BACKGROUND Currently,endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)is the main treatment for cholecystolithiasis combined with choledocholithiasis.However,the treatment is un...BACKGROUND Currently,endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)is the main treatment for cholecystolithiasis combined with choledocholithiasis.However,the treatment is unsatisfactory,and the development of better therapies is needed.AIM To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis.METHODS Patients(n=243)with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University(910th Hospital of Joint Logistic Support Force)between January 2019 and December 2023 were included in the study;111 patients(control group)underwent ERCP+LC and 132 patients(observation group)underwent LC+laparoscopic common bile duct exploration(LCBDE).Surgical success rates,residual stone rates,complications(pancreatitis,hyperamylasemia,biliary tract infection,and bile leakage),surgical indicators[intraoperative blood loss(IBL)and operation time(OT)],recovery indices(postoperative exhaust/defecation time and hospital stay),and serum inflammatory markers[C-reactive protein(CRP)],tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were compared.RESULTS No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups.However,the complication rate,IBL,OT,postoperative exhaust/defecation time,and hospital stays were significantly reduced in the observation group compared with the control group.Furthermore,CRP,TNF-α,and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group.CONCLUSION These results indicate that LC+LCBDE is safer than ERCP+LC for the treatment of cholecystolithiasis combined with choledocholithiasis.The surgical risks and postoperative complications were lower in the observation group compared with the control group.Thus,patients may recover quickly with less inflammation after LCBDE.展开更多
BACKGROUND Gamma-glutamyltransferase(GGT) is one of the most important laboratory tests for the evaluation of liver damage. Through a long-term clinical observation of patients with secondary asymptomatic choledocholi...BACKGROUND Gamma-glutamyltransferase(GGT) is one of the most important laboratory tests for the evaluation of liver damage. Through a long-term clinical observation of patients with secondary asymptomatic choledocholithiasis, we found that most patients had abnormal GGT serum levels.AIM To investigate the combination of serum GGT and alkaline phosphatase(ALP) in predicting the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis.METHODS In this retrospective cohort study, the clinical data of 829 patients with cholecystolithiasis admitted to the Third Affiliated Hospital of Zunyi Medical College from August 2014 to August 2017 were collected. Among these patients,151 patients had secondary asymptomatic choledocholithiasis and served as the observation group, and the remaining 678 cholecystolithiasis patients served as the control group. Serum liver function indexes were detected in both groups,and the receiver operating characteristic(commonly known as ROC) curves were constructed for markers showing statistical significances. The cutoff value,sensitivity, and specificity of each marker were calculated according to the ROC curves.RESULTS The overall incidence of asymptomatic choledocholithiasis secondary to cholecystolithiasis was 18.2%. The results of liver function indexes including serum aspartate aminotransferase, alanine aminotransferase, direct bilirubin and total bilirubin levels showed no significant differences between the two groups(P> 0.05). However, the serum GGT and ALP levels were significantly higher in the observation group than in the control group(P < 0.05). The ROC curve analysis showed that the area under the curve was 0.881(95%CI: 0.830-0.932), 0.647(95%CI: 0.583-0.711) and 0.923(0.892-0.953) for GGT, ALP, and GGT + ALP,respectively. The corresponding cut-off values of GGT and ALP were 95.5 U/L and 151.5 U/L, sensitivity were 90.8% and 65.1%, and specificity were 83.6% and59.8%, respectively. The sensitivity and specificity of GGT + ALP were 93.5% and85.1%, respectively.CONCLUSION An abnormally elevated serum GGT level has an important value in the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis.The combination of serum GGT and ALP has better diagnostic performance. As a convenient, rapid and inexpensive test, it should be applied in secondary asymptomatic choledocholithiasis routine screening.展开更多
AIM To explore the risk factors of gallbladder stone recurrence. METHODS A multifactorial analysis was made for 1058 patients in Shanghai area whose gallbladder stones disappeared after different kinds of nonsurgic...AIM To explore the risk factors of gallbladder stone recurrence. METHODS A multifactorial analysis was made for 1058 patients in Shanghai area whose gallbladder stones disappeared after different kinds of nonsurgical therapy, including oral litholytic therapy, extracorporeal shock wave lithotripsy and percutaneous choledocholithotripsy. Serum level of insulin and total bile acid were determined in 122 patients. RESULTS After 1 8 8 years of follow up, the recurrence rate of gallbladder stone was 11 6%, 22 4%, 29 5%, 36 4%, 39 3% and 39 7% respectively within 1, 2, 3, 4, 5 and over 5 years. The risk factors for the recurrence are: primary multiple gallstones ( P <0 05); family history of cholecystolithiasis ( P <0 05); greasy food intake ( P <0 01); low mean value of serum insulin ( P <0 01); and high mean value of total bile acid ( P <0 01). CONCLUSION The recurrence of cholecystolithiasis is related to overintake of high fat and high cholesterol food, and might also be related to low level of serum insulin.展开更多
BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases.Elderly patients are a ...BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases.Elderly patients are a high-risk group for surgical treatment.If the incarceration of gallstones cannot be relieved,emergency surgery is unavoidable.CASE SUMMARY We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis.He had several coexisting,high-risk underlying diseases,had a history of radical gastrectomy for gastric cancer,and was taking aspirin before the operation.Nevertheless,he underwent emergency laparoscopic cholecystectomy,with maintenance of postoperative heart and lung function,successfully recovered,and was discharged on day 8 after the operation.CONCLUSION Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic,the key is to abide strictly by the hospital's epidemic prevention regulations,fully implement the epidemic prevention procedure for emergency surgery,fully prepare before the operation,accurately perform the operation,and carefully manage the patient postoperatively.展开更多
