Colecistectomia robótica por incisão única na doença da vesícula biliar: revisão sistemática e metanálise / Robotic single-incision cholecystectomy in gallbladder disease: systematic review and meta-analysis

Introdução: A colecistectomia por incisão única assistida por robótica é técnica cirúrgica emergente para o tratamento da doença da vesícula biliar. Objetivo: Analisar os resultados clínicos e o custo efetividade dela, com foco no tempo de permanência hospitalar, tempo de operação, custo total e taxa de conversão entre robótica e outros procedimentos. Métodos: Revisão sistemática e metanálise foram realizadas de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Os bancos de dados PubMed, Embase e Cochrane foram pesquisados desde o início até março de 2023. Análise estatística foi feita usando o R versão 6.2.1. Metanálise de efeitos aleatórios com razão de risco, diferença média e intervalo de confiança de 95% foi estimada usando a variância inversa e o método de Mantel-Haenszel para resultados binários e o estimador DerSimonian-Laird para resultados contínuos. Resultados: Um total de 452 pacientes foram envolvidos, incluindo 4 estudos randomizados. Os desfechos escolhidos para metanálise foram: permanência hospitalar (MD −0.03 dias, CI 95% −0.12 a 0.18, p=0.708), tempo de operação (MD 12.93 min, CI 95% −21.40 a 47.25, p=0.460) e taxa de conversão (RR 0.90, CI 95% 0.44 a 1.83, p=0.771). Conclusão: Não houve diferença estatisticamente significativa em relação à duração da permanência hospitalar, tempo de operação e taxa de conversão entre a colecistectomia robótica por incisão única e outras técnicas cirúrgicas para a doença da vesícula biliar.

Introduction: Robotic-assisted single-incision cholecystectomy is an emerging surgical technique for the treatment of gallbladder disease. Objective: To analyze the clinical results and its cost effectiveness, focusing on length of hospital stay, operating time, total cost and conversion rate between robotics and other procedures. Methods: Systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Cochrane databases were searched from inception through March 2023. Statistical analysis was performed using R version 6.2.1. Random effects meta-analysis with hazard ratio, mean difference and 95% confidence interval was estimated using inverse variance and the Mantel-Haenszel method for binary outcomes and the DerSimonian-Laird estimator for continuous results. Results: A total of 452 patients were enrolled, including 4 randomized trials. The outcomes chosen for meta-analysis were: hospital stay (MD −0.03 days, CI 95% −0.12 to 0.18, p=0.708), operating time (MD 12.93 min, CI 95% −21.40 to 47.25, p=0.460) and of conversion (RR 0.90, CI 95% 0.44 to 1.83, p=0.771). Conclusion: There was no statistically significant difference regarding length of hospital stay, operating time and conversion rate between single-incision robotic cholecystectomy and other surgical techniques for gallbladder disease.

Resultados asociados con la realización de colecistectomía subtotal en un hospital de tercer nivel de Bogotá / Results of partial cholecystectomy in a tertiary level hospital in Bogotá

Resumen Introducción: La colecistectomía laparoscópica es actualmente el gold standard en patología vesicular litiásica. Hay un grupo de pacientes que tiene un gran proceso inflamatorio que impide la identificación adecuada del triángulo de seguridad. Dado lo anterior, una alternativa es la realización de colecistectomía subtotal por laparoscopia, para reducir el riesgo de lesión de vía biliar. Objetivo: Describir los resultados clínicos y quirúrgicos en pacientes que se sometieron a la realización de colecistectomía subtotal laparoscópica en el Hospital Universitario Clínica San Rafael en el periodo comprendido entre febrero de 2015 y febrero de 2017. Materiales y Método: Serie de casos, donde se realizó un análisis descriptivo para determinar la distribución de las variables, se utilizaron tablas de contingencia, pruebas Fischer según el caso y su distribución en número y normalidad. Resultados: Se obtuvo información de 28 pacientes, con un promedio de edad de 56,1 años, mayor proporción de hombres. En cuanto a las características clínicas se observaron los antecedentes de diabetes e hipertensión arterial. No hubo complicaciones ni sangrado intraoperatorio importantes. En resultados posoperatorios no se presentó lesión de vía biliar en ninguno, hubo 3 reingresos (10,7%) y hubo una reintervención relacionada con colección intraabdominal. Se reportó una mortalidad secundaria a neumonía. Conclusión: La colecistectomía subtotal es un procedimiento seguro en cuanto a la prevención de lesión de vía biliar.

