Objective To explore the operative managements of ectopic gallbladder during laparoscopic cholecystectomy (LC).Methods Twenty one cases of ectopic gallbladder undergone LC in this hospital were analyzed regarding the perioperative management, principle, and technique of operation.Results There were 2 cases of situs transversus, 1 case with gallbladder under right posterior lobe of liver, 2 under left lateral lobe of liver and 16 in the liver. All 21 cases of ectopic gallbladder had undergone LC successfully, and no complications were found during and after operation. Conclusion Anatomic ectopia of gallbladder tosses a challenging problem to laparoscopic surgeon. It is safe for surgeons to recognise actual anatomical anomaly and to manage them appropriately.
Objective To study the feasibility of radical resection of gallbladder cancer with extensive invasion. Methods A patient of the gallbladder cancer with invasion of liver, gastric antrum, duodenum, caput pancreatis and colon transversum, was received radical resection (including pancreatoduodenectomy, hepatectomy and colectomy). Results Seven months later, the value of CEA and Hb were normal and cancer recurrence was not observed. Conclusion The radical resection of gallbladder cancer with extensive invasion, can improve survival quality and extent survival time.
Objective To observe the expression of Ezrin protein in primary carcinoma of gallbladder tissue and the levels of CEA and CA19-9 in serum of patients with primary carcinoma of gallbladder, and to explore the relationship between the expressions of these measurements and clinicopathologic characteristics. Methods Immunohistochemistry was applied to analyze the expression of Ezrin protein in primary carcinoma of gallbladder and chronic cholecystitis tissue. The levels of CEA and CA19-9 in serum and clinicopathologic characteristics of all including patients were detected with clinical measurement. All data were analyzed statistically. Results ①The positive rates of Ezrin protein in primary carcinoma of gallbladder and chronic cholecystitis tissue were 66.7% （40/60） and 30.8%（4/13）, respectively (χ2=5.57, Plt;0.05). ②There was no difference between the expression of Ezrin protein in primary carcinoma of gallbladder tissue and age or gender (Pgt;0.05). However, difference was significant between the Ezrin expression and degree of difference, pNevin stages, pTNM stages, lymph node metastasis or distant metastasis (Plt;0.05). ③There were no differences between the positive rates of CEA and CA19-9 in primary carcinoma of gallbladder and age or gender (Pgt;0.05). However, differences were significant between the positive rates of CEA and CA19-9 and pNevin stages, pTNM stages, degree of difference, lymph node metastasis or distant metastasis (Plt;0.05). ④There was some relationship between the expression of Ezrin protein and the positive rate of CEA (rs=0.213, Plt;0.05), but not with the positive rate of CA19-9 (rs=0.081, Pgt;0.05). Conclusions The high expression of Ezrin protein may promote the invasion and metastasis in primary carcinoma of gallbladder. It could be possible to decide the outcome of primary carcinoma of gallbladder through the combined analysis on the expression of Ezrin protein and the serum levels of CEA and CA19-9.
ObjectiveTo evaluate the diagnostic value of ultrasound for gallbladder carcinoma (GA), in order to improve the ability of early ultrasonic and clinical diagnosis of GA. MethodsWe analyzed and compared the clinical data and ultrasonic results of 42 GA cases confirmed by surgery and pathology between January 2008 and December 2013, and summarized the classification, ultrasonographic features, and diagnosis of GA. ResultsAmong the 42 cases, 25 were correctly diagnosed by ultrasound (59.5%), among which 9 were thick-wall type, 11 were protrusion type and 5 were solid type. Seventeen cases were misdiagnosed (40.5%). Pathological results showed 14 cases of highly-differentiated adenocarcinoma, 16 of moderately differentiaed adenocarcinoma, 9 of poorly-differentiated adenocarcinoma, 2 of squamous adenocarcinoma and 1 of neuroendocrine carcinoma. ConclusionUltrasound is the preferred method for the diagnosis of GA because of its convenience, although the diagnostic accuracy is still not good and more efforts should be done.
