary ductal junction(APBDJ) and gallbladder carcinoma. MethodsThe current related literatures were reviewed.ResultsAPBDJ was associated with gallbladder carcinoma development. A proposed mechanism was free reflux of pancreatic juice into the gallbladder and molecular alterations of gallbladder epithelial cells.ConclusionAPBDJ is a high risk factor for gallbladder carcinoma. Prophylactic cholecystectomy is recommended for patients with APBDJ.
Objective To explore the effect of gallbladder preserving surgery with laparoscope and choledochoscope.Methods The data of 60 cases of gallbladder preserving surgery with laparoscope and choledochoscope （observation group） and carried out with the same period 61 cases of small incision gallbladder preserving surgery （control group） between June 2008 to January 2013 were retrospective analyzed. Results All patients were followed up for （18±2.4）months （6-36 months）. The intraoperative blood loss， postoperative gallbladder hemorrhage rate， gallbladder dysfunctionrate， postoperative hospitalization time， stone recurrence rate， and reoperation rate in observation group were less orlower or shorter than the control group （P＜0.05）. The operative time and hospital costs in observation group were longeror higher than that of the control group （P＜0.05）. The rest of the observation index of two groups were no significant differences （P＞0.05）. Conclusions The gallbladder preserving surgery with laparoscope and choledochoscope is safeand feasible in technique level， and the short-term effect after operation is better. But the operation indications must be controlled strictly. The long-term efficacy needs further accumulation of cases and collect enough evidence to verify.
ObjectiveTo investigate the CT and MR imaging features and distribution characteristics of lymphatic nodal involvement in patients with gallbladder carcinoma. MethodsThirtyseven histopathologically proven cases of gallbladder carcinoma with regional lymphatic nodal enlargement in upper abdomen were included into the study. The lymph nodal short diameter of equal to or larger than 10 mm was used as the criteria for positive lymphadenopathy. Thirtyone cases underwent contrastenhanced spiral CT scanning, 6 cases had MR imaging studies. CT and MR images were jointly evaluated by three radiologists with especial attention to the size and location of enlarged lymph nodes in upper abdomen.ResultsThe enlarged lymph nodes were observed in four anatomic locations in the upper abdominal region. ①The retroportal and retropancreatic group in which lymph nodes were located along the cystic duct and common bile duct, in the portocaval space and behind the pancreatic head. ②The celiac group in which enlarged nodes distributed along the common hepatic artery and surrounded the celiac trunk. ③The mesenteric group in which lymph nodes assembled at the mesenteric root and around the superior mesenteric vessels. ④The abdominal aorta group in which lymph nodes scattered at the left side of abdominal aorta and in the aortocaval space at the level of the left renal vein. The spiral CT visualization rates for the above 4 groups of lymphadenopathy were 89.1%(33/37), 78.3%(29/37), 29.8%(11/37) and 51.3%(19/37) respectively.ConclusionCT and MR can clearly depict the four location sites of lymphadenopathy in patients with gallbladder carcinoma, which closely reflects the three major lymphatic spreading pathways of gallbladder carcinoma, namely, the cholecystoretropancreatic, cholecystoceliac and cholecystomesenteric routes.
Objective To evaluate the sclerosing effects of several chemical sclerosants on the gallbadder mucosa in vivo. Methods Twentyeight rabbits were randomly divided into： Normal saline was used as contrast agent, and 95% ethanol, 5% tetracycline and compound phenol as sclerosants respectively. The cystic duct was ligated and cholecystostomy was performed for each animal. Sclerosants and contrast agent were injected into the gallbladder through a tube respectively and were kept in the gallbladder for 15 minutes. Animals were killed two weeks later; the gallbladder, bile duct and adjacent liver tissue were obtained for histopathological examination. Results With the naked eye, normal saline and 5% tetracycline made the cavity of the gallbladder unchanged; 95% ethanol made two gallbladder cavities occluded, two smaller, and three unchanged; and compound phenol made four gallbladder cavities occluded, and three smaller. In histopathological observations, 95% ethanol and compound phenol could make seven rabbits’ gallbladder mucosa completely destroyed (7/7); compared with normal saline (1/7), there was significant difference (P＜0.01). Five percent tetracycline had some effect of ablating the gallbladder mucosa (5/7), but compared with normal saline, there was no difference (Pgt;0.05). Conclusion Ninety-five percent ethanol can be clinically applied as an effective and safe sclerosant.
