Comparative study on the efficacy of transumbilical single port and three port laparoscopic cholecystectomy in the treatment of calculous cholecystitis / 国际外科学杂志

Objective:To explore the efficacy of transumbilical single-port and three-port laparoscopic cholecystectomy (LC) in the treatment of calculous cholecystitis and its influence on immunological indicators and recovery of gastrointestinal function.Methods:One hundred and twenty patients with calculous cholecystitis who were treated in Suzhou Municipal Hospital of Anhui Province from June 2018 to June 2020 were prospectively selected as the research subjects, and the patients were randomly divided into single-hole group and three-hole group by random number table method. Group of 60 cases. The single port group used the transumbilical single port method LC, and the three port group used the transumbilical three port method LC. Compare the 24-hour pain VAS scores and the use of analgesics of the two groups of patients; compare the surgical indicators of the two groups of patients; compare the immunological indicators of the two groups before and after treatment; compare the two groups of patients The recovery of gastrointestinal function after operation; the occurrence of postoperative complications between the two groups was compared.Results:There was no statistically significant difference in intraoperative blood loss, hospitalization expenses, preoperative IgG, IgA, IgM levels, and postoperative complications between the two groups of patients ( P>0.05). The two groups of patients had significantly lower levels of IgG, IgA, and IgM after treatment ( P<0.05). In the single hole group, the pain VAS score, the use rate of analgesics, the time of hospitalization, the time of anal exhaust, the time of bowel sound returning to normal and the time of defecation were (4.65±0.61) points, 11.67%(7/60), (2.52±0.47) d, (13.65±3.72) h, (11.64±3.25) h and (20.31±4.12) h, respectively. The three-hole group were (6.87±0.58) points, 23.33% (14/60), (4.58±0.37) d, (17.36±4.12) h, (15.47±4.12) h and (26.48±4.25) h, respectively. It was significantly lower in the single-hole group than in the three-hole group ( P<0.05). In the single hole group, the operation time, abdominal wall cosmetology score and the levels of IgG, IgA, IgM after treatment were (76.36±4.58) min, (4.72±0.13) points, (1 108.48±42.65) mg/dL, (208.12±10.86) mg/dL, (154.65±8.72) mg/dL, respectively. The three-hole group were (51.37±5.25) min, (3.25±0.35) mg/dL, (1 072.39±28.42) mg/dL, (193.08±10.35) mg/dL and (145.28±8.42) mg/dL, respectively, and those in the single-hole group were significantly higher than those in the three-hole group ( P<0.05). Conclusion:Under the premise of proficiency in surgical operation techniques, the single-port method reduces pain, reduces the use of analgesics, has less impact on immunological indicators, recovers gastrointestinal function faster, and has better postoperative abdominal wall cosmetic effects.

Retrospective analysis of early surgical treatment of acute calculous cholecystitis with elevated liver enzymes / 国际外科学杂志

