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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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Objective:To evaluate laparoscopic choledocholithotomy in patients with cholecystolithiasis and normal sized common bile duct(CBD) with choledocholithiasis.Methods:The clinical data of 393 patients with cholecystolithiasis and choledocholithiasis treated by LC combined with LCBDE at the Department of General Surgery of Hefei Second People's Hospital from Mar 2014 to Jul 2021 were retrospectively analyzed.Results:There were 280 CBD calculi cases in which CBD diameter >8 mm which was included into CBD dilated group, and 113 cases of CBD calculi with normal diameter (5 mm≤CBD diameter ≤8 mm). There was no difference in operative time and postoperative complications in the small diameter group. During the follow-up period, 1 case in the dilated group experienced biliary tract stenosis and treated by stenting. There was no statistical significance in biliary tract stenosis in both groups ( P>0.05).Stone recurrence occurred in 3 cases (2.7%) in the normal diameter group, all of which were removed by ERCP lithotomy. Stone recurrence occurred in 8 cases (2.9%) in the CBD dilated group, 7 were removed by ERCP stone extraction and 1 refused further treatment. Conclusion:It is safe and feasible to perform LC+LCBDE in patients with cholecystolithiasis complicating normal sized CBD stones.
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Objective:To investigate the expression and significance of human ether-a-go-go related gene (HERG) protein in interstitial cells of Cajal (ICC) in patients with gallbladder stones.Methods:The gallbladder tissues of 60 patients with gallbladder diseases who underwent cholecystectomy from January 2018 to December 2020 in the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital were collected, including 36 males and 24 females, aged (46.0±14.0) years. They were divided into two groups according to whether there were gallstones: gallstone group and control group (patients with gallbladder polyps and gallbladder adenomyosis), with 30 cases in each group. Color ultrasound was used to detect and calculate the gallbladder contraction rate. The neck, body and bottom tissues of the gallbladder were excised and sectioned. The expression of HERG protein and CD117 ( marker of ICC) was detected by immunofluorescence staining, immunohistochemistry and Western blot.Results:The gallbladder contraction rate in the gallstone group was (65.8±4.1)%, lower than that in the control group (73.8±5.3)%, with a statistically significant difference ( t=4.14, P<0.001). Immunohistochemistry showed that HERG protein was mainly distributed in the mucosal layer of gallbladder tissue, which was pale brown. The relative expression of HERG protein at the bottom of gallbladder in the gallstone group was (0.293±0.102), lower than that in the control group (0.694±0.059), with a statistically significant difference ( t=3.38, P=0.027). Immunofluorescence staining showed that HERG protein was mainly distributed in ICC of gallbladder epithelium. HERG protein expression in ICC at the bottom of gallbladder in gallstone group was lower than that in control group, while HERG protein expression at the neck and body of gallbladder had no significant difference. Conclusion:There are ICC and HERG protein in gallbladder tissue of patients with gallstone. The decrease of gallbladder contraction rate may be related to the decrease of HERG protein expression in ICC in gallbladder bottom tissue.
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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.