Introduction: Laparoscopic cholecystectomy is actually the gold standard surgical approach to the gallbladder disease. Some patients with severe cholecystitis and inflammatory changes that makes impossible to dissect the hepatocystic triangle. Is in this case, where the laparoscopic subtotal cholecystectomy is an option, to reduce the risk of biliary injury. Aim: To describe the clinical and surgical results in patients that underwent in laparoscopic subtotal cholecystectomy at Hospital Universitario Clínica San Rafael since February 2015 to February 2017. Materials and Method: A case series study was carried out, with a descriptive analysis to determine the distribution of them. We used contingency tables and fischer tests. Results: 28 laparoscopic subtotal cholecystectomy. The average age of 56.1 years, fifty percent was men. At the clinical characteristics, the history of diabetes and arterial hypertension was observed. There was no bile duct lesion in any and there was a reintervention due to intra-abdominal collection and only one mortality. 50% had biliary leakage and 25% of cases required endoscopic intervention. Conclusion: Laparoscopic subtotal cholecystectomy is a safe procedure.

Standardized diagnosis and treatment process of gallbladder disease and technical details / 中华消化外科杂志

Based on current diagnosis and treatment of gallbladder disease, the occur-rence of incidental gallbladder cancer is partly caused by the irregular clinical diagnosis and treatment process of gallbladder disease, which leads to the failure to make the diagnosis of gallbladder cancer in time, carry out the correct preoperative and intraoperative staging, and cause R 1 or R 2 resection. The authors summarize standardized diagnosis and treatment process of gallbladder disease and technical details. In clinical practice, the concept of incidental gallbladder cancer should be discarded, and various gallbladder diseases should be taken as a whole. A more standardized diagnosis and treatment process should be established to improve the diagnostic accuracy of gallbladder cancer and achieve radical resection, which eventually improve survival of patients.

Value of Contrast-enhanced Ultrasound in Differential Diagnosis between Cholesterol Polyp and Gallbladder Adenoma / 中国医学科学院学报

Objective To compare the performance of contrast-enhanced ultrasound(CEUS)and ultrasound(US)in the differential diagnosis between cholesterol polyps and gallbladder adenomas. Methods A total of 136 patients with gallbladder polyp lesions(GPLs)and undergoing cholecystectomy in the First Medical Center of Chinese PLA General Hospital from January 2019 to October 2020 were retrospectively analyzed.All the patients underwent US and CEUS examinations before cholecystectomy.US and CEUS images of cholesterol polyps and gallbladder adenomas were compared for the evaluation of the performance of CEUS in the diagnosis of gallbladder adenomas. Results The 136 cases of GPLs included 95 cases of cholesterol polyps and 41 cases of gallbladder adenomas.Cholesterol polyps and gallbladder adenomas showed significant differences in the maximum size of GPLs(

New progress of gallbladder polyps imaging diagnosis / 中华肝胆外科杂志

Gallbladder polyps is one of the most common diseases in the general surgery.How to get accurate preoperative diagnosis is of great significance for the choice of treatment options.This review summarizes the imaging methods commonly used in preoperative pathological diagnosis of gallbladder polyps,hoping to help clinicians in the development of treatment strategies for gallbladder polyps.