Objective:To investigate the safety and feasibility of early operation for acute calculous cholecystitis with elevated liver enzymes.Methods:The clinical data concerned about 39 patients with acute calculous cholecystitis complicated with elevated liver enzymes in The First Department of General Surgery, The First Affiliated Hospital of Anhui University of Science and Technology between January 2018 to December 2018 were analyzed retrospectively.There were 14 males and 25 females, the age was(57.59±15.30) years(range 29 to 84 years). All patients were given hepatoprotective therapy and antibiotic therapy, A total of 18 patients received early surgical treatment within 7 days (surgical group), 21 patients who received only hepatoprotective therapy and antibiotic therapy(control group). Observation indicators: (1)Total bilirubin, white blood cells and pancreatin in both groups at admission; (2)Data of liver enzyme indexes (ALT, AST, GGT) of the two groups at admission and 3 days after admission; (3)The length of hospital stay in the two groups, and gallstone-related events after discharge(the incidence of gallstone-related emergency, the rehospitalization rate). Normally distributed measurement data were expressed as mean±standard deviation( ± s), and comparison between groups were analyzed using t test; Non-normal distribution measurement data were represented by M( Q1, Q3), and comparison between groups were analyzed using Mann-Whitney U test. Comparison between groups were analyzed using chi-square test or Fisher method of count data. Results:There was no statistical difference between the two groups in terms of total bilirubin, white blood cells and pancreatin( P>0.05). There was no significant difference in liver enzyme indexes (ALT, AST, GGT) between the two groups when they were admitted to the hospital ( P>0.05) and 3 days later ( P>0.05). Before treatment, ALT、AST、GGT in surgical group were 161.00(83.75, 237.75) U/L, 63.50(49.50, 257.75) U/L, 245.50(66.75, 549.75) μmol/L, ALT, AST, GGT in control group were 187.00(64.00, 335.50) U/L, 104.00(53.50, 355.00) U/L, 299.00(136.50, 455.00) μmol/L, after 3 days antibiotic therapy and hepatoprotective therapy, ALT, AST, GGT in surgical group were 77.50(52.00, 111.00) U/L, 41.50(33.00, 53.75) U/L, 190.50(65.00, 372.00) μmol/L, ALT, AST, GGT in control group were 67.00(23.50, 129.50) U/L, 37.00(26.00, 61.50) U/L, 187.00(90.50, 337.00) μmol/L, levels of the two groups decreased significantly( P<0.05). There was no statistically significant difference in the length of hospital stay between the surgical group and the control group[(12.89±3.41) d vs (11.05±4.57) d, P>0.05]. After 12 months of follow-up, Gallstone-related events after discharge, the incidence of gallstone-related emergency in the surgical group was lower than that in the control group (5.6% vs 33.3%), the rehospitalization rate in the surgical group was significantly lower than that in the control group (5.6% vs 42.9%), there was statistically significant difference between the two groups ( P<0.05). Conclusion:Hepatoprotective therapy and antibiotic therapy and can effectively reduce the liver enzyme indexes of such patients in a short period of time, early surgical treatment after liver enzymes has decreased is a complete and safe option.

Research progress in surgical diagnosis and treatment of gallstones and acute calculous cholecystitis in the elderly / 国际外科学杂志

Gallstones and acute calculous cholecystitis are common diseases in surgery. China has entered an aging society. Elderly patients are a high incidence group of gallstones and acute calculous cholecystitis. Their surgical diagnosis and treatment strategies need to be formulated individually, and reasonable diagnosis and treatment methods should be comprehensively selected according to the patient′s condition and the medical level of the medical institution. For those who are in good physical condition and can tolerate the operation, it is recommended to give priority to surgical treatment, and the minimally invasive surgery mainly suitable for laparoscopic cholecystectomy (LC) is preferred. Open surgery is more appropriate for complicated conditions or patients whose general conditions are not suitable for laparoscopic surgery. Other minimally invasive treatment measures can be applied at the same time. For patients who can not tolerate surgical treatment, puncture, endoscopy, intervention and other means can be selected, combined with drugs for conservative treatment, so as to obtain the opportunity of surgical treatment or improve the prognosis. In this paper, the latest research literature at home and abroad has been collected to review and summarize the latest research progress in the physiology and aging characteristics of the biliary tract in the elderly, the diagnosis and treatment of gallstones and acute calculous cholecystitis. It is hoped that this paper can provide reference for the clinical diagnosis and treatment of such diseases, and think and prospect the future research.

Is combined rather than single antibiotic therapy actually reasonable in patients with acute calculous cholecystitis?

SUMMARY OBJECTIVE Acute calculous cholecystitis (AC) is a frequently encountered emergency surgery disease and its standard treatment is cholecystectomy. In patients with high risk in surgery, antibiotic treatment (AT) is important. In routine clinical practices, antibiotics are frequently used either as single or in combination in the treatment of AC. This study examined whether or not combined antibiotic treatment (CAT) had superiority over single antibiotic treatment (SAT) in AC. METHODS Patients with cholecystitis who received treatment in the period of 2016-2019 were retrospectively examined. The treatment procedures applied, patient findings, and laboratory data were analyzed using relevant statistical software. The patients were categorized into groups based on the treatment approaches applied, and the effects of SAT and CAT on infection parameters were analyzed. RESULTS In all, 184 patients received treatment for AC, with a mean age of 57.7, and the female-to-male ratio was 77:107. Of these, 139 patients received SAT and 45 received CAT. No significant difference was found in terms of effectiveness between the SAT and CAT in the patients who received early cholecystectomy treatment and those who received medical treatment with noninvasive intervention. CONCLUSIONS In patients with AC, antibiotics are commonly used either as single or in combination for prophylaxis and therapeutic purposes. As no significant difference was observed between single and combined use in terms of treatment effectiveness and hospitalization duration, CAT is not recommended due to its possibility of allergic side effects, toxicity, and cost-increasing effects.