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Objective:To investigate the feasibility and efficacy of transcystic injection of indocyanine green during laparoscopic cholecystectomy (LC) surgery in the treatment of patients with gallbladder stones combined with liver cirrhosis.Methods:The clinical data of 96 patients with cirrhosis who underwent LC for gallbladder stones with cholecystitis attacks in the Department of Hepatobiliary and Pancreatic Surgery of the Second People′s Hospital of Changzhou City from January 2018 to May 2022 were retrospectively analyzed. All patients were diagnosed by clinical history and auxiliary examination before surgery and underwent cholecystectomy according to their groups, which were divided into fluorescence group ( n=49) and white light group ( n=47) according to whether ICG was used or not, where the fluorescence group underwent LC in fluorescence mode after direct intraoperative injection of ICG via gallbladder. The two groups were compared in terms of identification time of the three tubes, operation time, intraoperative bleeding, intraoperative injury, intraoperative open abdomen and blood transfusion, postoperative drainage time, postoperative hospitalization time, postoperative complications and changes in infection and liver function indexes before and after surgery. The measurement data obeying normal distribution were expressed as mean±standard deviation( ± s), and independent sample t-test was used for comparison between groups. The measurement data obeying the skewed distribution were expressed by M( Q1, Q3), and the Mann-Whitney U test was used for comparison between groups. Count data were expressed as rates (%), and the chi-square test or Fisher′s exact probability method was used for comparison between groups. Results:The procedure was successfully performed in both groups, and the identification of triple-tube time, operative time, intraoperative bleeding, postoperative drainage time, postoperative hospital stay, postoperative ALT, postoperative GGT, and postoperative TBIL in the fluorescent group were (14.96±1.49) min, (52.14±7.36) min, 5(5, 10) mL, (1.61±0.61) d, (2.37±0.49) d, 31.5(22.0, 44.8) U/L, 38.0(21.0, 91.5) U/L, 18.0(11.5, 22.8) μmol/L, and (29.87±3.37) min, (84.36±13.25) min, 10(10, 20) mL, (2.70±0.69) d, (3.15±0.42) d, 45.0(28.0, 64.8) U/L, 73.0(32.0, 132.0) U/L, 23.0(16.1, 29.3) μmol/L in the white light group and the differences were statistically significant compared with the two groups( P<0.05). In the fluorescence group, there was no intraoperative injury and no cases of intraoperative opening, and there were 2 cases of postoperative complications, while in the white light group, there were 2 cases of intraoperative injury, 1 case of intraoperative opening, and 5 cases of postoperative complications, and there were no cases of blood transfusion in both groups. There was no statistically significant difference between the fluorescence group and the white light group when comparing the preoperative laboratory indexes of both groups ( P>0.05). When comparing the first postoperative white blood cell count, C-reactive protein, aspartate aminotransferase, and alkaline phosphatase indexes in the fluorescence group and the white light group, there was no statistically significant difference between the two groups ( P>0.05). Conclusion:When LC is performed in patients with symptomatic gallbladder stones combined with cirrhosis, intraoperative injection of indocyanine green via the gallbladder to visualize the gallbladder and bile duct structures is simple and easy to perform, and the safe and efficient dissection of extrahepatic bile ducts and gallbladder bed speeds up the procedure while reducing postoperative trauma.
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Gallbladder abdominal wall fistula is usually due to the acute cholecystitis with-out timely treatment, which leads the formation of abscess around the gallbladder, the gallbladder adhering to the abdominal wall and the abscess infiltrating into the skin to form a spontaneous abdominal wall fistula. Patient with gallbladder abdominal wall fistula may have the symptoms of cholecystolithiasis and acute cholecystitis. Ultrasound examination can detect the situation of gallbladder conveniently, including the internal echo after formation of abscess, the connection between the gallbladder and abdominal cavity, and the blood flow signal, to clarify the diagnosis for the subsequent treatment. The authors share the diagnosis and treatment experiences of an elderly patient with gallbladder abdominal wall fistula.
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Objective:To investigate the causes and prognosis of salvage cholecystectomy for relapsing cholecystolithiasis after gallbladder-preserving gall stones removal surgery.Methods:From Jul 2015 to Dec 2019, 24 referral patients with gallstone recurrence after gallbladder-preserving cholelithotomy surgery received salvage cholecystectomy. The clinical data was analyzed to explore the causes for re-operation and the prognosis.Results:Twenty-two cases had definite gallstone recurrence, among them 19 cases were symptomatic, 2 cases were operated on suspected gallbladder tumor and common bile duct stones induced acute cholangitis. Laparoscopic cholecystectomy was successfully performed in 23 cases and 1 case was converted to open surgery. No severe complication were observed in all the patients.Conclusions:Symptomatic gallstone recurrence is the most common causes of salvage cholecystectomy after gallbladder-preserving cholelithotomy. Laparoscopic surgery procedure is still highly successful.