Objective: To study the relationship between cholecystolithiasis and polypoid gallbladder( PLG),260 patients with polypoid gallbladder were investigated. The patients were divided into 2 groups: group A (PLG combined ...Objective: To study the relationship between cholecystolithiasis and polypoid gallbladder( PLG),260 patients with polypoid gallbladder were investigated. The patients were divided into 2 groups: group A (PLG combined with cholecystolithiasis) and group B( without cholecystolithiasis) . The clinical pathological characteristics were analyzed. The intestinal epithelium metaplasia and atypical hyperplasia of the gallbladder mucosa were observed under light microscope. Results: Intestinal epithelium metaplasia and atypical hyper-plasia of gallbladder mucosa were found in 47 of the 260 cases. The pathological lesions included 16 gallbladder carcinoma, 11 adenomatosis polyp, 5 myoadenoma, 7 cholesterol polyp, 4 inflammatory polyp and 4 adenomatosis hyperplasia, which occurred in 26 and 21 patients in group A and group B , i.e. 44.0% and 10.3% respectively. The difference between group A and group B was statistically significant (P < 0.01).Conclusion : Cholecystolithiasis and the succeeding inflammatory reaction is a risk-factor for the polypoid gallbladder to develop tumour.展开更多
In 1990, nanobacterium was found and named by Kajander.~1 With distinct mineralizing ability, nanobacteria are thought to play a role in extraskeletal calcifying diseases. It have been found in many human tissues, but...In 1990, nanobacterium was found and named by Kajander.~1 With distinct mineralizing ability, nanobacteria are thought to play a role in extraskeletal calcifying diseases. It have been found in many human tissues, but whether they exist in the bile or gallbladder mucosa remains unclear. The present study was undertaken to investigate by ELISA, bacterial culturing, immunohistochemical staining and transmission electron microscopy (TEM), whether nanobacteria exist in serum, bile or gallbladder mucosa of healthy people and patients with cholecystolithiasis.展开更多
BACKGROUND Clostridium difficile(C.difficile)infection(CDI)is a rare clinical disease caused by changes in the intestinal microenvironment,which has a variety of causes and a poor prognosis,and for which there is no s...BACKGROUND Clostridium difficile(C.difficile)infection(CDI)is a rare clinical disease caused by changes in the intestinal microenvironment,which has a variety of causes and a poor prognosis,and for which there is no standardized clinical treatment.CASE SUMMARY A patient experienced recurrent difficulty in bowel movements over the past decade.Recently,symptoms worsened within the last ten days,leading to a clinic visit due to constipation.The patient was subsequently referred to our depart-ment.Preoperatively,the patient was diagnosed with obstructed colon accom-panied by gallstones.Empirical antibiotics were administered both before and after surgery to prevent infection.On the fourth day post-surgery,symptoms of CDI emerged.Stool cultures confirmed the presence of C.difficile DNA.Treatment involved a combination of vancomycin and linezolid,resulting in the patient's successful recovery upon discharge.However,the patient failed to adhere to the prescribed medication after discharge and was discovered deceased during a follow-up two months later.CONCLUSION CDI is the leading cause of nosocomial post-operative care,with limited clinical cases and poor patient prognosis,and comprehensive clinical treatment guidelines are still lacking.This infection can be triggered by a variety of factors,including intestinal hypoxia,inappropriate antibiotic use,and bile acid circulation disorders.In patients with chronic bowel disease and related etiologies,prompt preoperative attention to possible CDI and preoperative bowel preparation is critical.Adequate and prolonged medication should be maintained in the treatment of CDI to prevent recurrence of the disease.展开更多
Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold stan...Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique(including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.展开更多
AIM: To analyze the efficacy of routine intraoperative ultrasound (IOUS) as a guide for understanding biliary tract anatomy, to avoid bile duct injury (BDI) after laparoscopic cholecystectomy (LC), as well as any burd...AIM: To analyze the efficacy of routine intraoperative ultrasound (IOUS) as a guide for understanding biliary tract anatomy, to avoid bile duct injury (BDI) after laparoscopic cholecystectomy (LC), as well as any burden during the learning period. METHODS: A retrospective analysis was performed using 644 consecutive patients who underwent LC from 1991 to 2006. An educational program with the use of IOUS as an operative guide has been used in 276 cases since 1998. RESULTS: IOUS was highly feasible even in patients with high-grade cholecystitis. No BDI was observed after the introduction of the educational program, despite 72% of operations being performed by inexperienced surgeons. Incidences of other morbidity, mortality, and late complications were comparable before and after the introduction of routine IOUS. However, the operation time was significantly extended after the educational program began (P < 0.001), and the grade of laparoscopic cholecystitis (P = 0.002), use of IOUS (P = 0.01), and the experience of the surgeons (P = 0.05) were significant factors for extending the length of operation. CONCLUSION: IOUS during LC was found to be a highly feasible modality, which provided accurate, real- time information about the biliary structures. Theeducational program using IOUS is expected to minimize the incidence of BDI following LC, especially when performed by less-skilled surgeons.展开更多