Efficacy of Shugan Lidan Decoction in Treating Acute Calculous Cholecystitis and Analysis of Its Mechanism Based on Network Pharmacology / 中国实验方剂学杂志

Objective:To explore the clinical efficacy of Shugan Lidan decoction（SLD） combined with laparoscopic cholecystectomy on acute calculous cholecystitis（ACC），and explore its mechanism based on network pharmacology. Method:In a retrospective analysis， 121 patients with ACC were divided into laparoscopic cholecystectomy+SLD group （observation group， 68 cases） and laparoscopic cholecystectomy group（control group，53 cases）. The postoperative recovery of the patients （time to first exhaust，time to temperature recovery，antibiotic use time and hospitalization time），serum inflammatory factor levels ［white blood cell count（WBC），C-reactive protein（CRP），interleukin-6（IL-6）］，immune index levels［claster of differentiation（CD）3⁺，CD4⁺/CD8⁺，immunoglobulin M（IgM）］ and safety were compared between these two groups. The TCMSP，BATMAN-TCM and TCMIP databases were used to collect all chemical components and targets of SLD. GeneCard and OMIM databases were combined to search ACC-related targets，and then the intersection ones of SLD-related targets and ACC-related targets were extracted to obtain the potential action targets of SLD for treatment of ACC. The STRING database platform was used to establish and analyze the protein-protein interaction （PPI） network，and Bioconductor software package was used for Kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment of the targets. Result:The time to first exhaust，antibiotic use time and hospitalization time of observation group were shorter than those of control group，and the differences were statistically significant（<italic>P</italic><0.05）. After treatment，the postoperative WBC，CRP，IL-6，CD4⁺/CD8⁺ and IgM in the two groups of patients were lower than those before treatment，and the postoperative CD3⁺ was higher than that before treatment，with statistically significant differences（<italic>P</italic><0.05）. The postoperative WBC，CRP，IL-6，CD4⁺/CD8⁺ and IgM in the observation group were lower than those in control group，and the CD3⁺ was higher than that of control group，with statistically significant differences（<italic>P</italic><0.05）. There was no statistical difference in adverse reactions between the two groups. Totally 159 components in SLD were screened，which acted synergistically on key targets such as IL-6，vascular endothelial growth factor A（VEGFA），insulin（INS），and epidermal growth factor receptor（EGFR），and participated in the regulation of HIF-1 signaling pathway，EGFR tyrosine kinase inhibitor resistance and PI3K-Akt signaling pathway in the treatment of ACC. Conclusion:SLD may regulate HIF-1 pathway and other signaling pathways by acting on IL-6，VEGFA，INS，EGFR and other targets，thereby reducing postoperative inflammatory factors，improving immune function，and promoting postoperative recovery in patients with ACC.

