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 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.
Objective To investigate the role of KiSS-1 gene in the metastatic process of carcinoma of gallbladder and the clinicopathologic significance of KiSS-1 gene expression in carcinoma of gallbladder. Methods Pathological specimens from 59 gallbladder carcinoma tissues (13 hepatic invasion and 13 lymphatic invasion tissues were included), matched with 7 para-tumor and 6 normal gallbladder tissues, were examined for the expression of KiSS-1 gene by tissue microarray technique and immunohistochemistry (EnVision). Results The positive rate of KiSS-1 expression was down-regulated (P＜0.05) in tumor tissues, as compared with normal and para-tumor tissues. In carcinoma of gallbladder, the expression of KiSS-1 had no relationship with the gender, age, tumor size, histological grade or differentiation, and metastasis of lymph node, while was associated with the depth of infiltration, invasion of liver and the clinical stages (Nevin). In Ⅰ+Ⅱ, Ⅲ+Ⅳ and Ⅴ stage, the positive rates of KiSS-1 were 92.3%, 57.1% and 27.8% respectively, with an undeniably clear lowering tendency (P=0.002). Conclusion Down-regulating expression of KiSS-1 is closely associated with the processes of genesis, invasion and metastasis in carcinoma of gallbladder, and may participate in regulating these processes.
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 compare the clinical efficacy and safety of different surgical methods in the treatment of early-stage gallbladder carcinoma (GBC). Methods The clinical data of 43 patients with early-stage GBC who received treatment in Peking University People’s Hospital from Jan. 2010 to Dec. 2016 were retrospectively analyzed. According to the surgical methods, the patients were divided into laparoscopic cholecystectomy (LC)+lymph node dissection (LND)+radiofrequency ablation (RA) group, open cholecystectomy (OC)+LND+RA group, and OC+LND+liver resection (LA) group. Operation duration, intraoperative blood loss, postoperative hospital stay, surgical complications, and long-term survival were compared among the 3 groups. Results All the 43 patients performed successful surgery without perioperative death. ① Operation duration and postoperative hospital stay. The differences of operation duration and postoperative hospital stay among the 3 groups were statistically significant (P<0.05). Compared with the LC+LND+RA group, operation duration and postoperative hospital stay of the OC+LND+RA group and the OC+LND+LR group were longer (P<0.017), but there was no statistically significant difference between the OC+LND+RA group and the OC+LND+LR group (P>0.017). ② Intraoperative blood loss. The difference of intraoperative blood loss among the 3 groups was statistically significant (P<0.001). Compared with the OC+LND+LR group, the intraoperative blood loss was lower in the LC+LND+RA group and the OC+LND+RA group (P<0.017), but there was no significant difference between the LC+LND+RA group and the OC+LND+RA group (P=0.172). ③ Postoperative complications. There was no significant difference in the incidence of postoperative complications among the 3 groups (P=0.326). ④ Long-term survival. There was no significant difference in survival curves among the 3 groups (P=0.057). Conclusions The method of cholecystectomy combined with LND and RA of gallbladder bed can achieve the radical effect on early-stage GBC (Tis–T2). Laparoscopic surgery, in particular, has shorter operation duration and faster recovery.
Objective To summarize the recent research situation and progress of decellularized matrix in tissue engineered trachea transplantation and to forecast the possible perspects. Methods Recent original articles about study and application for decellularized matrix in tissue engineered trachea were reviewed. The application and study of different decellularized matrices involved in animals or patients with tracheal lesions were elaborated. Results Decellularized matrices researched and applied in tissue engineered trachea include jejunum, urinary bladder, aorta, and trachea. Conclusion Decellularized urinary bladder matrix and jejunal matrix appears to be efficacious method for the patch repair of partial circumferential tracheal defects. The application of decellularized aortic matrix may need more study, and decellularized tracheal matrix has a bright future in long tracheal defects.