AIM To further study the properties of bileliquid crystals,and probe into the relationshipbetween bile liquid crystals and gallbladderstone formation,and provide evidence for theprevention and treatment of cholecystol...AIM To further study the properties of bileliquid crystals,and probe into the relationshipbetween bile liquid crystals and gallbladderstone formation,and provide evidence for theprevention and treatment of cholecystolithiasis.METHODS The optic properties of bile liquidcrystals in human body were determined by themethod of crystal optics under polarizingmicroscope with plane polarized light andperpendicular polarized light.RESULTS Under a polarizing microscope withplane polarized light,bile liquid crystalsscattered in bile appeared round,oval orirregularly round.The color of bile liquidcrystals was a little lighter than that of the bilearound.When the stage was turned round,thecolor of bile liquid crystals or the darkness andlightness of the color did not change obviously.On the border between bile liquid crystals andthe bile around,brighter Becke-Line could beobserved.When the microscope tube is lifted,Becke-Line moved inward,and when lowered,Becke-Line moved outward.Under aperpendicular polarized light,bile liquid crystalsshowd some special interference patterns,called Malta cross.When the stage was turninground at an angle of 360°,the Malta cross showed four times of extinction.In the vibratingdirection of 45° angle of relative to upper andlower polarizing plate,gypsum test-board withoptical path difference of 530 nm was inserted,the first and the third quadrants of Malta crossappeared to be blue,and the second and thefourth quadrants appeared orange.When micatest-board with optical path difference of 147 nmwas inserted,the first and the third quadrants ofMalta cross appeared yellow,and the secondand the fourth quadrants appeared dark grey.CONCLUSION The bile liquid crystals weredistributed in bile in the form of global grains.Their polychroism and absorption were slight,but the edge and Becke-Line were very clear.Itsrefractive index was larger than that of the bile.These liquid crystals were uniaxial positivecrystals.The interference colors were the firstorder grey-white.The double refractive index ofthe liquid crystals was △n=0.011-0.015.展开更多
AIM: To compare synchronous laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) and sequential LC combined with EST for treating cholecystocholedocholithiasis. METHODS: A total of 150 patie...AIM: To compare synchronous laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) and sequential LC combined with EST for treating cholecystocholedocholithiasis. METHODS: A total of 150 patients were included and retrospectively studied. Among these, 70 were selected for the synchronous operation, in which the scheme was endoscopic retrograde cholangiopancreatography combined with EST during LC. The other 80 patients were selected for the sequential operation, in which the scheme involved first cutting the papillary muscle under endoscopy and then performing LC. The indexes in the two groups, including the operation time, the success rate, the incidence of complications, and the length of the hospital stay, were observed.RESULTS: There were no significant differences between the groups in terms of the numbers of patients, sex distribution, age, American Society of Anesthesiologists score, serum bilirubin, γ-glutamyl transpeptidase, mean diameter of common bile duct stones, and previous medical and surgical history (P = 0.54, P = 0.18, P = 0.52, P = 0.22, P = 0.32, P = 0.42, P = 0.68, P = 0.70, P = 0.47 and P = 0.57). There was no significant difference in the surgical operation time between the two groups (112.1 ± 30.8 min vs 104.9 ± 18.2 min). Compared with the sequential operation group, the incidence of pancreatitis was lower (1.4% vs 6.3%), the incidence of hyperamylasemia (1.4% vs 10.0%, P < 0.05) was significantly reduced, and the length of the hospital stay was significantly shortened in the synchronous operation group (3 d vs 4.5 d, P < 0.001). CONCLUSION: For treatment of cholecystocholedo-cholithiasis, synchronous LC combined with EST reduces incidence of complications, decreases length of hospital stay, simplifies the surgical procedure, and reduces operation time.展开更多
AIM: To evaluate transvaginal hybrid-NOTES cholecystectomy(TVC) during its clinical establishment and compare it with the traditional laparoscopic technique(LC).METHODS: The specific problems and benefits of TVC were ...AIM: To evaluate transvaginal hybrid-NOTES cholecystectomy(TVC) during its clinical establishment and compare it with the traditional laparoscopic technique(LC).METHODS: The specific problems and benefits of TVC were reviewed using a registry analysis,a comparative cohort study and a randomized clinical trial. At first,feasibility,safety and specific complications of the TVC were analyzed based on the first 488 data sets of the German NOTES Registry(GNR). Hereafter,we compared the early postoperative results of our first 50 TVC-patients with those of 50 female LCpatients matched by age,BMI and ASA classification. The same cohort was contacted an average of two years later to evaluate long-term results concerning pain and satisfaction with the aesthetic results and the overall postoperative results as well as sexual intercourse by means of two domains of the German version of the Female Sexual Function Index(FSFI-d). Consequently,we performed a randomized clinical trial comparing 20 TVC-patients with 20 needlescopic/3-trocar cholecystectomies(NC) also concerning the early postoperative results as well as pain,satisfaction and quality of life by means of the Eypasch Gastrointestinal Quality of Life Index(GIQLI) in the later course. Finally,we discussed the results in accordance with other published studies.RESULTS: The complication(3.5%) and conversion rates(4.1%) for TVC were low in the GNR and comparable to those of the LC. Access related intraoperative complications included injuries to the bladder(n = 4; 0.8%) and bowel(n = 3; 0.6%). The study cohort revealed less postoperative pain after TVC comparing to the LC-patients on the day of surgery(NRS,1.5/10 vs 3.1/10,P = 0.003),in the morning(NRS,1.9/10 vs 2.8/10,P = 0.047) and in the evening(NRS,1.1/10 vs 1.8/10,P = 0.025) of postoperative day(POD) one. The randomized clinical trial consistently found less cumulative pain until POD 2(NRS,8/40 vs 14/40,P = 0.043),as well as until POD 10(NRS,22/190 vs 41/190,P = 0.010). Furthermore,the TVC-patients had a better quality of life on POD 10 than did the LC-patients(GIQLI,124/144 vs 107/144,P = 0.028). The complication rates were comparable and no specific problems were detected in the long-term follow-up for sexual intercourse for either group. The TVC-patients were more satisfied with the aesthetic result in the long-term course in the matched cohort analysis(1.00 vs 1.88,P < 0.001) as well as in the randomized clinical trial(1.00 vs 1.70,P < 0.001) when compared with the LC-patients.CONCLUSION: TVC is a feasible procedure with a high safety profile and has advantages in regard to postoperative pain and aesthetic results when compared with LC or NC.展开更多
