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Gallstone is a common and frequently-occurring disease in surgery,and its formation is a process of many factors,many links and many steps,often accompanied by a variety of metabolic diseases.The treatment of cholecystolithiasis,operation time and operation mode are influenced by many factors.Clinicians are often confused because of their different strategies in diagnosis and treatment.Based on the domestic and foreign research progress of diagnosis and treatment of gallbladder calculi,combined with clinical practice,this article discusses the existing problems in the diagnosis and treatment of gallstone problems,treatment principles,individualized treatment strategy to make a discussion,aimed at strengthening grassroots doctors and general practitioners awareness of gallstones,individual treatment protocol.Therefore we could avoid excessive and inadequate treatment,and make the treatment of "standardization"" individualization",the benefit of the "maximum".
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Objective To evaluate the function of Rouviere's sulcus with posterior cystohepatic triangle in prevention of bile duct injury in laparoscopic cholecystectomy.Methods The clinical data of 170 patients undergoing laparoscopic cholecystectomy through Rouviere's sulcus approach with posterior cystohepatic triangle from May 2016 to June 2017 in the Department of General Surgery,the Second People's Hospital of Wuhu were retrospectively analyzed.The incidences and types of Rouviere's sulcus were documented.Results The open type of Rouviere's sulcus was visualized in 108 patients(63.53％),the fused type in 44 patients(25.88％),and the deficient type in 18 patients (10.59％).Hence in a total of 152 (89.41％) patients had Rouviere's sulcus.All patients underwent laparoscopic cholecystectomy safely.There was no bile duct injury or mortality.Four patients (2.35％) were converted to open operation,all were deficient type of Rouviere's sulcus for chronic inflammation of the gallbladder triangle.Conclusion Rouviere's sulcus are present and visible in most patients.Guided by Rouviere's sulcus with posterior cystohepatic triangle it could be safely and effectively to expose the anatomical structure of Calot's triangle and prevent bile duct injury in laparoscopic cholecystectomy.
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OBJECTIVE To prepare the Graves disease (GD) mouse model through porcine thyroid globulin (PTG) injection and investigate the morbidity and stability of the model. METHODS C57BL6/N mice in model group received multi-point subcutaneous injection of PTG 25μg each week,six times in all. After the end of immunization,their heart rate and oxygen consumption were measured and serum triiodothyronine(T3)level was determined every two weeks. A model was considered successful if serum T3 level was higher than x+3s of the control group. Observation of the model lasted 12 weeks. At the 12th week,spleen and thymus gland indices,serum thyroid globulin antibodies and thyroid peroxidase antibodies were measured,and the thyroid glands were taken for pathological observation. RESULTS After six times of immunization,mice in model group showed increased heart rate(P<0.01),oxygen consumption(P<0.01)and T3 level(P<0.01)compared with control group. The morbidity was 77.7%for male mice and 88.8%for females. In addition,T3 level in model group remained higher than that in control group within 12 weeks after immunization. The T3 level tended to decrease in male mice,but remained at a relatively stable higher level in females. CONCLUSION This method is suitable for GD modeling due to its short model-making time,high morbidity and long durability.
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Liver is one of the most commonly metastases in patients with colorectal cancer.Curative hepatic resection is the first choice of liver metastasis of colorectal cancer,which can improve the survival rate ranging from 30％ to 40％ in 5-year.In this article,we will review the operation indication,mode and advance on the current treatment strategies of colorectal liver metastases,and discuss the decision-making process,emphasize a surgery - centered multidisciplinary treatment for the treatment of hepatic metastases from colorectal cancer,to improve the survival rate.
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Objective To investigate the expression of CCL20 and CCR6 in the patients with gastric cancer and To examine the relationship between chemokine expression and the occurrence and development of Gastric Cancer. Methods Real-time PCR , flow cytometry and ELISA are used to measure the gene transcription and protein expression levels of chemokine CCL20 and CCR6 in the serum of 50 patients with Gastric Cancer and 30 normal controls. Results The gene expression levels CCL20 and CCR6 in Gastric Cancer group are significantly higher than that in healthy controls. The level protein of CCL20 and CCR6 in peripheral blood of patients with gastric cancer are significantly higher than that in healthy peep le[ (45.4 ±10.9) pg/mL vs (18.6±4.7) pg/mL; (7.11 ±1.03%) vs (1.83±0.43%), P＜0.01. respectively],and the increase significantlyassociated with the clinical stage of Gastric Cancer. Conclusions The method for detecting the expression of CCL20 and CCR6 in patient with Gastric Cancer has been successfully established, and their expression levels were found to be correlated with the occurrence and development of Gastric Cancer. Thus, CCL20 and CCR6 may be involved in the regulatory mechanisms associated with the development of Gastric Cancer, and may be valuable in its diagnosis and prevention.
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Objective To explore the diagnosis and treatment of anatomic variation of the extrahepatic biliary tree in laparoscopic cholecystectomy(LC).Methods From October 1999 to January 2008,totally 1216 cases of LC were performed in our hospital,anatomic variation of the extrahepatic biliary tree was found in 15(1.2%) of them.Among the 15 patients,3 had wide and short cystic duct with the opening at the junction of the right and left hepatic ducts;1 patient showed dislocation of a relatively thin choledoch owing to calculus incarceration;1 case was found having a cystic duct parallel to the common hepatic duct with a low-level opening;1 patient had twisted cystic duct at the right side of the common bile duct with an opening at the right hepatic duct;2 patients were suffered from massive adhesion in the cystic ampulla that covering the common bile and common hepatic ducts;3 cases showed aberrant bile ducts lying on the gallbladder bed;3 patients were found having the right posterior hepatic duct opened to the common hepatic duct;1 case was diagnosed with Mirizzi syndrome,in whom the anatomical structure was unclear.For all of the patients,the abnormal structures were separated carefully,ligated with sutures or titanium clips if necessary.Results LC was completed in 13 of the 15 cases,the other 2 patients were converted to open surgery because of the injury to the right hepatic duct or Mirizzi syndrome.None of the series had intra-abdominal bleeding or infection,bowel injury,or death.The patients were followed up for 3 months to 4 years(over 1 year in 11 cases).None of them developed biliary stenosis or residual calculus.Conclusion Identification of the Calot triangle is crucial to prevent surgical injuries to the extrahepatic biliary tree.