A Prospective Study Comparing No Antibiotic versus Antibiotic Prophylaxis in Patients Undergoing Elective Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is one of the most common operations performed in general surgery. Elective laparoscopiccholecystectomy has a low risk for infective complications, and standard guidelines do not recommend prophylactic antibioticuse for low-risk cases. However, the use of antibiotic prophylaxis is very prevalent and the duration and dosage are inconsistentand varies widely among surgeons. This study is being done to assess the role of no antibiotic prophylaxis in the prevention ofwound infection in a patient undergoing elective laparoscopic cholecystectomy.Study Design and Period: The study was conducted in the Department of General Surgery at Christian Medical College,Ludhiana. This was an open labeled study conducted from the period of January 1, 2014, to December 31, 2014.Results: 92 patients suffering from chronic calculous cholecystitis undergoing elective laparoscopic cholecystectomy wereincluded in the study. Group A with 23 cases without prophylactic antibiotic. Group B with 69 cases with two doses of prophylacticantibiotics Inj. cefuroxime 1.5 gram 30 min prior to induction and after 6 h. The majority of our 81patients (88.04%) were females.The male to female ratio was 1:8. 3 patients (3.27%) in Group B had associated comorbidities except for diabetes mellitus. Themajority of patients 14 (60.86%) in Group A had taken 1-2 h of operative time while 58 patients (84.05%) patients in Group Bwith statistical insignificant P = 0.05. There was no fever in Group A patients while in Group B 2 patients (2.89%) had fever onsecond post-operative day which was not related to surgical site infection and that was due to superficial thrombophlebitis. InGroup A 18 patients (78.26%) were discharged on second postoperative days while 46 patients (66.67%) patients in Group Bwere discharged on second postoperative day. 8 patients (11.59%) in Group B were discharged on third postoperative days.There was no statistical difference in the duration of hospitalization between the two groups with P = 0.22. The overall incidenceof postoperative infective complications were nil in both groups either with patients having no prophylactic antibiotic or thosehaving prophylactic antibiotics

Study of histopathological spectrum of gallbladder in cholecystectomy specimens

Background: Cholecystitis is one of the most common indications for abdominal surgery. Routine examination of gallbladder grossly and microscopically shows lot of interesting findings. This study aims to quantify the various outcomes of routine gallbladder examination following cholecystectomy procedure.Methods: All clinical details and data from case sheet and patient history are collected and analysed for all the patients who underwent cholecystectomy surgery in the Department of General Surgery, Govt. Omandurar Medical College, Chennai, from August 2017 to August 2018. The Study period of this study was from August 2017 to August 2018. Three sections each from neck, body and fundus taken. Tissues were processed in automated tissue processor and paraffin blocks made. Statistical analysis of the data was done.Results: Total number of specimens received were 36. And among the cases the number of females were 33 and the number of males were 3. The number of cases of calculous cholecystitis were 31 and the number of cases with pigment stones were 26, number of cases with cholesterol stone were 2 and the number of cases with mixed stones were 3. The number of cases of acalculous cholecystitis were 5. The number of cases of cholecystectomy by laproscopy were 30 whereas the number of cases of cholecystectomy by open procedure were 6. Chronic cholecystitis was seen in 34 cases and chronic cholecystitis with stones was seen in 29 cases and chronic cholecystitis without stones was seen in 5 cases and Acute on chronic cholecystitis with pigment stone was seen in 1 case and xanthogranulomatous cholecystitis with pigment stone was seen in 1 case.Conclusions: The risk factors for developing chronic cholecystitis was seen in female gender. The predominant histomorphological pattern seen in this study group is chronic calculous cholecystitis. And the predominant type of stone found in this study is pigment stone compared to mixed and cholesterol stone.

Clinical Observation of Miao Medicine Jinyin Huashi Granule Combined with Western Medicine in the Treatment of Chronic Calculous Cholecystitis / 中国药房

OBJECTIVE:To investigate clinical efficacy and safety of Miao medicine Jinyin huashi granules combined with western medicine in the treatment of chronic calculous cholecystitis(CCC). METHODS:A total of 120 CCC patients in our hospi-tal during Jan. 2014-Jan. 2016 were randomly divided into control group and observation group,with 60 cases in each group. Con-trol group was given 50％ Magnesium sulfate solution 10 mL orally before meal,tid;amoxicillin 0.5 g orally,tid+Racanisodamine tablets 10 mg,tid+Compound dantong tablets 1 slice,tid,after meal. Observation group was additionally treated with Miao medi-cine Jinyin huashi granules 15 g,tid,on the basis of control group. Both groups were treated for consecutive 4 weeks. Clinical effi-cacies,the improvement of upper abdominal pain,nausea and greasy,calculus were observed in 2 groups. The thickness of gall-bladder,serum levels of IL-2 and IL-5,mRNA and protein expression of CYP7A1 and B-UCT were compared between 2 groups before and after treatment. The occurrence of ADR was recorded in 2 groups. RESULTS:Total response rate of observation group was 96.67％,which was significantly higher than 88.33％ of control group,with statistical significance (P<0.05). One d and one week after treatment,the improvement rates of upper abdominal pain were 63.33％ and 81.67％ in observation group, which were significantly than 36.67％ and 50.00％ of control group,with statistical significance(P<0.05). There was no statisti-cal significance in the improvement rate of nausea or greasy after treatment between 2 groups(P>0.05). The stone-free rate of ob-servation group was 33.33％ and significantly higher than 11.67％ of control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in the thickness of gallbladder wall,serum levels of IL-2 or IL-15,mRNA and pro-tein expression of CYP7A1 or B-UCT between 2 groups(P>0.05). After treatment,the thickness of gallbladder wall,serum lev-els of IL-2 and IL-15 were all decreased significantly in 2 groups,while mRNA and protein expression of CYP7A1 and B-UCT were increased significantly;observation group was significantly better than control group,with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Miao medicine Jinyin huashi granules combined with western medicine show significant therapeutic efficacy for CCC,can effectively improve right upper quadrant pain,nausea and greasy,decrease serum levels of IL-2 and IL-5 and up-regulate mRNA and protein expression of CYP7A1 and B-UCT with good safety.

