ABSTRACT
Objective:To compare the clinical effectiveness of laparoscopic cholecystectomy (LC)+ laparoscopic choledocholithotomy (LCBDE)+ one-stage suture and primary choledocholithotomy with endoscopic retrograde cholangiopancreatography (ERCP)+ endoscopic duodenal sphincterotomy (EST)+ nasobiliary drainage (ENBD)+ LC in the treatment of choledocholithiasis complicated with gallbladder stones.Methods:A total of 200 patients with choledocholithiasis complicated with gallbladder stones admitted to the General Surgery Department of Shanxi Bethune Hospital from June 2015 to February 2021 were collected, and patients were divided into LC+ LCBDE+ one-stage suture (one-stage suture group, n=130) and ERCP+ EST+ ENBD+ LC (endoscopic surgery group, n=70) according to different treatments. The amount of intraoperative blood loss, operation time, postoperative feeding time, postoperative incidence of pancreatitis, cholangitis and other complications (biliary leakage, abdominal bleeding, wound infection), hospitalization costs, postoperative hospital stay, etc were compared between two groups. Results:The postoperative incidence of pancreatitis in the one-stage suture group (0.7% vs 5.7%) and the hospitalization cost [(2.74±0.39) ten thousand yuan vs (3.86±0.63) ten thousand yuan] were significantly lower than those in the endoscopic surgery group. The operation time [(103.21±9.36) min vs (88.18±7.20)min] was significantly longer than that of the endoscopic surgery group, and postoperative feeding time [(3.3±0.3)d vs (2.2±0.8)d] were significantly later than the endoscopic surgery group ( P<0.05). The amount of intraoperative blood loss [(36.0±3.0)ml vs (37.3±2.7)ml], the incidence of postoperative cholangitis (1.5% vs 2.9%) and other complications [biliary leakage (2.3% vs 1.4%), abdominal bleeding (1.5% vs 4.3%), wound infection(0 vs 0)], postoperative hospital stay [(6.8±1.3)d vs (7.1)d] had no significant differences between the two group. Conclusions:The two minimally invasive methods for the treatment of choledocholithiasis complicated with gallbladder stones had good efficacy, but LC+ LCBDE+ one-stage suture can retain the sphincter function of Oddis, maintain the normal anatomy and physiology of the biliary tract, reduce the incidence of related complications, and contribute to the recovery of patients, with high safety, effectiveness and feasibility.
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Objective:To investigate the safety and efficacy of early oral feeding in the treatment of mild acute pancreatitis (MAP).Methods:Data of 100 MAP patients from April 2015 to June 2018 admitted in Department of General Surgery in Shanxi Bethune Hospital were collected. According to the time of food intake through the mouth, the patients were divided into early oral feeding group (food intake started when the symptoms of abdominal pain and abdominal distension were alleviated with gastrointestinal functional recovery, but serum amylase and lipase did not decrease to a level below 2 times of normal upper limits) and traditional oral feeding group (food intake started when the symptoms of abdominal pain and abdominal distension were alleviated with gastrointestinal functional recovery, but serum amylase and lipase decreased to a level below 2 times of normal upper limits), with 50 cases in each group. The incidence of abdominal pain or bloating, serum amylase, CRP, organ dysfunction, morbidity and mortality, and median length of hospital stay after eating were compared between the two groups.Results:There were no statistically significant differences on gender, age, etiology, abdominal pain and distension, increased serum amylase, increased blood CRP, and number of organ dysfunction cases between two groups, and there were no deaths in either group. However, the feeding time and length of hospital stay in the early oral feeding group were significantly shorter than those in the traditional oral feeding group, and the differences were statistically significant [(3.00±0.18)d versus (4.84±0.27)d, (8.24±0.33) D versus (9.00±0.26)d, both P<0.05]. Conclusions:Early oral feeding in MAP patients did not aggravate the disease, but helps to correct the nutritional status of the patients, with higher safety and effectiveness.
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<p><b>OBJECTIVE</b>To study the change of WT1 gene expression during human leukemic K562 cell differentiation and apoptosis induced by bufalin.</p><p><b>METHODS</b>Cell viability was determined by trypan blue exclusion, cell differentiation and apoptosis by nitro blue tetrazolium (NBT) reduction test, morphology and flow cytometry, expression of WT1 protein by Western blot analysis, and expression of WT1 mRNA by reverse transcriptase-polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>(1) The cell proliferation was inhibited by bufalin and the IC(50) at 24, 48, 72 h were 0.026, 0.032 and 0.006 micro mol/L, respectively. (2) Bufalin induced K562 cell differentiation towards macrophage/monocyte within concentration from 0.01 to 0.05 micro mol/L and apoptosis at higher than 0.026 micro mol/L. (3) The expression of WT1 protein and mRNA were downregulated by bufalin in the initial stage of differentiation and apoptosis induced by bufalin.</p><p><b>CONCLUSION</b>K562 cell differentiation and apoptosis induced by bufalin might relate to the downregulation of WT1 expression.</p>