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The adhesion in the gallbladder triangle is the most important factor influencing the conversion to laparotomy in laparoscopic cholecystectomy (LC).The degree of adhesion in the cholecystic triangle is closely related to the difficulty of LC operation.With the reduction of cholecystic triangle adhesion,the treatment of gallbladder during LC will be easy and the rate of conversion to laparotomy will decrease accordingly.In order to investigate the causes of cholecystic triangle adhesion and its influence on LC,this paper reviews the current research progress.
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Objective To compare the effect of TNF-α preconditioning and ischemic preconditioning on hepatic ischemia-reperfusion injury ( IRI) and investigate the underlying mechanisms of TNF-αpreconditioning. Methods Fourty healthy male Wistar rats were random-ly divided into four groups which were Sham-operated group ( SO) ,ischemia-reperfusion group ( IR group:produced by total inflow occlusion for 30 min) ,ischemic preconditioning group ( IPC group:induce with 10 min hepatic ischemic and open 10 min before IR) and TNF-αpre-conditioning group ( TPC group:intraperitoneal injection with 1 μg/kg TNF-a 30 min prior to IR) . The sample of blood and hepatic tissue of all groups were taken after experiment. The protein levels of NF-κBp65 and Bcl-2 in the hepatic tissue were detected by immunohistochemis-try. Results There was significant difference (P0. 05) between IPC group and TPC group. Conclusion TNF-α preconditioning decreased the intensity of hepatic IRI,just as ischemic preconditioning,by induces an de-crease in the NF-κBp65 expression and an increase in the Bcl-2 expression.
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Objective To study the relationship between Helicobacter pylori (Hp) DNA positive detection in bile of gallbladder and intragastric Hp's colony and its plausible mechanism.Methods Sixty patients of gallbladder innocence diseases were recruited in the case group and 30 health populations were recruited in the control group.13CPDB was used to detect the infection of Hp.The cytotoxin associated gene antigen (cagA) in gall and gall-stone were detected through PCR.The empty function was tested through B ultrasound.Results The infection rate of Hp in all cases is 50.0% (30/60) and 7 of 30 bile (23.3%) ,1 of 30 gallstones (3.3%) were positive for Hp cag-A by PCR analysis in positive Hp infection group,with none of the 30 bile were positive in negative group( x2 = 5.822 ,P ＜ 0.05 ).The contraction rate of gallbladder of Hp positive group ( 56.8 ± 17.1 ) %was lower than negetive group' s ( 69.4 ± 13.1 ) % and the control group' s (63.3 ± 17.1 ) % ( F = 5.633,P ＜0.05).Conclusions Hp DNA is present in bile of gallbladder,and is related with Hp infection in stomach.Impairment of the gallbladder empty function may be related with Hp infection.
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Objective To evaluate the effects of different surgical treatments on polycystic hepatic disease and multiple simple hepatic cysts.Methods A total of 35 cases of polycystic hepatic disease and 54 cases of multiple simple hepatic cysts were surgically treated in our department from Jan.1998 to Jan.2006.Of the 35 cases of polycystic hepatic disease,12 were treated with the partial hepatic resection in combination with cyst fenestration,18 with laparotomic fenestration,5 with laparoscopic fenestration.Of the 54 cases of multiple simple hepatic cysts,6were treated with percutaneons aspiration and instillation of sclerosing agents (ethanol) under the guidance of ultrasonography B,36 with laparotomic fenestration,13 with laparoscopic fenestration.The surgical outcome and longterm follow-up outcome were retrospectively analyzed.Results After treatment,all polycystic hepatic disease patients experienced relief of symptoms when discharged.And the follow-up for an average of 3.0 years showed that 2 patients developed recurrence after the partial hepatic resection in combination with cyst fenestration,8 after the laparotomic fenestration,5 after the laparoscopic fenestration.The recurring rates were 16.7%,44.4% and 100.0% ,respectively.However,all patients of multiple simple liver cysts cured.Conclusions The approach of partial hepatic resection in combination with cyst fenestration is the most effective treatment for polycystic hepatic disease.Liver transplantation can cure polycystic hepatic disease,and is the only effective approach for severe cases.Percutaneous aspiration under the guidance of ultrasonography B is only effective for relief of symptoms before operation.Laparoscopic fenestration should be applied with caution.Laparoscopic fenestration is the first choice for multiple simple hepatic cysts with clinical symptoms.
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Objective To study the relationship between the Helicobacter pylori (Hp) infection and the formation of gallstones. Methods In this controlled study, the Hp infection rate was detected in both 35 cases of simple gallbladder stones (Experimental Group) and 25 cases of polypoid lesions of the gallbladder (Control Group). The Hp cytotoxin associated gene antigen (cag-A) in bile and gallstones of the both groups was amplified by PCR technique. Results The Hp infection rate was 51.4% (18/35) in the Experimental Group and 48.0% (12/25) in the Control Group, without significant differences (?~2=0.069,P=0.793). In the Experimental Group, cag-A positive results were noted in bile samples in 7 cases (20.0%, 7/35) and in gallstone samples in 1 case (2.9%, 1/35), whereas in the Control Group there were no positive results observed. The Hp cag-A positive rate was significantly different between the two groups (?~2=5.822,P=0.016). The presence of Hp cag-A in bile was correlated with the Hp infection of the stomach (x~2=3.886,P=0.049). Conclusions That the DNA of the Hp can be found in bile and gallstones of patients with cholelithiasis indicates a correlation between Hp infection of the gallbladder and the formation of gallstones.