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Objective To investigate the association between gallstones (GS) and metabolic syndrome (MS) in southern Xinjiang, China, and to provide experience for the prevention and control of metabolic diseases in southern Xinjiang. Methods The patients with GS who visited First Division Hospital, Second Division Korla Hospital, and Third Division Hospital of Xinjiang Production and Construction Corps from March 2015 to March 2019 were enrolled as case group, and cluster sampling was used to select the individuals who underwent physical examination in Third Division 51st Regiment Hospital during the same period of time were enrolled as control group. According to inclusion and exclusion criteria, 1140 cases were enrolled in each group after 1∶ 1 matching based on age and sex. The t -test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; a logistic regression analysis was used to investigate the influencing factors for GS. Dummy variables were included by logistic regression to evaluate multiplicative interaction between MS components, and the parameter estimate and covariance matrix of the logistic regression model and interaction calculation table were used to calculate and evaluate additive interaction between MS components. Results The risk of GS in MS patients was 2.33 times that in non-MS patients (odds ratio [ OR ]=2.33, 95% confidence interval [ CI ]: 1.86-2.92). In addition, the components of MS also increased the risk of GS, including blood glucose ( OR =2.94, 95% CI : 2.36-3.68), blood pressure ( OR =1.50, 95% CI : 1.26-1.80), blood lipids ( OR =1.48, 95% CI : 1.25-1.75), and body mass index ( OR =1.44, 95% CI : 1.21-1.70). After adjustment for multiple factors, the risk of GS gradually increased with the increase in the number of metabolic abnormalities, i.e., one abnormality ( OR =1.55, 95% CI : 1.22-1.99), two abnormalities ( OR =2.13, 95% CI : 1.66-2.72), three abnormalities ( OR =3.48, 95% CI : 2.59-4.69), and four abnormalities ( OR =4.65, 95% CI : 2.79-7.84). No additive or multiplicative interaction was found between MS components. Conclusion GS is closely associated with MS in southern Xinjiang, and the risk of GS gradually increases with the increase in MS components. No additive or multiplicative interaction is found between GS and MS components.
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Three patients received surgical treatment in Department of Hepatobiliary Surgery of Mengchao Hepatobiliary Hospital from December 2020 to February 2022. Ceftriaxone sodium was given prophylactically before and after operation,and gallbladder silt stones were found by imaging examination on the 3rd, 3rd and 2nd after surgery in 3 patients, respectively. No special treatment was given,after the withdrawal of ceftriaxone sodium for 28, 38 and 48 d,radiographic examination showed that calculi disappeared spontaneously. It is suggested that the pseudolithiasis may be related to administration of ceftriaxone sodium.
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To investigate the feasibility and safety of endoscopic trans-gastric cholecystolithotomy(ETGC) combined with endoscopic retrograde cholangiopancreatography (ERCP) for cholecystolithiasis and choledocholithiasis. Data of patients with cholecystolithiasis and choledocholithiasis who underwent ETGC after ERCP in Zhongshan Hospital Affiliated to Fudan University from November 2018 to April 2019 were analyzed. Six patients with cholecystolithiasis and choledocholithiasis, 4 males and 2 females, were included in this study.The interval between ERCP and ETGC ranged from 1 to 77 days (median 5 days). All the 6 patients successfully completed ETGC after ERCP, with a surgical success rate of 100%. All the patients had multiple cholecystolithiasis and one patient was complicated with gallbladder polyps.The ETGC operation time was 22-100 min (median 65 min), and the length of hospital stay was 3-9 d (median 6.5 d). Two patients had dull pain in the upper abdomen and increased body temperature after surgery. Abdominal ultrasound in one patient suggested local effusion in the right upper abdomen.Both patients improved after conservative treatment.None of the patients had cholecystitis and cholangitis related symptoms such as right upper abdominal pain or fever during postoperative follow-up, and the follow-up rate was 100%with median follow-up time of 18 month.All the 6 patients underwent abdominal ultrasound examination after surgery. No recurrence occurred in 5 patients. One of the patients showed cholesterol crystals in the gallbladder wall and bile mud deposition.ETGC combined with ERCP is safe and feasible for cholecystolithiasis and choledocholithiasis.
