【Abstract】ObjectiveTo investigate the anatomic feature and special clinical manifestations of variant right intrahepatic bile duct draining into left hepatic bile duct near the umbilical portion. MethodsVariant right intrahepatic bile ducts joining into left hepatic bile ducts near the umbilical portions were identified through cholangiograms in 52 patients, who were included in this study. Their history, clinical process and operations were reviewed. ResultsThere were total 38 cases of intrahepatic gallstone in this group. High incidence of intrahepatic calculi was found in variant right intrahepatic bile ducts （23/38 cases, 60.52%） and left hepatic ducts （33/38 cases, 86.84%）. Most of these cases were accompanied with dilatation and stricture of bile ducts in these area. The gallstones in the variant right intrahepatic bile ducts were not detected in 8 cases (8/23) and the rate of residual gallstone was as high as 86.95%(20/23). Injury of variant right intrahepatic bile duct took place when left hepatectomy was performed in one case. ConclusionGallstone is very likely to be formed in the variant right intrahepatic bile duct due to derangement of bile hydrokinetics and compression of blood vessel. Special attention should be paid to the diagnosis and operation of this abnormity.
Objective To introduce the current status of clinical research on endoscopic cholecystolithotomy with reservation of gallbladder. Methods Literatures related to the basis, advantage, indication, contraindication, operative method and current controversy were reviewed and summarized. Results The objective evidences were afforded by postoperative complications of cholecystectomy for endoscopic cholecystolithotomy with reservation of gallbladder. The progress of endoscopic technique made it possible for reservation of gallbladder. The controversy in endoscopic cholecystolithotomy with reservation of gallbladder was focused on the choice of indications and operative procedure. Incorrect patient selection and undue pursuit of cholecystolithotomy with reservation of gallbladder would be completely opposite to the treatment of gallstone. Conclusion It is feasible for endoscopic cholecystolithotomy with reservation of gallbladder to remove completely stone and reserve gallbladder function, but further investigation and long-term follow up are required to delineate gallstone recurrence after operation.
The conectration of cholecystokinin infasting serum was determined by radioimmunoessay in 30 patients with gastric antrum cancer before and after radical sbutotal gastrectomy.It was 119.6±142.2pmol/L before the operation and 78.5±149.2pmol/L after the operation,which was significantly lower than that before the operation,P=0.022. The result suggests that the reduction of cholecytokinin secretion after gastrectomy was one of the important causes in the bile stasis,the disturbance of gallbladder emptying funcion and the formation of gallstone.
ObjectiveTo study the relationship between cholecystectomy and Helicobacter pylori （Hp） infection. MethodsOne hundred and eleven patients with cholecystolithiasis were chosen as the investigation group, while 577 patients with upper digestive tract symptoms without cholecystolithiasis as the control group. All the patients took the 13C breath test to determine whether they were infected by Hp. All the patients with Hp infection continued eradical therapy for Hp infection for one course after cholecystectomy and were followed up on outpatient basis. ResultsThe infection rate in the investigation group was 45.9%, while 27.4% in the control group. During the 3 to 6 months of followup for the patients undergoing eradical therapy for Hp infection, we found no patient complaining of epigastric pain, malaise, belching and nausea. ConclusionThe infection rate of Hp in patients with cholecystolithiasis is high, Hp may be one of the factors causing “postcholecystectomy syndrome”. Eradical therapy for Hp after cholecystectomy will help improve the effects of operation.
Objective To probe into disorder of plasma lipids and apolipoproteins in patients with gallstone,and their position and function in formation of gallstone. MethodsConcentration of plasma lipids and apolipoproteins in 94 healthy subjects and 161 patients with gallstones was investigated. ResultsThe gallstone group had a higher serum mean concentration of TG,Apo CⅡ,Apo CⅢ, and had a lower serum mean concentration of TC，HDLc，HDL2c，HDL3c and LDLc as compared with the control group (P＜0.01 or P＜0.05). Conclusion Higher serum mean concentration of TG，Apo CⅡ，Apo CⅢ, and lower serum mean concentration of TC, HDLc, HDL2c, HDL3c and LDLc, are characteristic of lipids metabolism and important cause of formation of gallstone.