AIM： To investigate the prevalence, risk factors, and selection of the study population for cholecystolithiasis in an urban population in Germany, in relation to our own findings and to the results in the internation...AIM： To investigate the prevalence, risk factors, and selection of the study population for cholecystolithiasis in an urban population in Germany, in relation to our own findings and to the results in the international literature. METHODS： A total of 2 147 persons （1 111 females, age 42.8 ＋ 12.7 years; 1 036 males, age 42.3 ＋ 13.1 years） participating in an investigation on the prevalence of Echinococcus rnultilocularis were studied for risk factors and prevalence of gallbladder stone disease. Risk factors were assessed by means of a standardized interview and calculation of body mass index （BMI）. A diagnostic ultrasound examination of the gallbladder was performed. Data were analyzed by multiple logistic regression, using the SAS statistical software package. RESULTS： Gallbladder stones were detected in 171 study participants （8.0%, n = 2 147）. Risk factors for the development of gallbladder stone disease included age, sex, BMI, and positive family history. In a separate analysis of female study participants, pregnancy （yes/no） and number of pregnancies did not exert any influence. CONCLUSION： Findings of the present study confirm that age, female sex, BMI, and positive family history are risk factors for the development of gallbladder stone disease. Pregnancy and the number of pregnancies, however, could not be shown to be risk factors. There seem to be no differences in the respective prevalence for gallbladder stone disease in urban and rural populations.展开更多
Laparoscopic cholecystectomy(LC)has gradually become the first choice for the treatment of cholecystolithiasis in recent years.Iatrogenic bile duct injury(IBDI)is an important clinical problem in LC.The anatomical var...Laparoscopic cholecystectomy(LC)has gradually become the first choice for the treatment of cholecystolithiasis in recent years.Iatrogenic bile duct injury(IBDI)is an important clinical problem in LC.The anatomical variation of the cystic duct increases the probability of IBDI and the difficulty of operation.We present a case of a 44-year-old male with a anatomical variation of the cystic duct complicated with cholecystolithiasis and choledocholithiasis,who successfully underwent choledocholithotomy,choledochoscopic exploration and T-tube drainage surgery.The patient recovered well and was discharged home on postoperative day 10.The T-tube was removed at 1 month postoperatively after cholangiography examination of no choledocholithiasis left.展开更多
Objective:To explore the safety and effectiveness nursing of 12 h discharged daytime laparoscopic cholecystectomy guided by enhanced recovery after surgery(ERAS)concept.Methods:Included 180 cases from the 12 h dischar...Objective:To explore the safety and effectiveness nursing of 12 h discharged daytime laparoscopic cholecystectomy guided by enhanced recovery after surgery(ERAS)concept.Methods:Included 180 cases from the 12 h discharged daytime laparoscopic cholecystectomy patients which assessmended and guided by ERAS,with the 180 case of routine cholecystectomy patients as control group at the same time.To quantitatively analyze the related indexes of perioperative period and ERAS concept,and evaluate the clinical safety,and effectiveness.Results:It displayed no significant differences in average age,gender distribution,duration of gallbladder related disease and distribution of clinical symptoms between the two groups(P>0.05).There were also no significant differences in preoperative smoking history,hypertension history,cardio-cerebrovascular history,abdominal operation history and disease composition ratio between the two groups(P>0.05).None of the patients had conversion to laparotomy.Compared with the conventional surgery group,there were no significant differences in the average amount of intraoperative blood loss,operation time and muscle strength before returning to the ward in patients with ERAS guided day surgery(P>0.05).When compared with the conventional surgery group,ERAS guided day surgery group had no significant difference in muscle strength between the two groups when going under the ground(t=1.64,P=0.082).Also,the level of peripheral white blood cells in patients with ERAS guided day surgery group was not significantly increased at 6 h after surgery.Meanwhile,liver function related indexes,transaminase,total bilirubin,indirect bilirubin were not significantly abnormal(P>0.05).Conclusion:12 h daytime laparoscopic cholecystectomy guided by ERAS concept can improve the clinical efficacy of patients with cholecystolithiasis,which is safe and feasible.展开更多
Objective： To explore the effect of Chinese herbs during the perioperative period of laparoscopic cholecystectomy （LC）. Methods： Three hundred and sixty patients of chronic lithic cholecystitis （LOOT） were rando...Objective： To explore the effect of Chinese herbs during the perioperative period of laparoscopic cholecystectomy （LC）. Methods： Three hundred and sixty patients of chronic lithic cholecystitis （LOOT） were randomly assigned to two groups by lottery, 180 patients in each group. During the peri-operative period, the control group was treated with conventional Western medicine and placebo. The treated group was given the same conventional Western medicine and Chinese herbal decoctions, with Shitong mixture No. 1 （石通1号） added before LC, and Liujunzi decoction （六君子汤） added after LC for three days. The operation time, body temperature after LC, white blood cell count, wind-breaking time after operation, as well as the changes of tongue coating in the first three post-operative days were recorded. Results： There was no significant difference between the two groups in operation time （P〉0.05）, while the improvement in body temperature recovery, windbreaking time and changes of tongue coating in the treated group were better than those in the control group （P〈0.01）. Conclusion： Applying Chinese herbs during perioperative period of LC could effectively benefit early recovery in such patients.展开更多
Cholecystitis is a common disease in East Asia. Some of the patients developed cystic artery pseudoaneurysm,a rare complication of cholecystitis. Over the past decades, there have been Tess than 20 reports of patients...Cholecystitis is a common disease in East Asia. Some of the patients developed cystic artery pseudoaneurysm,a rare complication of cholecystitis. Over the past decades, there have been Tess than 20 reports of patients with cystic artery pseudoaneurysm in the literature. Among them, three of the patients had gallbladder perforation which led to hemorrhagic shock,la We report a case of an 88-year-old woman with a cystic artery pseudoaneurysm following an episode of acute cholecystitis.展开更多