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Objective:To investigate the mRNA level of adiponectin in patients with gallstone of Hui and Han nationality in Qinghai Province and its clinical significance.Methods:From August 2017 to August 2018, 108 patients with gallbladder cholelithiasis and 91 patients with other benign diseases who were hospitalized in the Affiliated Hospital of Qinghai University from August 2017 to August 2018 were selected as the research objects. According to gallbladder cholesterol stone and the classification criteria of adult obesity, they were divided into gallstone-obesity group (56 cases), gallstone non-obesity group (52 cases), non gallstone obesity group (48 cases) and non gallstone non obesity group (43 cases). The levels of serum lipid (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), blood glucose (GLU), uric acid and high-sensitivity C protein (hs-CRP) were measured. Meanwhile, the adiponectin mRNA levels in omental adipose tissue and abdominal subcutaneous adipose tissue were detected by real time fluorescent quantitative polymerase chain reaction (qRT-PCR).Results:Compared with non gallstone and non obesity group, the serum TC [(4.57±0.49)mmol/L vs (5.63±0.53)mmol/L, (6.12±0.51)mmol/L, (6.85±0.43)mmol/L], TG [(1.50±0.32)mmol/L vs (2.06±0.33)mmol/L, (2.53±0.39)mmol/L, (2.96±0.34)mmol/L], LDL-C [(2.14±0.35)mmol/L vs (2.65±0.33)mmol/L, (3.05±0.37)mmol/L, (3.54±0.38)mmol/L], uric acid [(188.63±13.52)mmol/L vs (257.69±14.63)mmol/L, (306.96±18.96)mmol/L, (359.96±16.58)mmol/L], hs-CRP [(228.32±18.96)μmol/L vs (298.96±19.96)μmol/L, (354.96±19.96)μmol/L, (405.98±19.47)μmol/L] were increased in gallstone-obesity group, gallstone non-obesity group, non gallstone obesity group ( P<0.05), while the adiponectin mRNA [subcutaneous adipose tissue: (1.76±0.25) vs (1.43±0.23), (0.98±0.23), (0.68±0.29); omental adipose tissue: (2.15±0.29) vs (1.88±0.28), (1.56±0.27), (1.12±0.25)] and HDL-C levels [(2.15±0.11)mmol/L vs (1.79±0.15)mmol/L, (1.42±0.12)mmol/L, (1.15±0.09)mmol/L] were decreased ( P<0.05). Compared with the non gallstone obesity group, the serum levels of TC, TG, LDL-C, GLU, uric acid were increased in the gallstone non obesity group, gallstone obesity group, while the adiponectin mRNA and HDL-C levels were decreased ( P<0.05). Compared with the gallstone non obese group, the serum levels of TC, TG, LDL-C, GLU, uric acid and hs-CRP were increased in gallstone obese group, while the levels of adiponectin mRNA and HDL-C were decreased ( P<0.05). Adiponectin in omental adipose tissue and abdominal subcutaneous adipose tissue was positively correlated with HDL-C and negatively correlated with TC, TG, LDL-C, uric acid and hs-CRP ( P<0.05). Logistic regression analysis showed that low level of subcutaneous adiponectin, omental adiponectin and high level of TG were risk factors for gallstone in non obese population ( OR=2.340, 1.931, 2.784, P<0.05), while low level of subcutaneous adiponectin, omental adiponectin and high level of LDL-C were risk factors for gallstone in obese population ( OR=2.358, 2.596, 2.115, P<0.05). Conclusions:The adiponectin mRNA is decreased in the patients with gallstone of Hui/Han nationality in Qinghai Province. The low level of subcutaneous adiponectin and omental adiponectin are the risk factors for gallstone in obese or non obese people of Hui/Han nationality in Qinghai Province.
