ObjectiveTo evaluate the feasibility and surgical techniques of laparoscopic subtotal cholecystectomy （LSC) in treatment for patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy. MethodsThe clinical data of 83 patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy admitted to this hospital between January 2006 and April 2010 were analyzed retrospectively. ResultsEighty-one patients were performed LSC, 2 patients were converted to laparotomy. In which 39 patients with the part of wall residual of the fundus and (or) body of the gallbladder, 26 patients with residual of part of gallbladder neck, 18 patients with residual of part of gallbladder body and neck. Fifty-one cases were followed-up for 3 months to 4 years, there were 2 patients with the change like “mini gallbladder” by B ultrasound and no obviously clinical symptoms. There was no ostcholecystectomy syndrome in the patients with follow-up. ConclusionsLSC is a safe, effective, feasible procedure for severe gallstone gallbladder inflammation, adhesion, or atrophy, which can effectively prevent bile duct injury, bleeding, or other serious complications. While it can also reduce the rate of conversion to laparotomy.
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.
ObjectiveTo investigate the effect of combined or non-combined liver resection for T2a gallbladder cancer. MethodsAccording to the established inclusion and exclusion criteria, the patients with T2a gallbladder cancer admitted to Peking Union Medical College Hospital from January 2016 to December 2021 were retrospectively collected, then were assigned into combined with liver resection group and non-combined with liver resection group. The general characteristics, perioperative information, and prognosis of the two groups were compared. ResultsA total of 58 patients were enrolled in this study, including 23 males and 35 females; aged (64.8±11.1) years. There were 43 cases in the combined with liver resection group and 15 cases in the non-combined with liver resection group. There were no statistic differences in the demographic data, lifestyle, onset symptoms, preoperative combined diseases, and preoperative tumor markers between the two groups (P>0.05). Compared with the combined with liver resection group, the proportion of patients received bile duct resection was higher (P=0.013) and the operation time was shorter (P=0.045) in the non-combined with liver resection group. There were no statistic differences in the other perioperative informations between the two groups (P>0.05). A total of 12 patients had postoperative complications, including 3 cases of grade Ⅰ, 8 cases of grade Ⅱ, and 1 case of grade Ⅲa by Clavien-Dindo classification. All patients improved after treatment and were discharged smoothly. No patient was readmitted within 30 d after discharge. All 58 patients were followed up with a median follow up time of 29 months. During the follow-up period, there were 47 cases (81.0%) of tumor-free survival, 2 cases (3.4%) of survival with tumor, and 9 cases (15.5%) of death. There were no statistic differences in the overall survival and disease-free survival between the two groups by log-rank test (χ2=3.418, P=0.064; χ2=1.543, P=0.214). ConclusionFromthe results of this study, for T2a gallbladder cancer, liver resection would not result in increased complications or longer hospital stay, but don’t obviously improve prognosis.
Expression of bcl-2 in 45 cases of primary gallbladder carcinomas and 39 cases of gallbladder adenomas were detected by streptavidin-biotin-peroxidase complex (SABC) methods. The results revealed that the positive rate of bcl-2 in primary gallbladder carcinomas was 71.1% and that in gallbladder adenomas was 87.2%, there was no obvious difference between them (Ｐ＞0.05). Expression of bcl-2 in well, moderately and poorly differentiated primary gallbladder carcinomas were 82.8%, 82.4% and 50.0% respectively with significant statistical difference (Ｐ＜0.01). The positive rate of bcl-2 in stages Ⅰ,Ⅱ and Ⅲ of primary gallbladder carcinomas were 81.3% and 55.2% respectively with no significant differnce. The result suggests that expression of bcl-2 in primary gallbladder carcinomas has no correlation with clinic stages.
Objective To investigate the role of KiSS-1 gene in the metastatic process of carcinoma of gallbladder and the clinicopathologic significance of KiSS-1 gene expression in carcinoma of gallbladder. Methods Pathological specimens from 59 gallbladder carcinoma tissues (13 hepatic invasion and 13 lymphatic invasion tissues were included), matched with 7 para-tumor and 6 normal gallbladder tissues, were examined for the expression of KiSS-1 gene by tissue microarray technique and immunohistochemistry (EnVision). Results The positive rate of KiSS-1 expression was down-regulated (P＜0.05) in tumor tissues, as compared with normal and para-tumor tissues. In carcinoma of gallbladder, the expression of KiSS-1 had no relationship with the gender, age, tumor size, histological grade or differentiation, and metastasis of lymph node, while was associated with the depth of infiltration, invasion of liver and the clinical stages (Nevin). In Ⅰ+Ⅱ, Ⅲ+Ⅳ and Ⅴ stage, the positive rates of KiSS-1 were 92.3%, 57.1% and 27.8% respectively, with an undeniably clear lowering tendency (P=0.002). Conclusion Down-regulating expression of KiSS-1 is closely associated with the processes of genesis, invasion and metastasis in carcinoma of gallbladder, and may participate in regulating these processes.