The value of contrast-enhanced ultrasound and contrast-enhanced CT in the differential diagnosis of benign and malignant gallbladder diseases / 中华医学超声杂志（电子版）

Objective To comparatively analyze the image characteristic of contrast-enhanced ultrasound(CEUS)and contrast-enhanced computed tomography(CECT),and explore the diagnostic value of the two methods in benign and malignant lesions of gallbladder.Methods comparative analysis the image characteristic of CEUS and CECT,the preoperative diagnostic results of 86 cases of gallbladder diseases were confirmed by pathology.Results The enhancement patterns of CEUS and CECT in benign and malignant lesions of gallbladder are similar.The sensitivity,specificity and accuracy of CEUS were 77.9%(53/68),77.8%(14/18),77.9%(67/86),respectively.The sensitivity,specificity and accuracy of CECT were 75%(51/68),55.6%(10/18),70.9%(61/86),respectively.The sensitivity,specificity and accuracy of the combination of CEUS and CECT were 83.8%(57/68),55.6%(10/18),77.9%(67/86),respectively.The accuracy of the combination of CEUS and CECT was higher than that of CECT in the diagnosis of malignant gallbladder lesions [(53.9±10.00)s vs(35.50±6.72)s],the differences were statistically significant(t=6.729,P＜0.001).Conclusions The enhancement patterns of CEUS and CECT in benign and malignant gallbladder lesions are similar.The combination of CEUS and CECT is helpful for improving the diagnostic accuracy of malignant gallbladder lesions.CEUS and CECT could corroborate and complement each other,and provide more valuable information for the differential diagnosis of benign and malignant gallbladder lesions.

Dietary Patterns and Risk of Gallbladder Disease: A Hospital-based Case-Control Study in Adult Women.

Gallbladder disease is one of the most prevalent gastrointestinal disorders that may result from a complex interaction of genetic and environmental factors. This study examined the association of dietary patterns with gallstone disease among Iranian women. This case-control study was conducted in general teaching hospitals in Tehran, Iran. Participants were 101 female cases and 204 female controls aged 40-65 years who were admitted for problems other than GBD. Dietary patterns were identified using principal components analysis based on food frequency questionnaire. Compared to the control group, cases were less educated, less physically active, and consumed more total energy (p<0.02). Having ≥3 livebirths increased the risk of gallstone by more than 5 times, followed by having rapid weight loss, being single, having familial history of gallstone, and consuming high total energy. Two distinct dietary patterns were identified in women (healthy and unhealthy). After adjustment for several confounding variables, healthy dietary pattern was associated with a decreased risk of gallstone disease (OR=0.14, 95% CI 0.048-0.4) while unhealthy dietary pattern was associated with an increased risk (OR=3.77, 95% CI 1.52-9.36). These findings confirm that dietary pattern approach provides potentially useful and relevant information on the relationship between diet and disease. Identifying risk factors will provide an opportunity for prevention of gallbladder disease in developing countries facing an increased risk of obesity.

Clinical application research of contrast-enhanced ultrasound in differential diagnosis between benign and malignant gallbladder disease / 中华超声影像学杂志

Objective To discuss the blood perfusion characteristic of benign and malignant gallbladder disease by contrast-enhanced ultrasound(CEUS).Methods The enhancement characteristic of 62 patients with occupying lesions in gallbladder were observed.Four case of cholecystolithiasis accompany biliary sludge were proven by surgery and remaining 58 case were confirmed by histopathological examination.Their enhancement time and enhancement pattern were analyzed.Results The Time-to peak of benign and malignant disease were (22.4± 4.0)s and (27.7± 2.6)s (t =5.756,P ＜0.01),the Time-to-hypoenhancement of benign and malignant disease were (58.0 ± 7.3)s and (41.5 ± 4.0)s (t =10.33,P ＜0.01),respectively.The peak intensity of benign and malignant disease were (19.2 ± 3.6)dB and (25.1 ± 2.9) dB (t =6.85,P ＜0.01),the mean transit time of benign and malignant disease were (22.72 ± 4.7)s and (6.3± 6.4)s (t =15.001,P ＜0.01),respectively.The destruction of the gallbladder wall of benign and malignant disease were 0％ (0/36) and 57.7％ (15/26) (x2 =25.05,P ＜ 0.01),the inhomogeneous enhancement of benign except biliary sludge and malignant disease were 43.8％ (14/32) and 57.7％ (15/26) (x2 =1.115,P =0.291,respectively).In early phase,78.1％ (25/32) and 80.8 ％ (21/26) of benign disease except biliary sludge and malignant showed hyperenhancement respectively(x2 =3.15,P =0.207).In later phase,84.4％ (27/32) and 76.9％ (20/26) of benign disease except biliary sludge and malignant showed hypoenhancement respectively(x2 =3.615,P =0.164).Conclusions CEUS can obtain the information of blood perfusion and make quantitatively analysis about the enhancement time.It also facilitate the diagnosis of solid occupying lesion in gallbladder.

