ABSTRACT
Objective@#To study laparoscopic ultrasound assisted hepatectomy in treatment of intrahepatic and extrahepatic bile duct stones.@*Methods@#The data of 52 patients with hepatolithiasis who underwent laparoscopic hepatectomy from May 2014 to January 2019 at the Fuyang District First People's Hospital in Hangzhou were analyzed retrospectively. There were 28 men and 24 women. The median age was 56 years. Operative laparoscopic ultrasonography was used to detect the location, size, distribution of stones and their relations to blood vessels. A total of 43 patients underwent anatomic hepatectomy, while 38 patients underwent choledochoscopic stone extraction. A " T" tube was used according to intraoperative conditions.@*Results@#Laparoscopic surgery was successfully carried out in 50 patients, while conversion to open surgery was required in 2 patients because of adhesions and bleeding. Laparoscopic ultrasonography revealed intrahepatic calcifications in 5 patients and choledochoscopy in 2 patients. Postoperative complications included 5 patients who devleoped abdominal abscesses. The operation time was (289.0±132.0) minutes. The intraoperative blood loss was (451.0±256.0) ml. The hospitalization after operation was (12.0±3.0) days. In 52 patients, 4 patients had residual stones and the residual rate was 7.7%. All of them were completely removed by T-tube sinus 8 weeks after operation.@*Conclusions@#Laparoscopic ultrasound helped to detect relevant bile ducts containing stones, reduced chance of bleeding in surgery, helped to clarify location and distribution of stones, improved accuracy of diagnosis, and reduced unnecessary hepatectomy by clearly defining intrahepatic bile duct stones intraoperatively. The residual intrahepatic and intrahepatic bile duct stones rates were reduced, and the safety and accuracy of the operations were improved.
ABSTRACT
Objective To study laparoscopic ultrasound assisted hepatectomy in treatment of intrahepatic and extrahepatic bile duct stones.Methods The data of 52 patients with hepatolithiasis who underwent laparoscopic hepatectomy from May 2014 to January 2019 at the Fuyang District First People's Hospital in Hangzhou were analyzed retrospectively.There were 28 men and 24 women.The median age was 56years.Operative laparoscopic ultrasonography was used to detect the location,size,distribution of stones and their relations to blood vessels.A total of 43 patients underwent anatomic hepatectomy,while 38 patients underwent choledochoscopic stone extraction.A "T" tube was used according to intraoperative conditions.Results Laparoscopic surgery was successfully carried out in 50 patients,while conversion to open surgery was required in 2 patients because of adhesions and bleeding.Laparoscopic ultrasonography revealed intrahepatic calcifications in 5 patients and choledochoscopy in 2 patients.Postoperative complications included 5 patients who devleoped abdominal abscesses.The operation time was (289.0 ± 132.0) minutes.The intraoperative blood loss was (451.0 ±256.0) ml.The hospitalization after operation was (12.0 ±3.0)days.In 52 patients,4 patients had residual stones and the residual rate was 7.7％.All of them were completely removed by T-tube sinus 8 weeks after operation.Conclusions Laparoscopic ultrasound helped to detect relevant bile ducts containing stones,reduced chance of bleeding in surgery,helped to clarify location and distribution of stones,improved accuracy of diagnosis,and reduced unnecessary hepatectomy by clearly defining intrahepatic bile duct stones intraoperatively.The residual intrahepatic and intrahepatic bile duct stones rates were reduced,and the safety and accuracy of the operations were improved.
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Objective To study the safety,efficacy and advantages of enhanced recovery after surgery (ERAS) combined with clinical pathway management in laparoscopic common bile duct exploration and lithotomy (Laparoscopic common bile duct exploration,LCBDE).Methods 78 patients who underwent LCBDE in the Department of Hepatobiliary and Pancreatic Surgery in the First Hospital of Fuyang District in Hangzhou were selected as the non-ERAS group (the control group).76 patients who underwent LCBDE treated with fast track surgery and ERAS clinical pathway management were selected as the ERAS group.The data between the two groups which included the postoperative insulin resistance index,changes in C-reactive protein,duration of postoperative analgesic use and analgesia,timing of first passage of postoperative flatus,postoperative abdominal tube removal,postoperative bile leakage,recurrence of biliary stones,intestinal ileus and other complications.Results All the two groups were discharged home successfully.On preoperative 7 day,the differences on the postoperative insulin resistance index and the levels of C reactive protein were significantly different (P＜0.05).The time to first get out of bed after operation,the postoperative analgesic use,the time to first passage of flatus,the time to postoperative abdominal drainage tube removal,and the time to clamping of the T tube after operation were significantly different (all P＜0.05).The postoperative complications of pulmonary infection,abdominal infection and the incidence of prolonged intestinal ileus were significantly different (all P＜0.05).Conclusions ERAS combined with clinical pathway management reduced postoperative stress reaction and complication rate.The treatment accelerated recovery and shortened hospital stay for patients who underwent LCBDE,which led to good social and economic benefits.
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Objective To investigate the effect of cyanidin-3-glucopyranoside extracted from Chinese bayberry on proliferation and apoptosis of human gastric cell line SGC7901.Methods After cocultured with C3G on different concentrations,cell proliferation was determined by MTT assay; morphology of apoptosis were observed by laser confocal microscopy; TUNEL assay was applied to measure the apoptoic rate; The expression of Bcl-2,Bax,Caspase-3,ICAD protein were observed by Western blot assay.Results C3G significantly inhibited the proliferation of SGC7901 cells in a concentration-and timedependent manner as measured by MTT method(P ＜ 0.01).After cells were treated with C3G,the presence of typical morphological changes of apoptosis was confirmed with laser confocal microscopy after Hoechst 33258 fluorescence staining.TUNEL assay indicated that the number of apoptotic cells in C3G-treated group was greater than that in the gastric cancer cells group(P ＜ 0.01).The expression level of Bcl-2 was down-regulated while the expression level of Bax was up-regulated by C3G,the ratio of Bcl-2 protein and Bax protein decreased.C3G may accelerate the activation of procaspase-3 and down-regulate the expression of ICAD(P ＜ 0.01).Conclusions C3G inhibits SGC7901 cell growth and induces apoptosis in a concentraion-and time-dependent manner.This action may be mediated by down-regulating Bcl-2/Bax,resulting in Caspase-3 activition and decreased ICAD protein expression.