Objective To assess the efficacy and safety of laparoscopic nerve-sparing radical hysterectomy (LNSRH) in treatment of early cervical cancer. Methods Such databases as CBM (1960 to September 2011), CENTRAL (1966 to September 2011), MEDLINE (1966 to September 2011), The Cochrane Library, EMbase (1974 to September 2011) and CNKI (1994 to September 2011) were searched on computer, and relevant magazines were also searched manually. Data were extracted and the quality was assessed after including studies according to exclusive criteria, then meta-analysis was conducted using RevMan 5.1 software. Results Total 7 studies involving 506 cases were selected, of which 255 cases were in the LNSRH group and the other 251 cases were in the laparoscopic radical hysterectomy (LRH) group. There were no differences between the two groups in age, body mass index, clinical stage, pathological type and histological grade. The results of meta-analysis showed that: a) The operative time of LNSRH was longer than LRH, with significant difference (P=0.02). But there was no significant difference in intraoperative bleeding between the two groups (P=0.69); b) The length of dissected parametrium of LNSRH was shorter than LRH with significant difference (P=0.02). But there was no significant difference in the length of dissected vagina (P=0.69); and c) The functional recovery of the bladder in the LNSRH group was better than LRH (Plt;0.000 01). Conclusion LNSRH is safe and feasible in effectively alleviating the postoperative dysfunction of the bladder in early cervical cancer as well as in improving the quality of life for patients. It is regarded as a new model of operation. Because it has just been put into practice within a short time, and there is lack of multi-center, large-sample, prospective controlled studies at present, so its radical effectiveness, long-term recurrence rate, survival rate, etc. have not yet been confirmed. More high quality studies are needed to provide important data of comparison between LNSRH and LRH.
The quantitative studies of secretory granules andand lysosomes in gallbladder epithelium and gallbladder bile glycoprotein were performed in 20 gallstone patients and 15 gallstone-free subjects. The results showed that the number, the volume density and the total secrectory granules were significantly increased in gallstone patients compared with gallstone-free controls. The gallstone patients had a markedly reduced number,volume destiny and total lysosome area compared with gallstone-free subjects. The glycoprotein concenrtation in gallblader bile was increased up to 21.04±4.92g/L in gallstone paients,as compare with 13.02±5.72g/L(Plt;0.05)in the stone-free controls. The qualitity of secretory granules and lysosomes was directly proprtational to that of bile glycproteins. Evidence and secrectory granules and lysosomes was directly proporional to taht of bile glycoproteins. Evidence and argument are presentded suggesting that gallblader epithelium secrectory granules affect the concentration of bile glycoprotein and lysosomemay be related to the intracellular degradation of secretory granules.
【Abstract】Objective To investigate the features of gallbladder carcinoma in two-phase spiral CT, and to analysis the values of two-phase spiral CT for the differential diagnosis between gallbladder carcinoma and chronic cholecystitis. Methods The two-phase spiral CT manifestations of 30 cases of gallbladder carcinoma, proved by surgery and pathology, and 30 cases of chronic cholecystitis were analyzed. Results According to the CT findings, the gallbladder carcinoma was categorized into 3 types: intraluminal mass of gallbladder in 6 out of 30 (20.0%）， thickening of the gallbladder wall in 11 (33.7%), and mass replacing the normal gallbladder in 13(43.4%). The most common enhancement patterns of the wall in gallbladder carcinoma were hyperattenuation during the arterial phase, while isoattenuation with the adjacent hepatic parenchyma during the venous phase; or hyperattenuation during both phases. The most common enhancement pattern of the wall in chronic cholecystitis was isoattenuation during both phases, with clear hypoattenuation linear shadow in the gallbladder fossa. Other ancillary features of gallbladder carcinomas included: infiltration of the adjacent parenchyma, local lymphadenopathy and intrahepatic metastasis. Conclusion Two-phase spiral CT scan can identify the features of the gallbladder carcinoma and is helpful for the differential diagnosis of these two different disease entities.