Clinical analysis of residual gallbladder disease after laparoscopic cholecystectomy / 局解手术学杂志

Objective To analyze the causes of residual gallbladder disease after claparoscopic cholecystectomy. Methods From Feb-ruary 2006 to February 2013, there were 30 patients with residual gallbladder disease after laparoscopic cholecystectomy, and they were given second surgery in our hospital. Results The residual gallbladder lesions were successfully removed. Symtoms before operation were relieved or disappear. The average duration of hospital stays was 8. 2 d. The difference between before and after surgery was statistically significant(P<0. 05). There were 2 cases of delayed wound healing, and the others were of good curative effect. And blood test indicators of all the pa-tients recovered to normal when they leave hospital. Conclusion The surgery was carried out strictly accordding to the relevant procedure to prevent the occurrence of residual cystic lesions. If the patients were found to have obvious symptoms of residual gallbladder disease,they should be early diagnosed and recieved second surgery as soon as possible so as to cure disease and improve quality of life after surgery.

Influencing factors in elderly patients with schistosomiasis liver disease com-bined with gallbladder diseases / 中国血吸虫病防治杂志

Objective To understand the status of elderly patients with schistosomiasis liver diseases combined with gallblad-der diseases,and explore the influencing factors. Methods A total of 280 elderly patients with schistosomiasis liver disease were divided into two groups,198 cases of chronic liver fibrosis and 82 cases of liver cirrhosis,and the results of their gallbladder ultra-sound and liver function examinations were analyzed statistically. Results Among the 280 cases,157 patients were combined with gallbladder diseases(56.1%),including gallbladder wall thickening(28.2%,79/280),cholecystolithiasis(13.6%,38/280),cholecystitis(11.1%,31/280),and gallbladder polyp(3.2%,9/280). The incidence rates of gallbladder wall thickening, cholecystitis and cholecystolithiasis in the schistosomiasis patients with cirrhosis were significantly higher than those in the schisto-somiasis patients with liver fibrosis(χ2=4.568,P<0.05). Conclusion The main influencing factors of schistosomiasis liver dis-ease combined with gallbladder diseases are the age,the course of the disease,liver cirrhosis and the portal hypertension degree.

Clinicopathological features of polypoid lesions of the gallbladder: report of 1396 cases / 中华普通外科杂志

Objective To probe the differences in clinicopathological features between benign and malignant polypoid lesions of the gallbladder.Methods In this study,1396 PLG cases diagnosed by postoperative pathology between 2007.1 to 2009.12 were enrolled.Cases were divided into three groups according to the pathological classification:1339 cases of benign proliferative diseases ;42 cases of adenoma,15 cases of malignant disease.Comparing the clinical characteristics of the three groups,we screened out the risk factors for malignant transitions.Results Age (F =8.090,P =0.000),size of polyp (F =102.61,P =0.000),single vs multiple lesions (x2 =214.25,P =0.000),concurrent inflammation (x2 =9.362,P =0.009),and stones (x2 =34.022,P =0.000) were significantly different between the three groups.Conclusions Size of polyps over 0.8 cm,age over 60 years,single polyp,accompanied by stones and inflammation were the risk factors for malignancy in gallbladder polypoid lesions.