Objective To compare the clinical efficacy and safety of suturesuspension single hole laparoscopic cholecystectomy and traditional laparoscopic cholecystectomy (LC) in the treatment of gallbladder disease. Methods A total of 86 cases who got treatment in our hospital from February 2014 to July 2015 were collected prospectively, and then 86 cases were divided into 2 groups: 43 cases of control group underwent LC and 43 cases of experimental group underwent suturesuspension single hole laparoscopic cholecystectomy. Clinical efficacy and safety of the two groups were compared. Results ① Complication. No one suffered from bile duct injury, bile leakage, bile duct stricture, and umbilical hernia; but there were 2 cases suffered from complications in control group, including 1 case of abdominal pain and 1 case of bloating, and the morbidity was 4.65% (2/43). The morbidity of experimental group was 0, there was no significant difference between the 2 groups in the morbidity (P>0.05). During the follow-up period, 1 case suffered from long-term compilation in experimental group, and 2 cases in normal group, there was no significant difference in the long-term complication between the 2 groups (P>0.05). ② Operation and hospitalization. The blood loss and operation time in the experimental group were lower than those of the control group (P<0.05), but there was no significant difference in the hospital stay and hospitalization cost between the 2 groups (P>0.05). ③ Postoperative electrolytes, liver and kidney function. The levels of Na+ and K+ in the experimental group were higher than those of the control group (P<0.05), and the levels of alanine aminotransferase and aspartate aminotransferase were lower than those of control group (P<0.01), but there was no significant difference in the blood urea nitrogen and serum creatinine between the 2 groups (P>0.05). ④ The recovery of gastrointestinal function after surgery. The anal exhaust time and bowel sounds recovery time in experimental group were shorter than those of the control group (P<0.01). Conclusion Suturesus-pension single hole laparoscopic cholecystectomy in the treatment of gallbladder disease is safe, effective, and minimally invasive, and it has little disturbance on gastrointestinal function and liver function, which is worthy of clinical application.
ObjectiveTo discuss the reason and treatment strategy of gallbladder muddy stones after cholecysto-lithotomy. MethodsThe clinical data of 62 patients with gallbladder muddy stones after cholecystolithotomy who were treated in our hospital from December 2008 to December 2014 was analyzed retrospectively. ResultsThere were 43 patients without any symptom and 19 patients with acute cholecystitis in 62 patients. Four patients were diagnosed with septation gallbladder, 6 patients with long and tortuous cystic duct, 3 patients with calculus of cystic duct, 4 patients with common bile duct stones, 39 patients with periampullary diverticula, 18 patients with pancreaticobiliary maljunction, 6 patients with duodenal papilla stenosis, 29 patients with duodenal papillitis, and 3 patients with duodenal papilla adenocarcinoma. Two patients were treated with laparoscopic cholecystectomy (LC), 1 patient with endoscopic sphincterotomy (EST) /endoscopic balloon dilation (EPBD) and LC, 1 patient with percutaneous transhepafic gallbladder drainage (PTGD) and open cholec-ystectomy, 14 patients with PTGD and EST/EPBD, 1 patient with PTGD and hepatocholangioplasty with the use of gallbladder (HG), 34 patients with EST/EPBD, 3 patients with EST/EPBD and endoscopic biliay metal stent drainage (EBMSD), 5 patients with HG, and 1 patient with EST/EPBD and HG. The gallbladder muddy stones disappeared after operations in 55 patients with gallbladder reserved, and gallbladder ejection fraction increased from (42±12) % to (59±16) %. Of the 62 patients, 53 patients were followed up for 6 months to 6 years (the median time was 3.6-year). During the follow-up period, 3 patients were diagnosed with gallbladder stones, 2 patients with common bile duct stones, and 2 patients with intrahepatic and extrahepatic bile duct stones. ConclusionBile efferent tract obstruction is the important reason for the formation of gallbladder stones. HG, EST, and balloon expansion are the efficient methods to resolve the bile efferent tract obstruction.