Clinical efficacy Comparison between laparoscopy and open cholecystectomy for acute calculous cholecys-titis / 实用医学杂志

Objective To compare the clinical efficacy between laparoscopy and open cholecystectomy for patients of acute calculous cholecystitis. Methods Fifty patients of acute cholecystitis from February 2014 to February 2017 were divided into control group treated with open cholecystectomy and observation group with laparoscopic cholecystectomy;a retrospective analysis was conducted to compare time of resuming peristaltic sound ,postoperative 24h VAS score and hospitalization time. Results There were shorter time of resuming peristaltic sound,higher postoperative 24 h VAS score and shorter hospitalization time in observation group when compared with those in control group (P < 0.05). Conclusions For patients of acute calculous cholecystitis , laparoscopic cholecystectomy,is conducive to shortening patient′s recovery time,alleviating patients′ pain signifi-cantly and decreasing the incidence of complication.

The Clinical Curative Effect of Laparoscopic Cholecystectomy in Treatment of 1353 Patients with Acute Calculous Cholecystitis in Acute Stage / 昆明医科大学学报

Objective To explore the clinical curative effect of laparoscopic cholecystectomy (LC) in treatment of patients with acute calculouscholecystitis in acute stage. Methods We retrospectively analysed the data of 1353 patients with acute calculouscholecystitis in acute stage who received laparoscopic cholecystectomy in Dept.of General Surgery, The First Affiliated Hospital of Nanyang Medical College and Dept.of Hepatopancreatobiliary Surgery 3,The 2nd Affiliated Hospital of Kunming Medical University from August 2008 to December 2012. Results In 1353 patients, 1316 patients were performed LC successfully (97.27%) . One patient was found with bile duct injury and was cured after Laparoscopic T tube drainage. Two patients were found with postoperative bile leakage, one of them was found with wing hole effusion after removal of the abdominal cavity drainage tube, and was cured after continuous drainage. The operation time was 26-168 minutes, with an average of 47 minutes, the hospitalization time was 3-15 days, with an average of 7.3 days. No incision infection was found . 37 patients were transferred to laparotomy because of common bile duct injury in 2 cases, unclear gallbladder triangle in 23 cases, difficult operation after decompression result from high gall bladder pressure caused by big calculus incarceration in the gallbladder neck in 3 cases, gallbladder gallstone disease in 2 cases, atrophic and vitrified acute cholecystitis and biliary calculus in 2 cases, gallbladder artery bleeding in 4 cases and severe abdominal cavity adhesion in 1 case. Conclusion For patients with acute calculous cholecystitis in acute stage, LC is asafe, effective, and minimally invasive treatment method with quick recovery and low cost, but the operator must be familiar with the anatomy of Calot triangle,and has skilled LC operation skills.