Patrón de consumo alimentario en una muestra de adultos con Enfermedad Colelitiasica (EC)

En un estudio realizado en una muestra aleatoria de adultos de Rosario se encontró una tasa de prevalencia de Enfermedad Colelitiásica (EC) del 20,5%. Con el objetivo de determinar el patrón de consumo alimentario de estas personas y compararlo con las Raciones Dietéticas Recomendadas (RDA) se entrevistaron 44 de dichas personas con EC. Se les realizó una encuesta sobre hábitos alimentarios 5 años previos al diagnóstico, empleando un cuestionario semi-cuantitativo de frecuencia de consumo (FFQ) y un Atlas fotográfico de porciones estandarizadas. Se calcularon los promedios (± desvío estándar) de la edad, del Índice de Masa Corporal (IMC), del consumo de cada nutriente y de la energía total consumida (Kilocalorías). La significación estadística de las diferencias entre sexos se evaluó aplicando pruebas t de student. La edad de las personas estudiadas (18 varones y 26 mujeres) fue 63,8±13,8 años y el IMC fue 28,2±5,8. Consumos promedio diarios: Kcalorias 2941±791,1 ; Carbohidratos 295,3±96,9 g; Proteínas 131,6±36,8 g; Grasa 128,9± 43 g; Ácidos grasos saturados 41,9±18,6 g; Ácidos grasos poliinsaturados 13,8±8,7 g; Colesterol 455,4±186,8 mg; Sodio 2730±1552,1 mg; Potasio 2912,8±1001,4 mg; Calcio 719,3±403,3 mg; Hierro 16±4,6 mg; Fósforo 801,6±320,3 mg; Vitamina A 3121,7±1811,9 mcg; Vitamina B1 0,80±0,30 mg; Vitamina B2 1,9±0,8 mg; Vitamina C 157,6±114,1 mg; Niacina 6,9±2,7 mg; Fibra total 12± 5,3 g; Café 70,7±104,3 cc. Se concluye que el patrón alimentario de las personas con EC se caracterizó por un alto consumo de Grasas, Ácidos grasos saturados y Colesterol, no alcanzando las recomendaciones para Carbohidratos, Calcio, Niacina y Fibra.

Food intake pattern in a sample of adults with Gallbladder Disease (GD). In Rosario, Argentina, a 20,5% prevalence rate of Gallbladder Disease (GD) was found in a random sample of adults. The aim of this study was to determine the food consumption pattern of subjects with GD nested in that sample for further comparison with the Recommended Dietary Allowances (RDA). Forty-four subjects were interviewed about the food consumption during the five years before their diagnosis, by applying a semi-quantitative food frequency questionnaire (FFQ) and a photographic atlas of standardized portions. Age, body mass index (BMI), all consumed nutrients, and total energy intake (kilocalories) were reported as Mean ± standard deviation. Comparisons according to sex (18 males and 26 females) revealed no significant differences in the variables under analysis. Age and BMI in the overall sample were as follows 63.8±13.8 years and 28.2±5.8, respectively. Mean daily consumption of nutrients was as follows: Carbohydrates 295.3±96.9 g , Protein 131.6±36.8 g , Fat 128.9±43 g , Saturated fatty acids 41.9±18,6 g, Polyunsaturated fatty acids 13.8±8.7 g, Cholesterol 455.4±186.8 mg, Sodium 2730±1552.1 mg, Potassium 2912.8±1001.4 mg, Calcium 719.3±403.3 mg, Iron 16±4.6 mg, Phosphorus 801.6±320.3 mg, Vitamin A 3121.7±1811.9 mcg, Vitamin B1 0.80±0.30 mg, Vitamin B2 1.9±0.8 mg, Vitamin C 157.6±114.1 mg, Niacin 6.9±2.7 mg, Fiber 5.3±12 g, Coffee 70.7±104.3 cc (total energy intake 2941±791.1 Kcal). Subjects with GD have a history of higher intake of fat, saturated fatty acids and cholesterol with consumption of carbohydrates, calcium, niacin and fiber below the recommended quantities.