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Objective:To investigate the effect of laparoscopic cholecystectomy (LC) combined with common bile duct exploration (LCBDE) on pain stress and inflammatory factors in elderly patients with gallbladder stones and common bile duct stones.Methods:Eighty elderly patients with cholecystolithiasis and choledocholithiasis in Huadong Hospital Affiliated to Fudan University from January 2020 to January 2021 were selected. According to the surgical method, they were divided into observation group of 40 cases and control group of 40 cases. Patients in the observation group were treated with LC combined with LCBDE, and patients in the control group were treated with traditional open surgery. The perioperative indicators and complications, changes in pain stress and inflammatory factors before and 3 days after operation, and the quality of life before operation, 1 month after operation and 6 months after operation were compared between the two groups. Normally distributed measurement data were represented by mean±standard deviation ( Mean± SD), and t test was used to compare between groups. The chi-square test was used to compare the count data between groups. Results:The operation time, time to get out of bed, postoperative exhaust time, intraoperative blood loss, and postoperative complications in the observation group were (98.39±7.23) min, (1.56±0.37) d, (1.29±0.28) d, (38.94±5.64) mL, 5%, the control group were (107.53±9.98) min, (2.53±0.52) d, (2.16±0.34) d, (65.87±7.96) mL, 25%, the observation group were excellent in all indicators compared with the control group, the differences between the two groups were statistically significant ( P<0.05). After operation 3rd day, the serum 5-hydroxytryptamine, substance P and norepinephrine in the two groups were higher than before operation ( P<0.05); after operation 3rd day, serum 5-hydroxytryptamine, substance P and norepinephrine the observation group were (0.70±0.12) pg/mL, (175.42±17.87) ng/mL and (378.52±26.57) ng/mL, the control group were (1.02±0.18) pg/mL, (248.98±18.98) ng/mL, and (460.92±35.42) ng/mL. The indexes of the observation group were smaller than those of the control group, the differences between the two groups were statistically significant ( P<0.05). After operation 3rd day, the serum tumor necrosis factor-α, C-reactive protein and interleukin-6 in the two groups were higher than before operation ( P<0.05); after operation 3rd day, Serum tumor necrosis factor-α, C-reactive protein and interleukin-6 in the observation group were (108.76±10.86) pg/mL, (14.23±3.18) mg/L and (17.84±3.98) pg/mL, respectively, on the 3rd day after operation. The control group were (156.95±16.67) pg/mL, (26.52±4.59) mg/L and (28.53±5.67) pg/mL, the observation group indexes were all smaller than control group, the differences between the two groups were statistically significant ( P<0.05). The quality of life scores of the two groups at 1 month and 6 months after the operation were higher than before operation ( P<0.05); The quality of life scores of patients in the observation group at 1 month and 6 months after surgery were higher than control group ( P<0.05). Conclusion:LC combined with LCBDE treatment has little effect on pain stress and inflammatory factors in elderly patients with cholecystolithiasis and choledocholithiasis, and has fewer postoperative complications, and can improve the quality of life of patients.
