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Objective:To investigate the application value of choledochoscopy in the diagnosis of cholelithiasis related diseases.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 111 patients with cholelithiasis related diseases who were admitted to the Second Affiliated Hospital of Soochow University between January 2018 and April 2019 were collected. There were 45 males and 66 females, aged (55±16)years, with the range from 20 to 89 years. The mucosal course of biliary system and the submucosal vascular density of the 111 patients were observed by choledochoscopy during operation. Observation indicators: (1) patient examinations; (2) specific case analysis. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers or percentages. Results:(1) Patient examinations: 111 patients underwent intraoperative choledochoscopy examination, and 5 patients underwent pathological examination. Five of the 111 patients had the results of intraoperative choledochoscopy examination inconsistent with results of preoperative imaging examination. (2) Specific case analysis. Case 1: the patient was diagnosed with intrahepatic and extrahepatic bile duct stones preoperatively by computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) examination. Results of intraoperative choledochoscopy examination and electronic staining under choledochoscope showed abnormal mucosa at the opening of the original cholecyst duct in the common bile duct, thickened and disordered blood vessels, which indicated the possibility of malignant transformation. Results of intraoperative rapid frozen histopathological examination showed inflammatory cell infiltration in gallbladder neck and focal glandular epithelial high-grade intraepithelial neoplasia. Results of postoperative pathological examination showed high-grade intraepithelial neoplasia of the wall of gallbladder cervical ducts, focal infiltrating myowall carcinoma and strongly positive of Cytokeratin 7 diaminobenzine staining. Case 2: results of preoperative doppler ultrasonography and MRCP showed gallbladder polyps. Intraoperative choledochoscopy examination showed gallbladder polyps with adenoma and a blood vessel at polyp root, which was diagnosed as gallbladder polyp combined with adenoma. Results of electronic staining in narrow band imaging (NBI) showed gallbladder polyps with adenoma and thick blood vessels at polyp root. Results of intraoperative rapid frozen histopathological examination showed cholesterol polyps and focal adenomatous hyperplasia. Results of postoperative pathological examination showed chronic cholecystitis with cholesterol polyps and adenomatous hyperplasia of focal glands. Case 3: results of preoperative MRCP examination showed choledocholithiasis and intrahepatic bile duct stones. Results of intraoperative choledochoscopy examination showed intrahepatic bile duct stones of large size. The patient underwent holmium laser lithotripsy and mucosal hyperplasia with soft lesion and smooth mucous epithelium was found after the stone was broken. Results of NBI and methylene electron staining showed multiple submucosal tortuous vessels in proliferative lesions behind bile duct stone. Results of intraoperative rapid frozen histopathological examination showed adenoma with high-grade intraepithelial neoplasia. Case 4: results of preoperative MRCP examination showed intrahepatic and extrahepatic bile duct stones combined with dilatation of bile duct. Results of CT examination showed multiple soft tissue density shadows of intrahepatic and extrahepatic bile ducts, which was considered as biliary papillomatosis. Results of intraoperative choledochoscopy showed small stones in the lower common bile duct and multiple segmental proliferative flocculent hyperplasia lesions on the wall of the intrahepatic and extrahepatic bile ducts. Results of electronic staining in NBI showed multiple proliferative lesions in intrahepatic and extrahepatic bile ducts and multiple curved vascular shadows under the mucosa of the lesions. Results of intraoperative rapid frozen histopathological examination showed a denomatous hyperplasia with low-grade intraepithelial neoplasia. Results of postoperative pathological examination showed adenoma with low-grade intraepithelial neoplasia. Case 5: results of preoperative magnetic resonance imaging examination showed silt-like stones in the lower part of bile duct accompanied with dilatation of intrahepatic and extrahepatic bile ducts, neck of pancreatic duct was narrowed and the remaining areas were thickened. Results of CT examination showed multiple stones in the neck of the gallbladder and in the common bile duct, accompanied by dilatation of the intrahepatic and extrahepatic bile ducts and the main pancreatic duct, and the lower end of the common bile duct was slightly narrow which mean the possibility of ampulla space occupying could not be excluded. Results of preoperative endoscopic ultrasonography examination showed soft tissue occupation at the lower end of the common bile duct which considering as the possibility of entophytic adenoma, and small stones in the common bile duct. Results of preoperative endoscopic ultrasonography biopsy showed chronic inflammation of duodenal papilla. Results of intraoperative rapid frozen histopathological examination showed chronic inflammation of duodenal papilla. Results of intraoperative choledochoscopy examination and electronic staining under choledochoscope showed smooth mucosa of duodenal papilla, without lesion. Results of intraoperative choledochoscopy examination with endobronchial ultrasonography showed clear structure of mucosa and submucosal of duodenal papilla, without lesion.Conclusion:Choledochoscopy can be used in the auxiliary diagnosis of cholelithiasis related diseases.
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Objective To study the effect of behavior-changes-in-stages theory on defecation function of lower rectal cancer after sphincter-preserving operation. Methods 84 patients with lower rectal cancer undergoing sphincter-preserving operation from June 2013 to June 2016 were divided into control group (n=42)and intervention group (n=42)according to their willingness to care.The control group implemented routine nursing,mainly for diet intervention,wound care,bowel function training and in the intervention group the behavior-changes-in-stages theory was used.Comparisons were done between the groups in terms of the anus incontinence defecation function and quality of life for 6 months after operation. Result The degrees of anus incontinence and defecation function in the intervention group were both significantly better than those in the control group 6 months after the operation (P<0.05). Conclusions The behavior-change-in-stages plays a significant role in the postoperative rehabilitation.It can significantly reduce the anus incontinence, better the bowel function,improve the quality of life and promote rehabilitation.
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AIM: To investigate the variation of ?-AR in pulmonary microvascular endothelial cells and variation of GRK2 in lung and to explore the therapeutic effect of methlyprednisolone in severe acute pancreatitis-associated lung injury model in rats.METHODS: 36 rats were divided into three groups randomly: the control group,the experimental group,and the intervention group.In the experimental group,severe acute pancreatitis-associated lung injury model was induced in SD rats by retrograde injection of 5% sodium taurocholate into biliopancreatic duct.In the control group,laparotomy was performed,duodenum and pancreas were flipped only.In the intervention group,methlyprednisolone(30 mg/kg) was injected into rump muscle of rats after model developed.At 6 and 12 h after model was developed,the maximum binding capacity(Bmax) and the Kd value of ?-AR were detected in lung by means of radioactive ligand binding assay.GRK2 expression was detected in lung by means of immunofluorescence.RESULTS: The scores of the severity of pancreatitis and the severity of lung injury in the experimental group were obviously higher than those in control group.In the experimental group,Bmax was obviously lower,Kd and GRK2 were obviously higher than those in control group and the intervention group.CONCLUSION: The ?-AR in lung is lower down and GRK2 expression in lung is up-regulated in severe acute pancreatitis-associated lung injury model in rats.The therapeutic effect of methlyprednisolone to severe acute pancreatitis-associated lung injury is positive.