Relationship Between Gallbladder Distension and Lipid Profiles in Kawasaki Disease

BACKGROUND AND OBJECTIVES: Kawasaki disease (KD) is an acute systemic vasculitis in children which causes coronary arterial dilatation (CAD) and gallbladder distension (GBD). There is a dearth of investigating the relationship between the severity of KD and GBD with lipid profiles. SUBJECTS AND METHODS: A total of 80 patients with 'complete KD' who were diagnosed from January 2005 to May 2009 was enrolled in this study. Serum cholesterol {total, high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C)}, triglyceride (TG), complete blood count, inflammation markers {erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)} were measured at the time of admission during febrile period. Echocardiography and abdominal sonogram were performed in all patients to determine CAD and gallbladder size. According to GBD, patients with KD were classified as patients with GBD and patients without GBD. Between two groups, demographic and clinical data were analyzed. RESULTS: The serum level of LDL-C was significantly lower in patients with GBD (p=0.03) compared with patients without GBD or febrile control. There was no significant difference in inflammatory indices between patients with GBD and patients without GBD. GBD was not significant risk factor of CAD in this study (odds ratio=2.0, 95% confidence interval=0.82-5.3, p=0.16). CONCLUSION: This is the first study that highlights the relationship between the GBD and lipid metabolism in patients with KD. This study provides clinical insights about potential mechanism underpinning the relationship between the GBD and lipid metabolism.

Análise dos lipídios biliares no cálculo e na bile em portadores brasileiros de litíase biliar / Analysis of gallstones and biliar lipids in gallbladder disease of Brazilians patients

INTRODUÇÃO: A litíase biliar é uma doença do trato digestivo que apresenta prevalência variada em diferentes grupos étnicos e que gera altos gastos aos sistemas de saúde. A possibilidade de aplicação de tratamento não invasivo medicamentoso está direcionada a presença de cálculo de colesterol o que leva a necessidade de identificar corretamente os pacientes que podem beneficiar-se com o tratamento. No Brasil estima-se uma prevalência da doença em 9,3% da população em geral. Porém, ainda não há estudos que demonstrem a composição de cálculo de colesterol e pigmentos nos pacientes, bem como não há estudos de análise dos lipídios biliares e sua relação com os mecanismos fisiopatológicos da doença. Nossos objetivos foram analisar a composição do cálculo e da bile e compará-la com fatores pré-dispositivos da doença como tempo de nucleação e hiper saturação de colesterol em pacientes brasileiros. MÉTODOS: Foram analisadas 72 amostras de bile vesicular e cálculo biliar de pacientes com litíase biliar submetidos a procedimento cirúrgico laparoscópico em diferentes hospitais da grande São Paulo. Quatorze amostras de bile vesicular de pacientes que foram submetidos à laparoscopia por problemas gastrointestinais, mas que não apresentavam litíase biliar foram usadas como controle. Foram realizadas análises bioquímicas para avaliar a composição dos cálculos e da bile. Os cálculos foram analisados de acordo com a porcentagem de colesterol e bilirrubina em relação ao peso total do cálculo. A concentração dos ácidos biliares foi determinada pela técnica HPLC. O índice de saturação do colesterol foi calculado de acordo com a metodologia descrita por Carey. O tempo de nucleação foi avaliado através de microscopia de luz polarizada durante 21 dias. RESULTADOS: No grupo de pacientes com litíase biliar, 48 eram do sexo feminino (66,7%) e a média de idade foi 54,1 anos ± 13,1 (mínima de 18 anos e máxima de 75 anos). Do total de cálculos analisados (n=72) 75% foram classificados...