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ObjectiveTo investigate the clinical effect of laparoscopy, choledochoscopy, and duodenoscopy combined with T-tube-free drainage in the treatment of gallstones with common bile duct stones. MethodsA retrospective analysis was performed for the clinical data of 564 patients with gallstones and common bile duct stones who were admitted to Department of General Surgery, Pudong New Area People’s Hospital, Shanghai University of Medicine & Health Sciences, from December 2017 to December 2019. According to the surgical procedure, the patients were divided into laparoscopic transcystic common bile duct exploration (LTCBDE) group with 191 patients, three endoscopies+laparoscopic common bile duct exploration and primary suture (LBEPS) group with 138 patients, and endoscopic retrograde cholangiopancreatography (ERCP)+endoscopic sphincterotomy (EST)/endoscopic papillary balloon dilation (EPBD)+laparoscopic cholecystectomy (LC) group with 235 patients. The three groups were analyzed in terms of the general data including sex, age, bile duct diameter, and stone size/number, and surgical condition and complications were compared between groups. A one-way analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. ResultsThere were significant differences between the LBEPS group, the ERCP+EST/EPBD+LC group and the LTCBDE group in hospital costs, drainage volume, time to first flatus, length of hospital stay and time to extraction of drainage tube (F=416.40, 7.80, 33.99, 143.70, and 13.08, P＜0.001, P=0.020, P＜0.001, P＜0.001, and P＜0.001). Compared with the LBEPS group and ERCP+EST/EPBD+LC groups, the LTCBDE group had significantly lower hospital costs and a significantly longer time to first flatus, and significantly shorter length of hospital stay and time to extraction of drainage tube(all P＜0.05). No serious complication was observed after surgery, and there was no significant difference in the incidence rate of complications between the three groups (P＞0.05). All patients were discharged successfully after surgery. ConclusionThe three minimally invasive surgical procedures combined with T-tube-free drainage achieve the goal of little trauma and pain, fast postoperative recovery, and few serious complications, among which LTCBDE has the lowest treatment costs and the best postoperative recovery.
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ObjectiveTo investigate related factors for stone recurrence after endoscopic minimally invasive gallbladder-preserving cholecystolithotomy, and to establish a nomogram model for predicting the risk of stone recurrence after surgery based on independent risk factors. MethodsA retrospective analysis was performed for the clinical data of 144 patients with gallstones who underwent endoscopic minimally invasive gallbladder-preserving cholecystolithotomy in Qinghai University Affiliated Hospital from January 2012 to January 2018, and according to postoperative stone recurrence, the patients were divided into non-recurrence group and recurrence group. The chi-square test was used for comparison of categorical data between two groups. LASSO and logistic regression analyses were used to analyze independent risk factors for postoperative stone recurrence, and the corresponding nomogram prediction model was plotted according to regression coefficient. The calibration curve was plotted to evaluate the reliability of the predictive nomogram; Harrell consistency index was used to quantify the discriminatory performance of the predictive nomogram; the receiver operating characteristic (ROC) curve was used to evaluate the sensitivity, specificity, and area under the ROC curve (AUC) of this predictive nomogram. ResultsAll 144 patients underwent successful endoscopic minimally invasive gallbladder-preserving cholecystolithotomy, among whom 14 patients (9.7%) experienced stone recurrence after surgery. The multivariate analysis showed that family history (odds ratio ［OR］= 3.245, 95% confidence interval ［CI］: 0.752-13567, P=0.104), regular diet (OR=3.752, 95% CI: 1.067-14.141, P=0.041), stone homogeneity (OR=5.871, 95% CI: 1636-25.390, P=0.010), and medication compliance (OR=0.225, 95% CI: 0.057-0.799, P=0.024) were independent risk factors for recurrence. The nomogram model had an index of concordance (C-index) of 0.835 (95% CI: 0.732-0.938) in the modeling sample and 0.7925 in the verification sample, suggesting that the nomogram model in this study had good accuracy and discrimination. The predictive nomogram had an AUC of 0.835, suggesting that this nomogram had a relatively high predictive value. ConclusionFamily history, regular diet, stone homogeneity, and medication compliance are independent risk factors for stone recurrence after endoscopic minimally invasive gallbladder-preserving cholecystolithotomy, and the nomogram constructed based on these independent risk factors may help to predict the risk of postoperative stone recurrence.