文摘BACKGROUND Currently,endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)is the main treatment for cholecystolithiasis combined with choledocholithiasis.However,the treatment is unsatisfactory,and the development of better therapies is needed.AIM To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis.METHODS Patients(n=243)with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University(910th Hospital of Joint Logistic Support Force)between January 2019 and December 2023 were included in the study;111 patients(control group)underwent ERCP+LC and 132 patients(observation group)underwent LC+laparoscopic common bile duct exploration(LCBDE).Surgical success rates,residual stone rates,complications(pancreatitis,hyperamylasemia,biliary tract infection,and bile leakage),surgical indicators[intraoperative blood loss(IBL)and operation time(OT)],recovery indices(postoperative exhaust/defecation time and hospital stay),and serum inflammatory markers[C-reactive protein(CRP)],tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were compared.RESULTS No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups.However,the complication rate,IBL,OT,postoperative exhaust/defecation time,and hospital stays were significantly reduced in the observation group compared with the control group.Furthermore,CRP,TNF-α,and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group.CONCLUSION These results indicate that LC+LCBDE is safer than ERCP+LC for the treatment of cholecystolithiasis combined with choledocholithiasis.The surgical risks and postoperative complications were lower in the observation group compared with the control group.Thus,patients may recover quickly with less inflammation after LCBDE.
基金Supported by the Guizhou Provincial Department of Health Science and Technology Fund,No.GZWJKJ2014-2-151the Science and Technology Fund of Guizhou Province,No.QKH LH [2016]7421the Zunyi Science and Technology Research and Development Fund,No.ZSKHS[2016] 06
文摘BACKGROUND Gamma-glutamyltransferase(GGT) is one of the most important laboratory tests for the evaluation of liver damage. Through a long-term clinical observation of patients with secondary asymptomatic choledocholithiasis, we found that most patients had abnormal GGT serum levels.AIM To investigate the combination of serum GGT and alkaline phosphatase(ALP) in predicting the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis.METHODS In this retrospective cohort study, the clinical data of 829 patients with cholecystolithiasis admitted to the Third Affiliated Hospital of Zunyi Medical College from August 2014 to August 2017 were collected. Among these patients,151 patients had secondary asymptomatic choledocholithiasis and served as the observation group, and the remaining 678 cholecystolithiasis patients served as the control group. Serum liver function indexes were detected in both groups,and the receiver operating characteristic(commonly known as ROC) curves were constructed for markers showing statistical significances. The cutoff value,sensitivity, and specificity of each marker were calculated according to the ROC curves.RESULTS The overall incidence of asymptomatic choledocholithiasis secondary to cholecystolithiasis was 18.2%. The results of liver function indexes including serum aspartate aminotransferase, alanine aminotransferase, direct bilirubin and total bilirubin levels showed no significant differences between the two groups(P> 0.05). However, the serum GGT and ALP levels were significantly higher in the observation group than in the control group(P < 0.05). The ROC curve analysis showed that the area under the curve was 0.881(95%CI: 0.830-0.932), 0.647(95%CI: 0.583-0.711) and 0.923(0.892-0.953) for GGT, ALP, and GGT + ALP,respectively. The corresponding cut-off values of GGT and ALP were 95.5 U/L and 151.5 U/L, sensitivity were 90.8% and 65.1%, and specificity were 83.6% and59.8%, respectively. The sensitivity and specificity of GGT + ALP were 93.5% and85.1%, respectively.CONCLUSION An abnormally elevated serum GGT level has an important value in the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis.The combination of serum GGT and ALP has better diagnostic performance. As a convenient, rapid and inexpensive test, it should be applied in secondary asymptomatic choledocholithiasis routine screening.
文摘AIM To explore the risk factors of gallbladder stone recurrence. METHODS A multifactorial analysis was made for 1058 patients in Shanghai area whose gallbladder stones disappeared after different kinds of nonsurgical therapy, including oral litholytic therapy, extracorporeal shock wave lithotripsy and percutaneous choledocholithotripsy. Serum level of insulin and total bile acid were determined in 122 patients. RESULTS After 1 8 8 years of follow up, the recurrence rate of gallbladder stone was 11 6%, 22 4%, 29 5%, 36 4%, 39 3% and 39 7% respectively within 1, 2, 3, 4, 5 and over 5 years. The risk factors for the recurrence are: primary multiple gallstones ( P <0 05); family history of cholecystolithiasis ( P <0 05); greasy food intake ( P <0 01); low mean value of serum insulin ( P <0 01); and high mean value of total bile acid ( P <0 01). CONCLUSION The recurrence of cholecystolithiasis is related to overintake of high fat and high cholesterol food, and might also be related to low level of serum insulin.
基金Beijing Municipal Science and Technology Commission,No.Z171100000417056。
文摘BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases.Elderly patients are a high-risk group for surgical treatment.If the incarceration of gallstones cannot be relieved,emergency surgery is unavoidable.CASE SUMMARY We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis.He had several coexisting,high-risk underlying diseases,had a history of radical gastrectomy for gastric cancer,and was taking aspirin before the operation.Nevertheless,he underwent emergency laparoscopic cholecystectomy,with maintenance of postoperative heart and lung function,successfully recovered,and was discharged on day 8 after the operation.CONCLUSION Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic,the key is to abide strictly by the hospital's epidemic prevention regulations,fully implement the epidemic prevention procedure for emergency surgery,fully prepare before the operation,accurately perform the operation,and carefully manage the patient postoperatively.