Clinical experiences of LC treatment for acute calculous cholecystitis(120 cases) / 国际外科学杂志

Objective To explore the operative main points and clinical effects of LC treatment for acute calculous cholecystitis. Methods Between August 2006 and June 2008, LC treatment for acute calculous cholecystitis in 120 cases as performed, the data of which were analyzed retrospectively. Of these patients, there were gallbladder with adherent omentum (72 cases), gallbladder with adherent hepatic flexture of the colon (9 cases), gallbladder with duodenum (5 cases), obstruction of the cystic duet by a gllstone (68 cases), and Mirizzi syndrome(2 cases). Results All the 120 cases performed LC successfully. There were no converting to open operation, and no biliary leakage. The mean operating time was (45. 0 ± 13. 1) minutes. Conclusions Acute calculous cholecystitis was not a contraindication for LC. Rich experience and skilled technique were key points for the success of operation. It shows advantages of less pain, less complications and more rapid recovery.

Estudio de la morbi-mortalidad entre las colecistectomías convencionales y laparoscópicas, hospital de la Policía Nacional del Guayas / Study of morbidity and mortality between conventional and laparoscopic cholecystectomy, Guayas National Police hospital

Tipo de estudio: retrospectivo y descriptivo. Objetivo: determinar y comparar el número de colecistectomías convencionales y laparoscópicas para establecer la relación de morbimortalidad. Método: se incluyeron 49 pacientes con edades comprendidas entre 15 y 80 años, que fueron intervenidos quirúrgicamente por colecistectomía convencional o laparoscópica con diagnóstico de colecistitis calculosa o acalculosa, entre enero de 2001 y diciembre de 2003 del servicio de cirugía en el HDPNG-2. Resultados: se realizaron 49 colecistectomías en pacientes con colecistitis, 14 casos por video laparoscopía (28.57) y 35 casos por técnica convencional (71.43) siendo la patología causante más común la colelitiasis. La edad promedio fue de 42 años para el sexo femenino, y de 52.8 años para el sexo masculino, del total de intervenciones las cifras para las mujeres fueron las más frecuentes (65.3). La estancia hospitalaria promedio de colecistectomía convencional fue de cuatro días, y para la laparoscópica fue de dos días. El tiempo operatorio para los pacientes de la técnica convencional fue dentro del rango de 61 a 90 minutos, y para la técnica laparoscópica fue entre 46 a 60 minutos. El tiempo de restitución de la vía oral para los pacientes intervenidos convencionalmente fue entre 13 y 24 horas, mientras que para los intervenidos por laparoscopía fue de seis a doce horas. El inicio de la deambulación para los pacientes del primer grupo fue entre 13 y 24 horas, y para los del segundo fue entre seis y doce horas. Conclusiones: en este estudio se concluye que la colecistectomía por vía laparoscópica supera a la convencional en distintos aspectos: el dolor y las molestias postoperatorias, así como el período de recuperación, disminuyen de manera notoria. Los pacientes son dados de alta del hospital el mismo día o a la mañana siguiente. La cirugía laparoscópica es más aceptable desde el punto de vista estético.

Study Type: retrospective and descriptive. Objective: To set and compare the number of cnventional and laparoscopic cholecystectomies to establish the morbidity/mortality relation. Método: the study included 49 patients from 15 to 80 years old who had conventional or laparoscopic cholecystectomy after being diagnosed calculous or non calculous cholecystitis, since Jnuary 2001 to December 2003 in the Surgery Department in the NPHG-2. Results: 49 cholecystectomies were performered in patients with cholecystitis, in 14 cases by video-laparoscopy (28.57), and in 35 cases using the conventional technique (71.43). The most frequent causal pathology was cholelithiasis. Average age was in females 42, and 52.8 for males. Operations on women were the most frequent from the total (65.3). Average hospital stay for patients with conventional cholecystectomy was four days, and for those with laparoscopic cholecystectomy, was two days. Surgery time for patients operated with the conventional technique was from 61 to 90 minutes, and for patients operated with laparoscopic technique, it was from 46 to 60 minutes. Restitution time of oral way for patients operated conventionally was from 13 and 24 hours, whereas for those operated laparoscopically, it was from six to twelve hours. Patients of the first group began to mobilize from 13 to 24 hours after the operation; those of the second group began the mobilization from six to twelve hours after the operation. Conclusions: In this study we can conclude that laparoscopic cholecystectomy exceeds the conventional one in different aspects: pain and postoperative discomfort as well as recovery time decreases notoriously. Patients are discharged the day of the operation or the next morning. Laparoscopic surgery is more acceptable from the aesthetic point of view.