Objective To compare the clinical efficacy and safety of suturesuspension single hole laparoscopic cholecystectomy and traditional laparoscopic cholecystectomy (LC) in the treatment of gallbladder disease. Methods A total of 86 cases who got treatment in our hospital from February 2014 to July 2015 were collected prospectively, and then 86 cases were divided into 2 groups: 43 cases of control group underwent LC and 43 cases of experimental group underwent suturesuspension single hole laparoscopic cholecystectomy. Clinical efficacy and safety of the two groups were compared. Results ① Complication. No one suffered from bile duct injury, bile leakage, bile duct stricture, and umbilical hernia; but there were 2 cases suffered from complications in control group, including 1 case of abdominal pain and 1 case of bloating, and the morbidity was 4.65% (2/43). The morbidity of experimental group was 0, there was no significant difference between the 2 groups in the morbidity (P>0.05). During the follow-up period, 1 case suffered from long-term compilation in experimental group, and 2 cases in normal group, there was no significant difference in the long-term complication between the 2 groups (P>0.05). ② Operation and hospitalization. The blood loss and operation time in the experimental group were lower than those of the control group (P<0.05), but there was no significant difference in the hospital stay and hospitalization cost between the 2 groups (P>0.05). ③ Postoperative electrolytes, liver and kidney function. The levels of Na+ and K+ in the experimental group were higher than those of the control group (P<0.05), and the levels of alanine aminotransferase and aspartate aminotransferase were lower than those of control group (P<0.01), but there was no significant difference in the blood urea nitrogen and serum creatinine between the 2 groups (P>0.05). ④ The recovery of gastrointestinal function after surgery. The anal exhaust time and bowel sounds recovery time in experimental group were shorter than those of the control group (P<0.01). Conclusion Suturesus-pension single hole laparoscopic cholecystectomy in the treatment of gallbladder disease is safe, effective, and minimally invasive, and it has little disturbance on gastrointestinal function and liver function, which is worthy of clinical application.
To establ ish the animal model of the artificial physiological reflex arc with the reconstruction of the sensory and the motorial functions of atonic bladder simultaneously in the rats, and to provide the foundation to furtherinvestigate the repairing effectiveness of this technique. Methods There were 20 adult male SD rats (weighing 280-300 g)which were randomly divided into 2 groups (n=10): group A and group B. Group A was anastomosis of the ventral roots(VR) and the dorsal roots (DR) between L6 and S2 simultaneously to establ ish the model of the artificial physiological reflex arc. Group B was anastomosis of the main trunk between L6 and S2 to establ ish the model. The contents of the observation included: ① To measure the external diameter of the VR, DR and the main trunk of L6 and S2 with the sl iding cal iper; and to measure not only the distance between L6 and S2 but also the separable length of L6 with the ruler. ② Fast Blue dyeing of the VR, DR and the main trunk of L6 and S2 was performed to count their nerve fibers assisted by the Leica FW4000 system 2 weeks after opertation. ③ The observation of the urination of the rat and BBB scoring to evaluate the motorial function of the lower l imbs was performed postoperatively. Results ① L6 located in the lateral side of the S1-4 in the vertebral body of L6. The external diameters of the VR, DR and the main trunk of L6 were (0.68 ± 0.13), (0.88 ± 0.10) and (1.54 ± 0.33) mm, respectively, while those of S2 were (0.62 ± 0.08), (0.79 ± 0.14) and (1.39 ± 0.42) mm, respectively. The distance between L6 and S2 was (14.21 ± 1.95) mm, and the separable length of L6 was (10.76 ± 2.11) mm. Furthermore, the microdissection indicated the VR and the DR between L6 and S2 could be anastomosed respectively with no-tension at the level of the vertebral body of L6; and the main trunk of L6 and S2 could be anastomosed with no-tension at the level of the confluens of L5, 6. ② With Fast Blue dyeing, there were 892 ± 32, 354 ± 26 and 532 ± 17 nerve fibers of the VR, DR and the main trunk of L6, respectively. And there were 788 ± 29, 325 ± 19, and 478 ± 22 nerve fibers of the VR, DR and the main trunk of S2, respectively. There were no volar ulcer,trichomadesis and self-eating of the affected l imbs in the both groups postoperatively. The urinations of the rats after operationwere not different from those before operation. The mean BBB scores of pre- and postoperation in group A were 20.20 ± 0.35 and 19.80 ± 0.23, respectively; the mean BBB scores of pre- and postoperation in group B were 20.20 ± 0.35 and 19.20 ± 0.31, respectively. There was no significant difference of the above indexes between group A and group B (P gt; 0.05). Conclusion Anastomosis of the VR and the DR between L6 and S2 simultaneously in rats is an ideal animal model to establ ish the artificial physiological reflex arc owing to its simple and reproducible procedures.