Using radioimmunoassay (RIA) and immunohistochemical LASB technique, the level of serum estradiol (E2), testosterone (T), progesterone (P), estrogen receptors (ER) and progesterone receptors (PR) in 30 male patients with gallstones were detected. The results showed that the level of serum P, E2/T and PR was higher. This suggests that the metabolic disorder of gonadal hormones play an important role in gallstone formation.
Objective To discuss the relationship between motilin, vasoactive intestinal peptide and the gallstone formation. Methods The level of motilin, vasoactive intestinal peptide in plasma, bile and gallbladder tissue of 48 cases of chololithiasis before operation and the first, third, seventh day after cholecystectomy were mesured by radioimmunoassay. Results The level of motilin in plasma was markedly increased in patients with chololithiasis before cholecystectomy and the first day after cholecystectomy. The level of motilin, vasoactive intestinal peptide in bile and gallbladder tissue were significantly increased in patients and motilin was positively correlated with vasoactive intestinal peptide in the gallbladder tissue. Conclusion Motilin, vasoactive intestinal peptide might affect the gallstone formation by affecting the motility of gallbladder.
In 100 patients with gallstone, blood glucose, insulin were measured and BT-PAMA test, amino acid consumption test were made. Result: 71 patients were found with symptoms of the gut disorders, 12 cases with hyperglycemia (among them, 6 cases had chronic hepatic disease), 14 with exocrine pancreatic insufficiency, 26 with induration of the head of pancrease. The authors consider that hyper glycemia is correlated with chronic hepatic disease and that the gallstone migration impaires the pancreatic structure and function might be one of the factors which induces the symptom of gut disorders in patients with gallstone.
ObjectiveTo explore the relationship between the -2548 G/A functional polymorphism in the 5′ promoter region of the leptin gene and gallstones. Methods The -2548 G/A polymorphisms of leptin gene were determined by polymerase chain reactionrestriction fragment length polymorphism technology (PCRRFLP) in 118 patients with cholesterol gallstones and 53 normal control subjects. Then the allele and genotype distribution were studied. Results The distribution of leptin2458 G/A in two groups was statistically significantly different: the genotype frequency of AA+GA of patients in gallstone group was higher than that in control group (χ2=4.251, P=0.039). AA+AG genotype had 2.813 times greater risk for gallstone disease compared with GG genotype (OR=2.813, 95% CI=1.020-7.757). Allele frequency distribution in the two groups was different: the allele frequency of A of patients in gallstone group was higher than that in control group (χ2=5.791, P=0.016). The risk of gallstone disease in the A alleles carriers was 1.777 times as higher as the carriers of G alleles (OR=1.777, 95% CI=1.110-2.844). ConclusionThe -2548 G/A polymorphism in the 5′ promoter region of leptin gene is significantly correlated with the gallstones. The A alleles of leptin may be a genetic factor which contributes to individual susceptibility for gallstone, while the G alleles of leptin may be a genetic factor that prevents people from gallstone.
ObjectiveTo evaluate the feasibility of clipless laparoscopic cholecystectomy (LC) to patients with calculous cholecystitis in acute inflammation stage. Methods The clinical data of 169 patients with calculous cholecystitis in acute inflammation stage who underwent clipless LC from December 2008 to July 2010 were analyzed. ResultsAll patients were successfully operated by LC except one case who suffered from gallbladder perforation and a conversion to open surgery was performed. The operation time ranged from 25-70 min (mean 38 min). The blood loss ranged from 10-200 ml (mean 22 ml). Peritoneal drainage was done in 38 patients, and the drainage time ranged from 1-6 d (mean 1.8 d). The time to out-of-bed activity was at 2 h after operation and the hospitalization time was 3-7 d (mean 3.5 d). There was no complication such as bile duct injury, hemorrhage, billiary leakage, and intra-abdominal infection. ConclusionWith improvement of operator’s experiences and skills, the clipless LC becomes feasible and safe for patients with calculous cholecystitis in acute inflammation stage.