文摘Objective: To study the relationship between cholecystolithiasis and polypoid gallbladder( PLG),260 patients with polypoid gallbladder were investigated. The patients were divided into 2 groups: group A (PLG combined with cholecystolithiasis) and group B( without cholecystolithiasis) . The clinical pathological characteristics were analyzed. The intestinal epithelium metaplasia and atypical hyperplasia of the gallbladder mucosa were observed under light microscope. Results: Intestinal epithelium metaplasia and atypical hyper-plasia of gallbladder mucosa were found in 47 of the 260 cases. The pathological lesions included 16 gallbladder carcinoma, 11 adenomatosis polyp, 5 myoadenoma, 7 cholesterol polyp, 4 inflammatory polyp and 4 adenomatosis hyperplasia, which occurred in 26 and 21 patients in group A and group B , i.e. 44.0% and 10.3% respectively. The difference between group A and group B was statistically significant (P < 0.01).Conclusion : Cholecystolithiasis and the succeeding inflammatory reaction is a risk-factor for the polypoid gallbladder to develop tumour.
文摘In 1990, nanobacterium was found and named by Kajander.~1 With distinct mineralizing ability, nanobacteria are thought to play a role in extraskeletal calcifying diseases. It have been found in many human tissues, but whether they exist in the bile or gallbladder mucosa remains unclear. The present study was undertaken to investigate by ELISA, bacterial culturing, immunohistochemical staining and transmission electron microscopy (TEM), whether nanobacteria exist in serum, bile or gallbladder mucosa of healthy people and patients with cholecystolithiasis.
文摘BACKGROUND Clostridium difficile(C.difficile)infection(CDI)is a rare clinical disease caused by changes in the intestinal microenvironment,which has a variety of causes and a poor prognosis,and for which there is no standardized clinical treatment.CASE SUMMARY A patient experienced recurrent difficulty in bowel movements over the past decade.Recently,symptoms worsened within the last ten days,leading to a clinic visit due to constipation.The patient was subsequently referred to our depart-ment.Preoperatively,the patient was diagnosed with obstructed colon accom-panied by gallstones.Empirical antibiotics were administered both before and after surgery to prevent infection.On the fourth day post-surgery,symptoms of CDI emerged.Stool cultures confirmed the presence of C.difficile DNA.Treatment involved a combination of vancomycin and linezolid,resulting in the patient's successful recovery upon discharge.However,the patient failed to adhere to the prescribed medication after discharge and was discovered deceased during a follow-up two months later.CONCLUSION CDI is the leading cause of nosocomial post-operative care,with limited clinical cases and poor patient prognosis,and comprehensive clinical treatment guidelines are still lacking.This infection can be triggered by a variety of factors,including intestinal hypoxia,inappropriate antibiotic use,and bile acid circulation disorders.In patients with chronic bowel disease and related etiologies,prompt preoperative attention to possible CDI and preoperative bowel preparation is critical.Adequate and prolonged medication should be maintained in the treatment of CDI to prevent recurrence of the disease.
文摘Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique(including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.
文摘AIM: To analyze the efficacy of routine intraoperative ultrasound (IOUS) as a guide for understanding biliary tract anatomy, to avoid bile duct injury (BDI) after laparoscopic cholecystectomy (LC), as well as any burden during the learning period. METHODS: A retrospective analysis was performed using 644 consecutive patients who underwent LC from 1991 to 2006. An educational program with the use of IOUS as an operative guide has been used in 276 cases since 1998. RESULTS: IOUS was highly feasible even in patients with high-grade cholecystitis. No BDI was observed after the introduction of the educational program, despite 72% of operations being performed by inexperienced surgeons. Incidences of other morbidity, mortality, and late complications were comparable before and after the introduction of routine IOUS. However, the operation time was significantly extended after the educational program began (P < 0.001), and the grade of laparoscopic cholecystitis (P = 0.002), use of IOUS (P = 0.01), and the experience of the surgeons (P = 0.05) were significant factors for extending the length of operation. CONCLUSION: IOUS during LC was found to be a highly feasible modality, which provided accurate, real- time information about the biliary structures. Theeducational program using IOUS is expected to minimize the incidence of BDI following LC, especially when performed by less-skilled surgeons.
基金the National Natural Science Foundation of China,No.39560026Applied Basic Research Fund of Yunnan Provincial Science and Technology Committee,No.92C059
文摘AIM To further study the properties of bileliquid crystals,and probe into the relationshipbetween bile liquid crystals and gallbladderstone formation,and provide evidence for theprevention and treatment of cholecystolithiasis.METHODS The optic properties of bile liquidcrystals in human body were determined by themethod of crystal optics under polarizingmicroscope with plane polarized light andperpendicular polarized light.RESULTS Under a polarizing microscope withplane polarized light,bile liquid crystalsscattered in bile appeared round,oval orirregularly round.The color of bile liquidcrystals was a little lighter than that of the bilearound.When the stage was turned round,thecolor of bile liquid crystals or the darkness andlightness of the color did not change obviously.On the border between bile liquid crystals andthe bile around,brighter Becke-Line could beobserved.When the microscope tube is lifted,Becke-Line moved inward,and when lowered,Becke-Line moved outward.Under aperpendicular polarized light,bile liquid crystalsshowd some special interference patterns,called Malta cross.When the stage was turninground at an angle of 360°,the Malta cross showed four times of extinction.In the vibratingdirection of 45° angle of relative to upper andlower polarizing plate,gypsum test-board withoptical path difference of 530 nm was inserted,the first and the third quadrants of Malta crossappeared to be blue,and the second and thefourth quadrants appeared orange.When micatest-board with optical path difference of 147 nmwas inserted,the first and the third quadrants ofMalta cross appeared yellow,and the secondand the fourth quadrants appeared dark grey.CONCLUSION The bile liquid crystals weredistributed in bile in the form of global grains.Their polychroism and absorption were slight,but the edge and Becke-Line were very clear.Itsrefractive index was larger than that of the bile.These liquid crystals were uniaxial positivecrystals.The interference colors were the firstorder grey-white.The double refractive index ofthe liquid crystals was △n=0.011-0.015.