Introduction: Gallstone disease represents a prevalent and costly health problem. The changing epidemiology and the emerging non-surgical interventions for gallstone disease necessitate the definition of target populations for future therapies. The prevalence of biliary lithiasis in Brazil is around 9,3% of the general population with more than 20 years old, however it is necessary investigative studies to determine the composition of the gallstones and the correlation between bile lipids and disease physiopathology factors. Objectives: This study aimed to define patterns of gallstone composition and evaluate the biliary predictors factors of gallstone disease as nucleation time and cholesterol saturation index in Brazilian patients. Methods: Seventy two post- cholecystectomy gallstone specimens and gallbladder bile were obtained from different hospitals of the city of Sao Paulo. Fourteen gallbladder bile samples were obtained as control samples, from patients who underwent laparoscopic surgery due to gastrointestinal symptoms without gallbladder disease. Biochemistry analyses were performed to determine the composition of the gallstones and bile. Gallstones were classified according to their cholesterol and bilirrubin content linked with their dry weight. The concentration of bile salts was evaluated by HPLC technique. The cholesterol saturation index (CSI) was calculated in accordance with Carey methods. The nucleation time was evaluated by polarized light microscopy during 21 days. Results: There were 48 women and 22 men in the Gallbladder disease patients group. The mean age of the patients were 54,1 ± 13,1 years old (range 18 75 years old). Cholesterol stones were found in 75% of the stones. The bile of the cholesterol gallstone patients presented lower concentration of phospholipids (p<0,05), higher CSI (p<0,001), lower nucleation time (p<0,05) and higher concentration of deoxicholic acid (p<0,05) when compared with control group...

Indication for surgical treatment of polypoid lesion of gallbladder / 中华全科医师杂志

This study was to investigate the indication for surgical treatment of polypoid lesion of gallbladder (PLG). Clinical and pathological data from 121 PLG patients undergoing laparoscopic cholecysteotomy were retrospectively analyzed. Asymptomatic or moderate symptomatic PLG was seen in 67. Pathology test-confirmed cholesterol, hyperplasia, and adenomatous polyps were found in 111 (91.7%), 8 (6. 6%), and 2 (1.7%), respectively. Our data suggest that most PLG might be benign and have non-neoplasm nature. Over-operation may be unnecessary, and the indication for surgical procedure should be prudently controlled.

Clinical Summary of 1260 Patients with "Three Holes and One Hook in The End" Laparoscopic Cholecystectomy / 中国普外基础与临床杂志

Objective To summarize the experiences of "three holes and one hook in the end(TOE)" laparoscopic cholecystectomy(LC) in 1 260 cases and to investigate the operation procedures,technical points and the prevention of complications.Methods The data of 1 260 patients suffering from chronic calculous cholecystitis,acute calculous cholecystitis,atrophic cholecystitis,gallbladder polyps etc.,who were admitted to this hospital and treated by TOE from March 1999 to March 2008 were included and analysed retrospectively in this study.Results One thousand two hundred and sixty of cases were cured,including 1 252 cases of succeeding LC(99.37%),conversions to open in 8 cases,no death,no bile duct injury,with intraoperative hemorrhage in 3 cases,umbilicus infection in 2 cases,gallbladder fossa hydrops in 3 cases,with operation time for 8-60 min(mean 38.5 min) and hospitalization for 3-7 d(mean 5 d) after surgery.During the follow up of 1 002 cases for 1 to 7 years(mean 3.5 years),there were no complications such as bile fistula,bile duct stricture,residual stones of biliary duct,etc..Conclusion TOE is worthy of application and promotion for the excellent effectiveness,few complications,rapid recovery and safety.

The diagnosis and treatment of adenomyomatosis of the gallbladder / 中华普通外科杂志

Objective To investigate the clinical feature and treatment of adenomyomatosis of the gallbladder(GBA).Methods Thirty-three cases of GBA admitted from 1992 to 2007 were reviewed retrospectively and their clinical characters were sununarized. Results These cases were divided into three types grossly:14 cages of diffuse type,10 cases of segmental type and 9 Cages of localized type.Cholelithiasis wag associated in 21 cases and 11 cases with cholecystitis.Main clinical presentations included pain in the upper abdomen,discomfort after meal,nausea and vomit.Preoperative correct diagnosis was achieved in only six cases.Twenty-eight patients underwent laparoscopic cholecystectomy and three did open cholecystectomy.Concomirant exploration of common bile duct with T tube drainage and resection of liver ansioma was performed in one each.Adenomyomatosis of the gallbladder was diagnosed by pathologic examination in all cases. Condusions Due to the high rate of combination with cholelithiasis and cholecystitis,GBA has no specific clinical manifestations.The preoperative diagnosis lies on radiological examinations.Cholecystectomy is an appropriate treatment as adenomyomatesis of the gallbladder has a malignant potential.