Injury of the gallbladder beds on the liver during laparoscopic cholecystectomy of 178 cases for the last year waas analysed. Reoperations in 6 cases with one death due to major postoperative complications. These injuries could be classified into 3 degrees according to extent of liver parenchyma denuded in the bed . Degree Ⅰ, no liver was denuded in the bed with the fibromembranous lining intact (49 cases);Degree Ⅱ, liver denuded area was less than one half of the bed (90 cases);Degree Ⅲ, liver denuded area was greater than half of the bed ( 39 cases). There was close relationship between grade of the bed injury and the postoperative complication. Leaving the lining intact of the bed was most important during the lapatoscopic cholecystectomy in order to prevent complication from the bed. The method was discussed. Drainage of the subhapatic space was suggested when liver bed is denuded.
ObjectiveTo study the effects of the expressions of endostatin, basic fibroblast growth factor (bFGF) and CD34 on oncogenesis and progression of gallbladder cancer, and to explore some valuable criterias for its biotherapy. Methods The expressions of endostatin, bFGF and CD34 were studied by means of immunohistochemistry (SP) in 61 cases of gallbladder cancer and 10 cases of normal cholecystic tissue, and microvessel density (MVD) was calculated by the expression of CD34. Their relationships with clinical pathological features were also investigated. Results The expression rates of endostatin in normal cholecystic tissue and in gallbladder cancer tissue were 40.00% (4/10) and 77.05% (47/61) respectively, which had statistical difference (P＜0.05). The expression of endostatin in 61 cases of caner was relational to clinical stage and metastasis of lymph nodes (P＜0.05), while no significant correlation was detected with sex and age of patient, location of tumor, size of tumor and histologic grade (P＞0.05). The expression rates of bFGF in normal cholecystic tissue and in gallbladder cancer tissue were 20.00%（2/10） and 67.21% （41/61） respectively, which had statistical difference (P＜0.05). The expression of bFGF in 61 cases of caner was relational to clinical stage and metastasis of lymph nodes (P＜0.05), while no significant correlation was detected with sex and age of patient, location of tumor, size of tumor and histologic grade (P＞0.05). MVD in gallbladder cancer tissue and in normal cholecystic tissue was （76.66±20.15） piece/HP and (29.53±5.03) piece/HP respectively, showing significant difference (P＜0.01). In 61 cases of cancer, MVD in clinical stage Ⅲ～Ⅴ 〔(80.53±17.98) piece/HP〕 was much higher than that in stage Ⅰ+Ⅱ 〔(46.79±5.38) piece/HP〕, P＜0.01; MVD was higher in those with lymph nodes metastasis 〔(94.60±7.28) piece/HP〕 than those without metastasis 〔(58.12±9.24) piece/HP〕, P＜0.01; and MVD was (60.59±14.71) piece/HP in histologic grade G1， (83.08±15.30) piece/HP in G2， and (96.53±6.92) piece/HP in G3, the difference was significant among them （P＜0.01）. There was no significant correlation between MVD and sex and age of patient, location of tumor and size of tumor (P＞0.05). There were statistically significant correlations between expressions of endostatin and MVD （P＜0.01）, expressions of bFGF and MVD （P＜0.01）. Conclusions The result suggests that endostatin, bFGF and CD34 play roles in oncogenesis and progression of gallbladder cancer. Detection of these proteins has positive effects on diagnosis, malignant degree determination and treatment of gallbladder cancer.