文摘AIM: To compare synchronous laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) and sequential LC combined with EST for treating cholecystocholedocholithiasis. METHODS: A total of 150 patients were included and retrospectively studied. Among these, 70 were selected for the synchronous operation, in which the scheme was endoscopic retrograde cholangiopancreatography combined with EST during LC. The other 80 patients were selected for the sequential operation, in which the scheme involved first cutting the papillary muscle under endoscopy and then performing LC. The indexes in the two groups, including the operation time, the success rate, the incidence of complications, and the length of the hospital stay, were observed.RESULTS: There were no significant differences between the groups in terms of the numbers of patients, sex distribution, age, American Society of Anesthesiologists score, serum bilirubin, γ-glutamyl transpeptidase, mean diameter of common bile duct stones, and previous medical and surgical history (P = 0.54, P = 0.18, P = 0.52, P = 0.22, P = 0.32, P = 0.42, P = 0.68, P = 0.70, P = 0.47 and P = 0.57). There was no significant difference in the surgical operation time between the two groups (112.1 ± 30.8 min vs 104.9 ± 18.2 min). Compared with the sequential operation group, the incidence of pancreatitis was lower (1.4% vs 6.3%), the incidence of hyperamylasemia (1.4% vs 10.0%, P < 0.05) was significantly reduced, and the length of the hospital stay was significantly shortened in the synchronous operation group (3 d vs 4.5 d, P < 0.001). CONCLUSION: For treatment of cholecystocholedo-cholithiasis, synchronous LC combined with EST reduces incidence of complications, decreases length of hospital stay, simplifies the surgical procedure, and reduces operation time.
文摘AIM: To evaluate transvaginal hybrid-NOTES cholecystectomy(TVC) during its clinical establishment and compare it with the traditional laparoscopic technique(LC).METHODS: The specific problems and benefits of TVC were reviewed using a registry analysis,a comparative cohort study and a randomized clinical trial. At first,feasibility,safety and specific complications of the TVC were analyzed based on the first 488 data sets of the German NOTES Registry(GNR). Hereafter,we compared the early postoperative results of our first 50 TVC-patients with those of 50 female LCpatients matched by age,BMI and ASA classification. The same cohort was contacted an average of two years later to evaluate long-term results concerning pain and satisfaction with the aesthetic results and the overall postoperative results as well as sexual intercourse by means of two domains of the German version of the Female Sexual Function Index(FSFI-d). Consequently,we performed a randomized clinical trial comparing 20 TVC-patients with 20 needlescopic/3-trocar cholecystectomies(NC) also concerning the early postoperative results as well as pain,satisfaction and quality of life by means of the Eypasch Gastrointestinal Quality of Life Index(GIQLI) in the later course. Finally,we discussed the results in accordance with other published studies.RESULTS: The complication(3.5%) and conversion rates(4.1%) for TVC were low in the GNR and comparable to those of the LC. Access related intraoperative complications included injuries to the bladder(n = 4; 0.8%) and bowel(n = 3; 0.6%). The study cohort revealed less postoperative pain after TVC comparing to the LC-patients on the day of surgery(NRS,1.5/10 vs 3.1/10,P = 0.003),in the morning(NRS,1.9/10 vs 2.8/10,P = 0.047) and in the evening(NRS,1.1/10 vs 1.8/10,P = 0.025) of postoperative day(POD) one. The randomized clinical trial consistently found less cumulative pain until POD 2(NRS,8/40 vs 14/40,P = 0.043),as well as until POD 10(NRS,22/190 vs 41/190,P = 0.010). Furthermore,the TVC-patients had a better quality of life on POD 10 than did the LC-patients(GIQLI,124/144 vs 107/144,P = 0.028). The complication rates were comparable and no specific problems were detected in the long-term follow-up for sexual intercourse for either group. The TVC-patients were more satisfied with the aesthetic result in the long-term course in the matched cohort analysis(1.00 vs 1.88,P < 0.001) as well as in the randomized clinical trial(1.00 vs 1.70,P < 0.001) when compared with the LC-patients.CONCLUSION: TVC is a feasible procedure with a high safety profile and has advantages in regard to postoperative pain and aesthetic results when compared with LC or NC.
文摘AIM： To investigate the prevalence, risk factors, and selection of the study population for cholecystolithiasis in an urban population in Germany, in relation to our own findings and to the results in the international literature. METHODS： A total of 2 147 persons （1 111 females, age 42.8 ＋ 12.7 years; 1 036 males, age 42.3 ＋ 13.1 years） participating in an investigation on the prevalence of Echinococcus rnultilocularis were studied for risk factors and prevalence of gallbladder stone disease. Risk factors were assessed by means of a standardized interview and calculation of body mass index （BMI）. A diagnostic ultrasound examination of the gallbladder was performed. Data were analyzed by multiple logistic regression, using the SAS statistical software package. RESULTS： Gallbladder stones were detected in 171 study participants （8.0%, n = 2 147）. Risk factors for the development of gallbladder stone disease included age, sex, BMI, and positive family history. In a separate analysis of female study participants, pregnancy （yes/no） and number of pregnancies did not exert any influence. CONCLUSION： Findings of the present study confirm that age, female sex, BMI, and positive family history are risk factors for the development of gallbladder stone disease. Pregnancy and the number of pregnancies, however, could not be shown to be risk factors. There seem to be no differences in the respective prevalence for gallbladder stone disease in urban and rural populations.