A Case of Hemobilia Caused by Calculous Cholecystitis / 대한소화기내시경학회지

Hemobilia is a status of bleeding into the biliary tract, which is caused by abnormal communication between the intrahepatic blood vessels and biliary tract, and is a rare cause of upper gastrointestinal hemorrhage. Most cases of the hemobilia originating in the gallbladder are related to gallstones. However, hemobilia is a rare complication of calculous cholecystitis. We report a case of hemobilia as a complication of calculous cholecystitis in a patient given continuous aspirin medication.

Clinical Analysis for the Treatment of 35 Cases with Acute Calculous Cholecystitis by Laparoscopic Cholecystectomy / 医学研究杂志

Objective To observe the therapeutic effect of Laparescopic Cholecystectomy(LC) on acute calculous cholecystitis.Methods The data from 35 patients receiving laparoscopic cholecystectomy for acute calculous cholecystitis were analyzed.Results Successful rate of operation was 100% in all cases with no complications such as biliarducy injury,intestines damage and hemorrhage taken place,and mortality was 0%.Conclusion LC is safe for treatment of acute calculous cholecystitis.

Clinical Analysis of Cholecystitis: Acalculous Cholecystitis Compared to Calculous Cholecystitis

PURPOSE: The purpose of this study was to analyse the characteristics of acalculous cholecystitis (AC) compared with those of calculous cholecystitis (CC), and also to find the relationship of preoperative radiologic findings to the classification of pathological degree of inflammation of the gallbladder in AC. METHODS: Between March 1996 and June 2000 a total of 163 patients undergoing cholecystectomy for cholecystitis were divided into group AC (21 patients) and group CC (142 patients) and retrospectively studied by analyzing clinical data. RESULTS: The incidence of AC among cholecystitis cases was 12.9%. there was male preponderance in group AC whereas female preponderance in group CC (P<0.036). The pulse rate (P<0.02) and white blood cell count (P<0.003) were significantly elevated in group AC. Possible etiological factors were found in 6 cases (28%) in group AC. The rates of preoperatively observed pericholecystic fluid collection in US (P<0.033) and dilatation of the gallbladder in CT (0.012) were significantly higher in group AC than in group CC. Additionally, the rate of tube drainage during surgery was significantly higher in group AC than group CC (P<0.02). Finally, wall thickness (P<0.05), dilatation (P<0.05) of the gallbladder in CT and the total sum of findings in CT (P<0.01) and US (P<0.05) were strongly related to the degree of inflammation of the gallbladder. CONCLUSION: The majority of AC patients exhibit nonspecific clinical findings, often delaying diagnosis; however, if it develops, AC tends to display more acute and inflammatory characteristics than calculous cholecystitis. laparoscopic surgery cannot be sucessful in cases of delayed diagnosis. US, CT and scintigram are useful diagnostic tools if we interpretate each finding in relation to the severity of inflammation.

THE EFFECTS OF CALCULOUS CHOLECYSTITIS ON CORONARY HEART DISEASA-AREPORT OF 6 CASES / 西安交通大学学报(医学版)

The paper reports 6 cases of calculous cholecystitis accompanied with coronary heart disease, All of them had angina attacks before cholecystectomy,And angina was often induced by biliary colic. Electrocaraio graphics showed that the coronary bloodsupplies of these cases were insufficicnt. these patients had been followed for 6 months to 11.5 years after operation(average 3.5 years). Angina disappeared completely in 4 cases and deminished in 2 cases. ECG abnormalities complerely recovcd in 2 cased, improved in 2 and remained unchanged in 2. One of 6 cases who had suffered from atrial premature best and atria lfibrillation for 9 years had no attack after cholecystectomy. The cardiac status improved in all of them. According to the above observations it is suggested that the coexisting of calculous cholecystitis and coronary heart disease is not in contrndication to cholecystectomy. Such cases should be treated with elective cholecystectomy as early as possible under well preoperative preparation This not only can treat and prevent cholelithiasis and its complications, but also may improve the condition and prognosis of coronary heart disease.