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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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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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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 investigate the feasibility and safety of endoscopic trans-gastric gallbladder-preserving cholecystolithotomy (ETGC) for gallstones.@*Methods@#The clinical data of 84 cholecystolithiasis patients, who received ETGC at Endoscopic Center of Zhongshan Hospital from March 2017 to May 2019 were analyzed retrospectively. The operation completion rate, operation time, complications and recurrence of calculus were summarized.@*Results@#In the 84 cases of cholecystolithiasis, there were 19 cases (22.6%) of single stone, 53 cases (63.1%) of multiple stones, and 12 cases (14.3%) of gallstones with gallbladder polyps. A total of 82 patients (97.6%) successfully completed ETGC with median operation time of 88 min. Ten patients (12.2%) suffered from abdominal pain after operation, of which 6 patients relieved after conservative treatments. The other 4 cases, including 2 cases of hemoperitoneum, 1 case of biliary fistula, and 1 case of choledocholithiasis with obstructive jaundice, were recovered after corresponding interventions. As of June 14, 2019, 5 cases were lost to follow-up (follow-up rate was 93.9%, 77/82). Residual stones were found in 2 cases (2.6%, 2/77). Stone recurrence was discovered in 4 cases (5.2%, 4/7), and 2 cases (2.6%, 2/77) had cholesterol crystallization in gallbladder.@*Conclusion@#ETGC is minimally invasive, feasible and safe in treatment of cholecystolithiasis, and can retain the function of gallbladder. However, how to completely remove the stones and avoid residue by ETGC still needs further exploration, and its long-term efficacy still needs further observation.
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Objective To investigate the feasibility and safety of endoscopic trans-gastric gallbladder-preserving cholecystolithotomy (ETGC) for gallstones. Methods The clinical data of 84 cholecystolithiasis patients, who received ETGC at Endoscopic Center of Zhongshan Hospital from March 2017 to May 2019 were analyzed retrospectively. The operation completion rate, operation time, complications and recurrence of calculus were summarized. Results In the 84 cases of cholecystolithiasis, there were 19 cases ( 22. 6％) of single stone, 53 cases ( 63. 1％) of multiple stones, and 12 cases ( 14. 3％) of gallstones with gallbladder polyps. A total of 82 patients ( 97. 6％) successfully completed ETGC with median operation time of 88 min. Ten patients ( 12. 2％) suffered from abdominal pain after operation, of which 6 patients relieved after conservative treatments. The other 4 cases, including 2 cases of hemoperitoneum, 1 case of biliary fistula, and 1 case of choledocholithiasis with obstructive jaundice, were recovered after corresponding interventions. As of June 14, 2019, 5 cases were lost to follow-up ( follow-up rate was 93. 9％, 77/82 ) . Residual stones were found in 2 cases ( 2. 6％, 2/77 ) . Stone recurrence was discovered in 4 cases ( 5. 2％, 4/7 ) , and 2 cases ( 2. 6％, 2/77 ) had cholesterol crystallization in gallbladder. Conclusion ETGC is minimally invasive, feasible and safe in treatment of cholecystolithiasis, and can retain the function of gallbladder. However, how to completely remove the stones and avoid residue by ETGC still needs further exploration, and its long-term efficacy still needs further observation.
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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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For answering the question of whether the operation of cholecystolithotomy with gallbladder conservation is popular in overseas, the author made a literature review.It was found that in the past 340 years'' clinical practice in western countries, the research on preservation of gallbladder has been persisted till now.Many methods have been created with certain effects and at the same time some problems.Further studies are needed.
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Gallstone is a common and multiple benign disease,that has become an important public health problem.Focusing on the recent dispute about cholelithotomy or cholecystectomy and analysis of recent literatures,the author put forward to grasp the treatment principles performed by academician Huang Zhiqiang and discuss the crucial problems of treatment strategy about benign gallbladder disease from the following four aspects:(1) The key point of Cholelithotomy is to protect the gallbladder,not only to preserve the gallbladder.(2) The training,guidance and practice of clinical research on benign gallbladder diseases such as gallstones need to be further standardized.(3)The operation of gallstones is relatively easy while the and patients' prognosis is relatively complex.The choice of surgical indications is very important,and both of over treatment and inadequate treatment should be emphasized.(4) The epidemiological investigation and prevention of gallstones need to be strengthened.
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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 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.