基金supported by the Science and Technology Foundation of Shandong Province(ZR2021MH033)China Postdoctoral Science Foundation(2018M632679).
文摘Laparoscopic cholecystectomy(LC)has gradually become the first choice for the treatment of cholecystolithiasis in recent years.Iatrogenic bile duct injury(IBDI)is an important clinical problem in LC.The anatomical variation of the cystic duct increases the probability of IBDI and the difficulty of operation.We present a case of a 44-year-old male with a anatomical variation of the cystic duct complicated with cholecystolithiasis and choledocholithiasis,who successfully underwent choledocholithotomy,choledochoscopic exploration and T-tube drainage surgery.The patient recovered well and was discharged home on postoperative day 10.The T-tube was removed at 1 month postoperatively after cholangiography examination of no choledocholithiasis left.
基金Research and Application of Clinical Diagnosis and Treatment Technology in Capital(Z211100002921025)。
文摘Objective:To explore the safety and effectiveness nursing of 12 h discharged daytime laparoscopic cholecystectomy guided by enhanced recovery after surgery(ERAS)concept.Methods:Included 180 cases from the 12 h discharged daytime laparoscopic cholecystectomy patients which assessmended and guided by ERAS,with the 180 case of routine cholecystectomy patients as control group at the same time.To quantitatively analyze the related indexes of perioperative period and ERAS concept,and evaluate the clinical safety,and effectiveness.Results:It displayed no significant differences in average age,gender distribution,duration of gallbladder related disease and distribution of clinical symptoms between the two groups(P>0.05).There were also no significant differences in preoperative smoking history,hypertension history,cardio-cerebrovascular history,abdominal operation history and disease composition ratio between the two groups(P>0.05).None of the patients had conversion to laparotomy.Compared with the conventional surgery group,there were no significant differences in the average amount of intraoperative blood loss,operation time and muscle strength before returning to the ward in patients with ERAS guided day surgery(P>0.05).When compared with the conventional surgery group,ERAS guided day surgery group had no significant difference in muscle strength between the two groups when going under the ground(t=1.64,P=0.082).Also,the level of peripheral white blood cells in patients with ERAS guided day surgery group was not significantly increased at 6 h after surgery.Meanwhile,liver function related indexes,transaminase,total bilirubin,indirect bilirubin were not significantly abnormal(P>0.05).Conclusion:12 h daytime laparoscopic cholecystectomy guided by ERAS concept can improve the clinical efficacy of patients with cholecystolithiasis,which is safe and feasible.
文摘一、临床资料
患者,男,35岁,米-17飞行员,飞行时间4000 h.于2012年4月5日因右侧间断性腰痛1周,加重1d入院.患者曾于2006年因胆囊结石住院期间体检发现多囊肾、多囊肝;其祖父患有多囊肾病史.并于2011年12月2日因体检发现双肾结石2周,入解放军第四五二医院治疗.患者入院查体:腹平,全腹柔软,无压痛及肌紧张,双侧肾区稍叩击痛,输尿管走行区无压痛,膀胱区无膨隆,无压痛.B超检查示:右肾积液,右输尿管上段扩张,双肾结石.中下腹CT示:右肾小结石,右输尿管上段小结石,多囊肝、多囊肾.静脉肾盂造影结果示:双肾功能良好,肝、肾功能正常.诊断:右输尿管结石,双肾结石,多囊肾,多囊肝.治疗上给予多饮水,适当活动,联合给予抗感染、解痉、利尿等对症治疗,于2012年4月19日经尿道排出结石1枚,长径约0.5 cm.
基金Sichuan Provincial Administration of Traditional Chinese Medicine (No. 06172)
文摘Objective： To explore the effect of Chinese herbs during the perioperative period of laparoscopic cholecystectomy （LC）. Methods： Three hundred and sixty patients of chronic lithic cholecystitis （LOOT） were randomly assigned to two groups by lottery, 180 patients in each group. During the peri-operative period, the control group was treated with conventional Western medicine and placebo. The treated group was given the same conventional Western medicine and Chinese herbal decoctions, with Shitong mixture No. 1 （石通1号） added before LC, and Liujunzi decoction （六君子汤） added after LC for three days. The operation time, body temperature after LC, white blood cell count, wind-breaking time after operation, as well as the changes of tongue coating in the first three post-operative days were recorded. Results： There was no significant difference between the two groups in operation time （P〉0.05）, while the improvement in body temperature recovery, windbreaking time and changes of tongue coating in the treated group were better than those in the control group （P〈0.01）. Conclusion： Applying Chinese herbs during perioperative period of LC could effectively benefit early recovery in such patients.
文摘Cholecystitis is a common disease in East Asia. Some of the patients developed cystic artery pseudoaneurysm,a rare complication of cholecystitis. Over the past decades, there have been Tess than 20 reports of patients with cystic artery pseudoaneurysm in the literature. Among them, three of the patients had gallbladder perforation which led to hemorrhagic shock,la We report a case of an 88-year-old woman with a cystic artery pseudoaneurysm following an episode of acute cholecystitis.
