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Objective To discuss the effect of abnormal biliary dynamics on the formation of cholelithiasis.Methods A total of 35 cases of gallstone(Gallstone Group),25 cases of gallbladder polypoid lesions(Polypus Group),and 30 normal cases(Control Group) were included in this study.The fasting gallbladder volume was measured with B-ultrasonography,the serum concentration of vasoactive intestinal poly-peptide(VIP) was determined with radioimmunoassay,and the expression of cholecystokinin-A(CCK-A) receptor in the gallbladder mucous membrane was detected with reverse transcriptase polymerase chain reactions(rt-PCR). Results ①The fasting gallbladder volume was significantly greater in the Gallstone Group than in the other two groups(F=3.45,P=0.039).②The gallbladder contraction rate was significantly lower in the Gallstone Group than in the other two groups(F=5.747,P=0.005).③The postprandial increases of VIP of the three groups were not of statistical significance(F=0.768,P=0.47).④Compared with the Polypus Group,the expression of CCK-A receptor in the Gallstone Group was significantly decreased(t?=4.390,P=0.022).Conclusions ① The increase of the fasting gallbladder volume in the Gallstone Group is associated with the formation of gallstones.②In the Gallstone Group,depressed gallbladder contraction results in the formation of gallstones.③The decreased expression of CCK-A receptor leads to depressed gallbladder contraction,which facilitates the formation of gallstones.④Serum VIP is not related to the formation of gallstones.
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Objective To study the relationship between the Helicobacter pylori (Hp) infection and the formation of gallstones. Methods In this controlled study, the Hp infection rate was detected in both 35 cases of simple gallbladder stones (Experimental Group) and 25 cases of polypoid lesions of the gallbladder (Control Group). The Hp cytotoxin associated gene antigen (cag-A) in bile and gallstones of the both groups was amplified by PCR technique. Results The Hp infection rate was 51.4% (18/35) in the Experimental Group and 48.0% (12/25) in the Control Group, without significant differences (?~2=0.069,P=0.793). In the Experimental Group, cag-A positive results were noted in bile samples in 7 cases (20.0%, 7/35) and in gallstone samples in 1 case (2.9%, 1/35), whereas in the Control Group there were no positive results observed. The Hp cag-A positive rate was significantly different between the two groups (?~2=5.822,P=0.016). The presence of Hp cag-A in bile was correlated with the Hp infection of the stomach (x~2=3.886,P=0.049). Conclusions That the DNA of the Hp can be found in bile and gallstones of patients with cholelithiasis indicates a correlation between Hp infection of the gallbladder and the formation of gallstones.
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Objective To study the prevention and treatment of pneumoperitoneum-related complications after laparoscopic cholecystectomy (LC). Methods A retrospective analysis was made on clinical data of 1 100 cases of LC from October 1993 to January 2003. The cases were divided into two groups: 980 cases admitted before September 2001 received a 14 mmHg carbon dioxide pneumoperitoneum (Group A), and 120 cases after September 2001 received a 10 mmHg pneumoperitoneum (Group B). Results Carbonemia happened in 2 cases in the Group A but in no cases in the Group B. The incidence of postoperative shoulder pain was significantly lower in the Group B (19 2%, 23/120) than in the Group A (43 9%, 430/980) ( ? 2 =26 951, P =0 000). The incidence of postoperative nausea and vomiting (PONV) was significantly lower in the Group B (25 8%, 31/120) than in the Group A (61 2%, 600/980) ( ? 2 =54 750, P =0 000). Conclusions Carbonemia, shoulder pain and PONV can be reduced by regulating the ventilation and decreasing the pneumoperitoneum pressure.
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Objective To observe the length of duration of free gas presence in abdomen after laparoscopic cholecystectomy (LC). Methods A Series of chest X-ray examinations following LC in 69 patients in this hospital from April 2002 to December 2002 were taken to review the condition of subphrenic free gas. Results Gas was detected on (1.8?1.1) days following LC and was completely absorbed within 6 days after LC. The logarithm of the length of duration of pneumoperitoneum had a parallel relationship with the subphrenic residual gas volume within 24 postoperative hours ( r =0.616, P =0.000), bore a negative relationship with the pneumoperitoneum time ( r =-0.228, P =0.014), and was not correlated with age, body weight, height, operation time and consumption of CO 2. Conclusions Clearing intraabdominal CO 2 gas away so far as possible can shorten the length of duration of gas presence in abdomen.
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In the present study,50 patients were treated by mesh & plug hernia repair with Bard R Mesh & FerFix R Plug. Operation time ranged from 24 min to 71 min with mean time being 43.2min.There was no need for analgestic.Hospitalization time ranged from 3d to 7d with mean time being 4.5d.The patients were followed up for 6w to 20 months.No recurrence occurred.
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0.05). The stepwise regression analysis showed that the logarithm of the duration of residual gas had a parallel relationship with the gas volume under the hemi-diaphragm 24 hours after operation(r=0.616,P=0.006),a negative correlation with the duration of pneumoperitoneum (r=-0.228,P=0.014), and no correlation with patients’ age,body weight,height,operation time and gas volume consumed. Postoperatively, 26 patients reported postoperative shoulder pain. The shoulder pain VAS scores were significantly increased with the increasing of CO_2 pressure in the three groups (F=9.635, P=0.000). The shoulder pain VAS scores had a parallel relationship with the gas volume under the right hemi-diaphragm 24 hours after operation (r=0.333, P=0.005) and the duration of residual gas (r=0.296, P=0.014). Conclusions The CO_2 should be removed as thoroughly as possible at the end of operation to reduce the absorption of residual gas. The different CO_2 pressures of pneumoperitoneum have little effects on the volume of residual CO_2 24 hours after operation and the duration of residual gas. The shoulder pain following LC, will be aggravated with the increasing of pneumoperitoneum pressure. The over-stretching of the diaphragmatic fibers due to insufflation is the main cause of shoulder pain.
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Objective To summarize the experience of combination use of biliary stent placement and drainage with primary suture of the common bile duct in the treatment of choledocholithiasis. Methods Laparoscopic common bile duct exploration combined with flexible choledochoscopy was performed in 16 patients with choledocholithiasis from June 2005 to March 2006. During the operation, a patented “biliary stent for internal drainage” was introduced into the common bile duct, and primary sutures were performed to close the bile duct. Postoperatively, the stent was removed under gastroscope or duodenoscope. Results All the 16 operations were successfully accomplished without conversions to open surgery. The operative time was 90~260 min (mean, 145 min). The biliary stent was removed 5~7 days after the surgery. Follow-up for 3~12 months showed no residual stones or biliary stenosis. Conclusions Combination use of biliary stent drainage and primary suture of the common bile duct in the treatment of choledocholithiasis is safe and feasible.
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Objective To determine if the carbon dioxide (CO 2) pressure used in laparoscopic cholecystectomy (LC) has any effect on the occurrence of postoperative shoulder pain. Methods One hundred and twenty consecutive patients undergoing LC were prospectively divided into three groups(40 patients in each group): Patients in group A underwent LC with 10 mm Hg of CO 2, those in group B with 12 mm Hg of CO 2, and in group C with 14 mm Hg of CO 2. PaO 2?PaCO 2?pH before and after LC were recorded. Shoulder pain was recorded on a visual analogue pain scale 1,3,6,12,24,48,72,96 h after operation. Results The intraoperative CO 2 consumption was significantly higher in group C (F=11.38,P