Clinic Study and Analysis of Bile Reflux Gastritis / 医学研究杂志

Objective To explore the clinical character istics of bile reflux gastritis. Methods We observed 1328 patients with bile reflux gastritis(excluding gastritis of the remnant stomach),and selected 425 superficial gastritis as control group.All the patients took helicobacter pylori(Hp) rapid urease examination. 664 cases in observed group and all in patients of control group were examined for bile disease by UB. Results In 1328 patients,there were 797 male and 531 female,and the ratio of male and female was 1.5/1.The detecting rate of bile reflux gastritis was decreased along with aging. Among all the patients,there were 651 simple superficial gastritis(49%),86 gastric ulcer(6.5%),412 duodenal ulcer (31%),122 combined ulcer(9.2%) and 57 other disease(4.7%).In observed group,1030 HP(77.56%) were regative; 298 Hp(22.44%) were positive,and in control group,282 Hp(66.35%) were regative,147 Hp(33.65%) were positive.The amount of gallbladder disease resection was 221(33.3%),which was more than that of control group(16.9%). Conclusion The detecting rate of bile reflux gastritis was decreased along with aging.Bile reflux gastritis is more often combined with ulcer disease or gallbladder disease. The Hp infection rate of bile reflux gastritis is significant lower than that of non-bile reflux gastritis.

A clinical comparison between laparoscopic and open cholecystectomy in elderly patients / 中国微创外科杂志

Objective To compare the safety between laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) for benign gallbladder diseases in elderly patients. Methods A total of 120 patients above the age of 60 with indications for cholecystectomy and tolerance to general anesthesia were divided into two groups (LC Group and OC Group), in admission order of odd or even, with 60 patients in each group. Peri-operative parameters including operation time, analgetic consumption, postoperative gastrointestinal recovery time, length of duration with fluid infusion, length of bed rest, postoperative complications, and hospital stay were compared between the two groups. Serum total triiodothyronine (TT3) and thyroid stimulating hormone (TSH) levels, as well as the functional recovery of the abdominal muscles, were also recorded and compared. Results Peri-operative parameters were better in the LC Group than in the OC Group. Serum TT3 levels decreased significantly after surgery in both the LC Group (F=8.26,P=0.000) and the OC Group (F=124.70,P=0.000), with a more significant difference in the OC Group.Postoperatively,serum TSH levels decreased insignificantly in the LC Group (F=1.87,P=0.157) and significantly in the OC Group (F=27.24,P=0.000). Lasegue’s test at 7 days after surgery showed significantly higher leg-raising times in the LC Group than in the OC Group (t=3.640,P=0.000). Conclusions Laparoscopic cholecystectomy is superior to open cholecystectomy in the treatment of benign gallbladder diseases in elderly patients.

Diagnosis and treatment of acute acalculous cholecystitis / 临床外科杂志

Objective To investigate the cause, diagno sis and treatment of acute acalculous cholecystitis(AAC).Method 32 cases of AAC which were treated from 1990 to 2000 were analyzed retrosp ective ly.Results 25 cases were diagnosed by B-ultrasonograph ,th e positive rate of diagnosis was 88.0%(22/25),7 cases were diagnosed by CT,6 c ases were definitely diagnosed(85.7%).All of them underwent operations, cholec ystectomy was performed in 29 patients,cholecystostomy in 2, subtotal cholecyste ctomy in 1 .Of them 31 were cured and one died.Conclusions The cause of AAC is very complication, the preoperative diagnosis is difficult, it is easy to be misdiagnosed. Surgeon should pay more attention to AAC. B-ultra sonograph is the first choice of the diagnosis of AAC,CT can give a hand to diag nosis. The early operation resection is the most effective method.