ObjectiveTo analyze the epidemiological characteristics and trends of gallbladder cancer incidence and mortality in Zhejiang cancer registration areas from 2000 to 2021, providing a basis for formulating prevention and control strategies for gallbladder cancer. MethodsData on incidence and mortality were collected from 22 cancer registry areas in Zhejiang Province from 2000 to 2021, calculating the crude incidence (mortality), age-standardized incidence / mortality rate by Chinese standard population(ASR China), age-standardized incidence /mortality rate by World standard population (ASR World) and cumulative rate (0–74 years old). The average annual percentage change (AAPC) was calculated by using Joinpoint software. ResultsIn 2021, the crude incidence of gallbladder cancer in Zhejiang cancer registration areas was 6.79 per 100 000. The ASR China and ASR World were 2.99 and 2.96 per 100 000, respectively, ranking 18th of all new cancer cases. The incidence ASR China in female (3.13 per 100 000) was higher than that in male (2.85 per 100 000). The incidence ASR China in rural areas (3.01 per 100 000) was slightly higher than that in urban areas (2.97 per 100 000). The crude mortality of gallbladder cancer was 5.14 per 100 000, with the mortality ASR China and ASR World of 2.09 and 2.10 per 100 000, respectively, ranking 10th of all new cancer deaths. The mortality ASR China in female (2.19 per 100 000) was higher than that in male (1.98 per 100 000). The mortality ASR China in urban areas (2.11 per 100 000) was slightly higher than that in rural areas (2.07 per 100 000). Both the crude incidence and mortality of gallbladder cancer increased with age. The crude incidence and mortality showed an upward trend over time, with AAPC of 2.59% and 3.75%, respectively (P<0.001). The incidence ASR China did not show significant changes over time (AAPC=0.05%, P=0.856). The incidence ASR China in male and rural areas showed increasing trends over time, with AAPCs of 0.89% (P=0.016) and 1.14% (P=0.001), respectively. The incidence ASR China in female and urban areas showed no significant trends over time, with AAPCs of –0.26% (P=0.503) and –0.02% (P=0.967), respectively. The mortality showed a slower upward trend after adjusting the age structure (AAPC=1.01%, P=0.020). ConclusionsThe elderly population in rural areas, especially elderly women, are the primary targets for the prevention and control of gallbladder cancer. Aging is the main factor contributing to the increase in the incidence and mortality of gallbladder cancer. After adjusting for demographic factors, the overall upward trend of the incidence in the male population and rural areas, as well as mortality, cannot be ignored.
With the development and popularization of imaging technology, the discovery of gallbladder lesions has become common, among which non-neoplastic lesions (such as gallbladder stones, cholecystitis, gallbladder polyps, gallbladder adenomyosis, etc.) are common but sometimes the imaging manifestations are not specific, and there are many kinds of such diseases, so accurate imaging diagnosis is still quite challenging. Familiarity and understanding of the typical imaging manifestations of these diseases will help to improve the early and accurate diagnosis and help to distinguish them from gallbladder malignant diseases, which is of great significance to the diagnosis, guiding treatment and prognosis of patients.
ObjectiveTo analyze risk and therapy strategy of tiny gallbladder stones during laparoscopic cholecystectomy (LC).MethodThe clinical data of 932 patients with tiny gallbladder stones performed LC from September 2013 to July 2014 were analyzed retrospectively.ResultsThe LC was successful in all the patients. The gallbladders were ruptured in 86 (9.23%) patients during operation. Following up 1-3 months, there were 26 patients with right upper abdominal pain and with residual small stones in the abdominal cavity, 57 patients without uncomfortable symptoms and without residual gallstone, 2 cases complicated with lesser abdominal abscess, 1 case complicated with incision infection. The incisional hernia and acute pancreatitis were not found.ConclusionsThe gallbladder with full of tiny stones performed LC easily leads to choledocholithiasis or acute pancreatitis. If intraoperative gallbladder rupture, the tiny stones might be residual in the peritoneal cavity and lead to abdominal infection or abscess, and incision infection or trocar site hernia. Specific operation could effectively avoid adverse complications.