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Objective To investigate the association of the polymorphisms of the FGB gene rs4220 and rs1044291 loci with plasma fibrinogen (Fg) level and gallstones in Xinjiang, China. Methods Blood samples were collected from 150 Uygur and Han patients with gallstones and 150 Uygur and Han individuals without gallstones who were hospitalized or underwent physical examination in The People's Hospital of Xinjiang Uygur Autonomous Region from December 2017 to May 2020. Plasma Fg level was measured, and based on the previous results of whole exon sequencing of the FGB gene, the SNaPshot method was used to identify the genotype at rs4220 and rs1044291 loci of the FGB gene. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; a multivariate logistic regression analysis was used to investigate the association between each variable and gallstones. Results For the Chinese Han population, the gallstones group had a significantly higher plasma Fg level than the control group [2.90 (2.43-3.49) g/L vs 2.47 (2.06-3.02) g/L, Z =-3.62, P 0.05). For the Chinese Han population, the subjects carrying GG genotype at the rs4220 locus in the gallstones group had a significantly higher plasma Fg level than those in the control group [2.84(2.32-3.61) g/L vs 2.34(2.05-2.75) g/L, Z =-3.04, P 0.05). Conclusion The influence of FGB gene polymorphism on plasma Fg level may be associated with race, and FGB gene polymorphisms at the rs4220 and rs1044291 loci may be involved in the pathogenesis of gallstones by regulating Fg level in the population in Xinjiang.
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Resumen Objetivos: Determinar si existe asociación entre hipercolesterolemia y colesterolosis o litiasis vesicular. Material y métodos: Estudio de serie de casos comparativo, retrospectivo, realizado entre enero del 2014 y diciembre del 2015, en el Hospital Belén de Trujillo-Perú. Formaron parte del estudio todos aquellos casos productos de colecistectomía que tuvieron un perfil lipídico. Se revisaron 1069 historias clínicas en las que se encontraron 143 casos que tenían perfil lipídico. Resultados: El rango de edad varió entre 17 y 95 años con una edad promedio de 50 años. De estos, 36 casos (25,2%) tenían colesterolosis. La relación varón:mujer fue 1:2,6 y una edad promedio de 44,5 años. Tuvieron colecistolitiasis 119 casos (83,2%), con una relación varón:mujer 1:3,1 y una edad promedio de 48 años. Hubo hipercolesterolemia (≥ 200mg/dl) en 51 casos (35,7%). En 29 (20,3%) casos se observó colesterolosis con colecistolitiasis y 7 (4,9%) pacientes tuvieron colesterolosis acalculosa. No se encontró asociación entre hipercolesterolemia y colesterolosis (p=0,284), ni con litiasis vesicular (p=0,169). Conclusiones: No existe asociación estadísticamente significativa entre hipercolesterolemia con colesterolosis, ni con litiasis vesicular.
Summary Objective: To determine if an association hypercholesterolemia and cholesterolosis or gallbladder lithiasis does exist. Methods: AA case series study was conducted between January 2014 and December 2015 in Hospital Belén, Trujillo- Perú. Patients were those in whom a cholecystectomy had been performed (1069) and a lipid profile was available (143). Results: Age range was 17-95 years with a mean age of 50; 36 (25.2%) had cholesterolosis, male to female ratio was 1:2,6. Gallbladder lithiasis was found in 119 cases (83.2%), male to female ratio is 1:3.1 and a mean age of 48. Hypercholesterolemia (≥ 200 mg/dl) was found in 51 cases (35.7%); 29 20.3% cholesterolosis with gallbladder lithiasis and 7 (4.9%) had acalculous cholesterolosis. No association was found between hypercholesterolemia and cholesterolosis (p=0.284) nor with gallbladder lithiasis (p=0.169). Conclusions: No significant association between hypercholesterolemia and cholesterolosis or gallbladder lithiasis was found.
