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Objective:To investigate the effect of polyene phosphatidylcholine combined with Shudan decoction on the recovery of gallbladder function after gallbladder-preserving cholecystolithotomy.Methods:Sixty patients with gallbladder stone admitted to Shenzhen Hospital (Longgang), Beijing University of Chinese Medicine from June 2018 to July 2021 were selected. All patients were received gallbladder-preserving cholecystolithotomy, and they were divided in two groups by random number table, each group with 30 patients. The control group was treated with polyene phosphatidylcholine capsule after the operation, while the observation group was treated with Shudan decoction on the basis of the control group. After 30 d of continuous treatment, the traditional Chinese medicine symptoms score, gallbladder contraction function and the levels of serum alkaline phosphatase (ALP), gamma-glutamine transferase (GGT), incidence of adverse reactions, clinical efficacy were compared between the two groups.Results:After treatment, the scores of abdominal distension, abdominal pain and anorexia in the observation group were lower than those in the control group ( P<0.05). After treatment, the thickness of the gallbladder wall in the observation group was lower than that in the control group and the the gallbladder contraction rate was higher than that in the control group: (2.62 ± 0.29) mm vs. (3.21 ± 0.32) mm, (74.17 ± 6.49)% vs. (62.03 ± 6.05)%, there were statistical differences ( P<0.05). After treatment, the levels of GGT and ALP in the observation group were lower than those in the control group: (132.32 ± 30.09) U/L vs. (150.27 ± 30.33)U/L, (56.12 ± 14.89) U/L vs. (75.07 ± 16.22) U/L, there were statistical differences ( P<0.05). The total effective rate in the observation group was higher than that in the control group: 96.67%(29/30) vs. 80.00%(24/30), there was statistical difference ( χ2 = 4.04, P<0.05). The adverse reactions in the two groups had no significant differences ( P>0.05). Conclusions:Polyene phosphatidylcholine combined with Shudan decoction has a definite efficacy for patients with cholecystolithiasis after gallbladder-preserving cholecystolithotomy, and can effectively promote the recovery of their gallbladder function and with good safety.
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Choledochoscopic minimally invasive gallbladder-preserving cholecystolithotomy is a surgical method for preserving the gallbladder in the treatment of gallstones, and recurrence of gallstones is a hot topic for gallbladder-preserving cholecystolithotomy. The postoperative recurrence rate of gallstones can be reduced by selecting appropriate surgical indications and adopting effective preventive measures after surgery. This article reviews the indications for minimally invasive gallbladder-preserving cholecystolithotomy and postoperative preventive measures for the recurrence of gallstones, in order to better understand the influencing factors for recurrence and provide guidance for the treatment of gallstones by minimally invasive gallbladder-preserving cholecystolithotomy.
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Choledochoscopic minimally invasive gallbladder-preserving cholecystolithotomy is a surgical method for preserving the gallbladder in the treatment of gallstones, and recurrence of gallstones is a hot topic for gallbladder-preserving cholecystolithotomy. The postoperative recurrence rate of gallstones can be reduced by selecting appropriate surgical indications and adopting effective preventive measures after surgery. This article reviews the indications for minimally invasive gallbladder-preserving cholecystolithotomy and postoperative preventive measures for the recurrence of gallstones, in order to better understand the influencing factors for recurrence and provide guidance for the treatment of gallstones by minimally invasive gallbladder-preserving cholecystolithotomy.
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Objective To evaluate the clinical application of continuous two-layer suture of gallbladder incision with a single absorbable suture on laparoscopic minimally invasive gallbladder-preserving cholecystolithotomy. Methods The clinical data of 74 cases underwent laparoscopic minimally invasive gallbladder-preserving cholecystolithotomy were retrospectively analyzed. Main surgical procedures included the longitudinal incision of gallbladder wall, choledochoscopy and the removal of all stones and the closure of the gallbladder incision. The mucous incision was first closed using a 4-0 absorbable suture with continuous everting suture. Using the same suture, the seromuscular incision was then closed with continuous invering suture. The operation time, suturing time, complications and postoperative hospitalization time were also documented. Results Laparoscopic gallbladder-preserving cholecystolithotomy was successfully performed in all cases using the suturing technique introduced in Methods. The operation time was 33~78 min (average 45.11 ± 14.96 min). Suturing time for gallbladder incision was 9 ~ 22 min (average 14.86 ± 3.88 min). No severe complications occurred, such as bile leakage, peritonitis, residual gallstone, hemorrhage or infection. The postoperative hospitalization time was 2~4 d (average 3.21 ± 0.69 d). A postoperative follow-up of 3 ~ 62 months (average 35.50 ± 18.94 months) indicated gallbladder stone recurrence of 2 cases, with a recurrence rate of 2.7%. Continuous two-layer suture of gallbladder incision with a single absorbable suture is a safe, practical and reliable technique for the closure of the gallbladder incision in laparoscopic gallbladder-preserving cholecystolithotomy.