Bladder has many important functions as a urine storage and voiding organ. Bladder injury caused by various pathological factors may need bladder reconstruction. Currently the standard procedure for bladder reconstruction is gastrointestinal replacement. However, due to the significant difference in their structure and function, intestinal segment replacement may lead to complications such as hematuria, dysuria, calculi and tumor. With the recent advance in tissue engineering and regenerative medicine, new techniques have emerged for the repair of bladder defects. This paper reviews the recent progress in three aspects of urinary bladder tissue engineering, i.e., seeding cells, scaffolds and growth factors.
Objective To assess the efficacy and the treatment-induced side effects of intravesically administered Epirubicin (EPI) following TUR in patients with Ta and T1 superficial bladder cancer compared to TUR alone. Methods According to the Cochrane reviewer’s handbook, included studies were those on patients with histologically confirmed Ta and T1 bladder cancer. EPI and EPI derivatives, dose and schedule would be considerd appropriate for inclusion. The search strategy was developed according to the Collaborative Review Group search strategy. Medline, EMbase, CBMdisc and the Cochrane library, articles of conference proceedings, and academic collections were searched for randomised controlled trials (RCTs) and quasi-RCT comparing intravesical EPI following TUR with TUR alone. Data were extracted from each identified paper independently by two reviewers. Trials were assessed for quality according to the method of Jadad scale. RevMan4.2 software developed by the Cochrane Collaboration was used for satistical analysis. Results Two hundred and thirteen related articles were identified, but only 10 were included in our systematic review. 3 articles were high quality and the rest were low. The pooled RR=1.51 (95%CI 1.32 to 1.72) and the pooled RR=1.49 (95%CI 1.35 to 1.66) in patients with Ta and T1 bladdercancer at 1 and 2 years respectively; The pooled RR=1.34 (95%CI 1.22 to 1.48) when comparing relative efficacy of intravesical EPI (drug doselt;50 mg) following TUR with TUR alone; The pooled RR=1.63 (95%CI 1.48 to 1.79) when comparing relative efficacy of intravesical EPI (drug dosegt;50 mg) following TUR with TUR alone. RR=1.49 (95%CI 1.33 to 1.66) and RR=1.56 (95%CI 1.36 to 1.84) when comparing relative efficacy of single intravesical EPI following TUR with TUR alone respectively. RR=0.79 (95%CI 0.53 to 1.17) when comparing the incidence of disease progression of intravesical doxorubicin following TUR with TUR alone. RR=4.34 (95%CI 2.62 to 7.19) when comparing side effect of intravesical EPI following TUR with TUR alone. Conclusions Intravesically administered EPI following TUR in patients with Ta and T1 superficial bladder cancer may reduce the incidence of tumour recurrence, but cannot reduce the incidence of disease progreesion. Intravesically administered EPI following TUR has some side effects but can be tolerated and has no influence on the life of patients.
Objective To investigate the relationship between microvessel density(MVD) and lymph node metastasis and prognosis in gallbladder carcinoma. MethodsThe MVD in 42 gallbladder carcinoma by immunohistochemical SP method using a polyclonal antibody to FⅧ and the relationship between MVD and histologic types, depth of invasion, lymph node metastasis, distant metastasis and prognosis was studied. Results The value of MVD was correlated with the depth of invasion (P＜0.05), lymph node metastasis (P＜0.01) and distant metastasis (P＜0.05). It was not significantly related to the pathologic pattern and tumor differentiation. The significantly negtive correlation was found between MVD and 5-year survival in patients with gallbladder carcinoma. Conclusion MVD is bly related to the metastasis of gallbladder carcinoma. It may serve as a prognotic factor.