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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 discusses the clinical application value and safety of endoscopic minimally invasive cholecystolithotomy in gallstones treatment .Methods To retrospectively analyzes the clinical data of 94 patients with gallbladder stone from Feb .2010 to Feb .2013 ,and divided into endoscopic minimally invasive cholecystolithotomy (EMIC) group (46 cases) and laparoscopic chole-cystectomy (LC) group (48 cases) .Observed two groups of operation time ,intraoperative blood loss ,intraoperative bile duct inju-ry ,anal exhaust time ,postoperative hospitalization time ,bile reflux gastritis ,abdominal distention ,diarrhea ,common bile duct calculi and hospitalization expenses ,etc .Results Two groups of operation time ,hospitalization expenses ,length of hospital stay ,and intra-operative blood loss have no obvious difference(P>0 .05) ,in EMIC set ,the exhaust time ,postoperative bile duct calculi incidence , intraoperative bile duct injury ,bile reflux gastritis incidence and the incidence of abdominal distension ,diarrhea are significantly less than LC group (P<0 .05) .Conclusion The endoscopic minimally invasive cholecystolithotomy compared with laparoscopic chole-cystectomy had high security ,light pain ,quicker recovery ,less complications advantages .It has already achieved the purpose of min-imally invasive treatment ,while maintaining the integrity of bile duct and gallbladder function ,thus it is worthy of promoting .
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Objective To investigate the effect of choledochoscopic gallbladder-preserving cholecystolithotomy combined with traditional Chinese medicine treatment.Methods A randomized controlled clinical study was conducted to analyze the 91 patients who were treated with choledochoscopic gallbladder-preserving cholecystolithotomy and 92 patients who underwent the same operation combined with subsequent treatment of traditional Chinese medicine.Intraoperative,postoperative and follow-up data were compared between the 2 groups (including operation time,blood loss,the rate of biliary fistula and common bile duct injury during the operation,gallbladder contraction function,the recurrence rate of gallstone,etc).Results In the simple choledochoscopic gallbladder-preserving cholecystolithotomy group,rate of gallstone recurrence was 7.7％ (7/91),the gallbladder wall was (3.5 ±0.6) mm,the gallbladder contraction function was (34.0 ± 3.6)％.However,the comprehensive treatment group,the rate of gallstone recurrence was 1.1％ (1/92),the gallbladder wall was(2.5 ±0.5) mm,the gallbladder contraction function was(48.0 ±4.5)％.There were significant differences between the two groups respectively (P ＜ 0.01,respectively).Conclusion Choledochoscopic gallbladder-preserving cholecystolithotomy combined with traditional Chinese medicine treatment is a safe,feasible,and minimal invasive approach for gallstone,and it can be considered as a alternative treatment of gallstone.
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Intramural gallstone is a special kind of gallstone and the mechanism may be related with increasing pressure in gallbladder lumen,inflammation of gallbladder and the formation of Rokitansky-Aschoff sinuses in the gallbladder wall.There is a close relationship between intramural gallstone and lumen stone.Intramural gallstone provides a new challenge to cholecystolithotomy with gallbladder preservation.But study on intramural gallstone may also offer a new idea for the mechanism of gallstone formation.
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OBJECTIVE: To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. MATERIALS AND METHODS: Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. RESULTS: Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). CONCLUSION: Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis.
Sujets)
Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Alliages , Cholécystite aigüe/imagerie diagnostique , Cholécystostomie/instrumentation , Sédation consciente , Conception d'appareillage , Études de faisabilité , Radioscopie , Polyéthylène , Polytétrafluoroéthylène , Radiographie interventionnelle , Résultat thérapeutique , Échographie interventionnelleRésumé
Objective To explore the relationship between the ultrastructure and gallstone recurrence after cholecystolithotomy.Methods By implanting human cholesterol gallstone into the gallbladder of rabbits, the ultrasructure of the gallbladder was observed with scanning eleetron microscope and transmission electron microscope,3 months before and after cholecystolithotomy.Results ln the stone-implanted group,the epithelium cells were massively damaged,nuclei karyopyknosis,mitochondria destroyed, and phagolysosomes increased. After the gallstone removal, the epitheliune cells did not recover completely where exposed connective tissues and covering surface by mucus. In cytoplasm, the lysosome decreased, and mucus granules secretion increased and actively secreted into the gallbladder lumen.Conclusions The pathologic changes of chronic cholecystitis caused by implanting stones in rabbits is similar to that of the chronic calculous cholecystitis in human.The basic cause of gallstone recurrence after cholecystolithotomy might be that the ultrastructural changes not be restored and the mucus secretion increased obviously in gallbladder.