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Objective@#To compare the efficacy of laparoscopic choledochoscopic cholelithotripsy and laparoscopic cholecystectomy in the treatment of cholecystolithiasis.@*Methods@#A retrospective study was conducted in 81 cases of cholecystolithiasis who admitted to the People's Hospital of Yuci District from March 2013 to March 2018.The patients were divided into control group (n=38, laparoscopic cholecystectomy) and study group (n=43, laparoscopic choledochoscope choledocholithotomy) according to the different surgical method.The perioperative indicators, liver function indicators, recurrence rate and complications were compared between the two groups.@*Results@#The operation time, hospital stay, recovery time of gastrointestinal function, recovery time of diet after operation and intraoperative bleeding volume in the study group were (43.59±4.59)min, (7.24±1.17)d, (15.51±2.09)d, (2.88±0.42)d, (15.07±1.32)mL, respectively, which were better than those in the control group [(55.23±5.47)min, (9.12±1.32)d, (26.48±3.48)d, (3.53±0.58)d, (24.65±1.48)mL] (t=10.411, 6.796, 17.426, 5.823, 6.864, all P=0.000). The levels of total bilirubin (TBIL), alanine transferase (ALT), aspartate aminotransferase (AST) and total protein (TP) at 1 day after operation in the study group were (24.39±2.21)μmol/L, (29.09±4.68)U/L, (29.02±4.41)U/L, (21.95±2.52)g/L, respectively, which were lower than those in the control group [(28.43±2.31)μmol/L, (34.39±4.28)U/L, (35.31±3.08)U/L, (25.28±2.42)g/L] (t=8.038, 5.293, 7.348, 6.046, all P=0.000). TBIL, ALT, ALT, AST, AST, TP levels at 3 days after surgery in the study group were (20.32±2.24)μmol/L, (24.61±4.26)U/L, (23.68±4.79)U/L, (18.94±2.89)g/L, respectively, which were lower than those in the control group [(24.45±2.02)μmol/L, (29.81±3.32)U/L, (27.94±4.50)U/L, (21.41±2.87)g/L] (t=8.669, 6.609, 4.109, 3.851; all P=0.000). The recurrence rates of the control group and the study group were 5.26% (2/38) and 6.98% (3/43), respectively, there was no statistically significant difference between the two groups (χ2=0.102, P=0.749). The incidence of complications in the study group was 4.65% (2/43), which was lower than 21.05% (8/38) in the control group, the difference was statistically significant (χ2=5.015, P=0.025).@*Conclusion@#Compared with laparoscopic cholecystectomy, laparoscopic assisted choledochoscopic choledocholithotomy has better curative effect, it can reduce the damage to liver function, with low incidence of complications, and it has high clinical value.
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At present, the epidemic of coronavirus disease 2019 is still serious, and the prevention and control of this epidemic is taken seriously throughout the country. As one of the most common acute abdominal diseases in hepatobiliary surgery, gallstones with acute cholecystitis has sudden onset and rapid progression and thus requires early diagnosis and timely and effective treatment. During the prevention and control of the epidemic, patients should be admitted properly to reduce nosocomial infection. Gallstones with acute cholecystitis is often accompanied by pyrexia, and therefore, the presence or absence of severe acute respiratory syndrome coronavirus 2 infection should be clarified. Treatment regimen should be selected appropriately and individualized treatment measures should be developed. While ensuring that patients receive timely and effective diagnosis and treatment, hospitals should adopt prevention and control measures for patients and their caregivers to reduce nosocomial infection. The personal protection of medical personnel should also be taken seriously, and scientific measures should be implemented to guarantee their safety.
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Laparoscopic cholecystectomy is considered the gold standard for the treatment of symptomatic cholecystolithiasis and has become one of the typical representatives of minimally invasive surgery. This article briefly introduces the contraindication and indication for laparoscopic cholecystectomy, commonly used surgical procedures, and possible complications and related treatment methods, emphasizes the improvement of surgical procedure and the development of new equipment for cholecystectomy, and points out the current status, problems, and development trend of laparoscopic cholecystectomy, in order to provide a reference for better application of laparoscopic cholecystectomy in clinical practice.
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In recent years, more and more patients with metabolic syndrome also have gallstones, and gallstones may lead to life-threatening diseases such as acute cholecystitis, acute obstructive cholangitis, and pancreatitis. This article summarizes the association of obesity, hyperlipidemia, hyperglycemia, and hypertension in metabolic syndrome with gallstones and discusses related mechanisms, in order to provide guidance for the screening, diagnosis, treatment, and prevention of gallstones.