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Objective To explore the means of haemostasis in gallbladder preserving cholecystolithotomy. Methods The clinical data of 31 cases were retrospectively analyzed, summarizes the successful experiences. Results There appeared 31 cases the gallbladder internal bleeding in 512 cases gallbladder preserving cholecystolithotomy. In all the cases, 31 operations were stopped bleeding satisfactorily and performed successfully without conversion to conventional laparoscopic surgery, without perforation of gallbladder. pressure and lavage hemostasis had common effect, the control coagulation hemostasis had satisfaction rate 96.6%. Except one patient used gallbladder whole layers suture method. Conclusion The control coagulation hemostasis with the high-frequency electric knife is the optimal way, pressure and lavage hemostasis is basal, and gallbladder whole layers suture method is supplement.
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Objective To explore the influence of gallbladder contraction function for gallbladderpreserving cholecystolithotomy by laparoscope combined with choledochoscope laparoscope.Methods Seventy-three patients with benign gallbladder diseases were selected.Patients treated with laparoscopic cholecystectomy were enrolled in LC group (31 patients),while those treated with endoscopic minimally invasive cholecystolithotomy (EMIC) were enrolled in EMIC group (42 patients).Operation situation,treatment outcome and postoperative complications were analyzed between two groups.At the same time,the level of cholecystokinin was detected with double antibody sandwich method in two groups,and the gallbladder contraction function of patients in EMIC group were detected with color Doppler.Results All patients were completed surgery without relapse cases.The operation time in EMIC group was longer than that in LC group:(84.6 ± 11.4) min vs.(72.1 ± 13.6) min,t =4.076,P ＜ 0.05.But the intraoperative bleed and postoperative complications in EMIC group were lower than those in LC group:(11.3 ± 4.8) ml vs.(19.6 ± 5.5) ml,t =3.715,P ＜0.05;2.38％ vs.16.14％,x2 =4.469,P ＜0.05.There were no recurrence.The levels of cholecystokinin in two groups before operation had no significant difference (P ＞ 0.05).After treatment for 1,6,12 months,the levels of cholecystokinin in EMIC group were (33.6 ± 10.6),(49.4 ± 12.7),(63.4 ± 14.6)ng/L,in LC group were (21.4 ± 9.1),(11.3 ± 7.4),(6.7 ± 2.7) ng/L,the levels of cholecystokinin in EMIC group were significantly higher than those in LC group (t =3.472,17.514,31.472,P ＜ 0.05 or ＜ 0.01).After treatment for 1 month,the rate of gallbladder contraction in EMIC group was significantly lower than that before treatment:(22.8 ± 4.5)％ vs.(39.2 ± 7.6)％,t =6.003,P ＜ 0.05).After treatment for 6 months,the rate of gallbladder contraction in EMIC group was recovered,after treatment for 12 months,the rate of gallbladder contraction in EMIC group was significantly higer than that before treatment:(48.8 ± 7.6)％ vs.(39.2 ± 7.6)％,t =3.054,P ＜ 0.01.Conclusions Gallbladder-preserving cholecystolithotomy by laparoscope combined with choledochoscope can get less iatrogenic trauma,which contribute to a protective effect on gallbladder contraction function on the base of high stone removal rate.It has promotive value in benign gallbladder diseases.
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Objective To investigate the clinical efficacy of ultrasound-guided double-tract percutaneous cholecystostomy combined with choledochoscopic gallbladder-preserving cholecystolithotomy for the elderly patients with acute calculous cholecystitis.Methods The clinical data of 35 elderly patients with cholecystolithiasis who were admitted to the General Hospital of Chengdu Military Command from January 2012 to December 2013 were retrospectively analyzed.All the 35 patients received ultrasound-guided double-tract percutaneous drainage,and then received choledochoscopic gallbladder-preserving cholecystolithotomy.The long-term oral use of anti-inflammatory and cholagogue medications after operation reduced recurrence of cholecystolithiasis.All the patients were followed up by telephone interview and outpatient examination till June 30,2014.Results All the 35 patients undergoing successfully the ultrasound-guided double-tract percutaneous cholecystostomy.Of the 35 patients,1 patient with the puncture bleeding was cured successfully by symptomatic treatment,1 patient was treated by cholecystectomy due to the unformed sinus tract under costal margin,and other 34 patients underwent successfully cholecystolithotomy.The follow-up was carried out for 4 to 24 months and 1 patient was diagnosed as with recurrence of cholecystolithiasic.Conclusion Ultrasound-guided double-tract percutaneous cholecystostomy combined with choledochoscopic gallbladder-preserving cholecystolithotomy for elderly patients with acute calculous cholecystitis is safe and feasible,with an advantage of promotional value.