ObjectiveTo evaluate the security and feasibility of transumbilical laparoendoscopic single-site cholecystectomy (TULESC) with conventional laparoscopic instruments. MethodsThe clinical data of 62 adult patients undergoing TULESC between October 2011 and June 2013 were analyzed retrospectively. There were 13 males and 49 females aged between 22 and 70 years old averaging 40±15. Forty-nine patients suffered from chronic cholecystitis with cholelithiasis, 10 from asymptomatic cholelithiasis and 3 from cholecystic polyposis. A single arc incision was cut on the edge of the umbilicus, and two 10 mm Trocars and one 5 mm Trocar were placed by puncture. Cholecystectomy was performed with conventional laparoscopic instruments and equipment. ResultsAll the 62 patients underwent TULESC successfully without severe complications such as bile leakage or biliary injury. The operation time was 20-70 minutes with the average of (40±15) minutes; The blood loss was 5-40 mL with the average of (15±10) mL. All the patients were discharged from the hospital within 3 to 7 days after surgery, averaging 4.0±1.0. During the 1 to 12-month follow-up (averaging 3 months), there was no obviously visible scars on the abdominal wall and the aesthetic effect was significant. ConclusionTULESC with conventional laparoscopic instruments and equipment is safe, feasible and cosmetic.
The present study was designed to elucidate the role of apoE polymorphism in the lithogenesis of cholecystolithiasis and to explore the hereditary pathogenesis of the disease. Polymerase Chain Reaction (PRC) was used as researching apoE phenotypes and allele frequencies in patients with gallstones (n=87) and in controls (n=50), and the fasting serum lipids of subjects were also measured. The characteristics of lipid variants were analysed among the patients with different apoE phenotypes. The results showed that the levels of TG (1.43mmol/L), VLDL-C(0.68mmol/L) in E2/3 patients were greatly higher than those in E2/3 controls (1.06mmol/L, Ｐ＜0.05 and 0.48mmol/L, Ｐ＜0.05), and LDL-C (1.41mmol/L) was markably lower in E2/3 patients than that in controls (2.04mmol/L, Ｐ＜0.05). The levels of serum lipids decreased significantly in E3/3 patients with HDL-C (0.89mmol/L), HDL2-C (0.49mmol/L), HDL3-C (0.39mmol/L), and compared with those in E3/3 controls (1.28mmol/L Ｐ＜0.05, 0.73mmol/L Ｐ＜0.001 and 0.55mmol/L Ｐ＜0.001). In E3/4 patients there were only slight changes of VLDL-C, LDL-C level. The results suggest that the average level of serum lipids in the same apoE phenotype patients with gallstones is higher than that in controls, and the different apoE phenotypes patients with gallstones have different characteristics of dyslipidemia. ε2 allele is probably one of the dangerous factor in the lithogenesis of cholecystolithiasis.
63 normal human gallbladders (non-stone group) and 47 inflammed cholesterol stone gallbladders(stone group) were assayed for the amount of macrophages(ΜΦ),the levels of tumor necro-sis factor (TNF) and interleukin 1(1L-1).It was found that in stone group,the amount of ΜΦ was significantly higher than in non-stone group(ΜΦ4101.90±295.72 vs 572.13±30.07AU,Plt;0.01).The levels of TNF and 1L-1 released mainly from the MΦ in stone group were also significantly increased in comparison with those in non-stone group(TNF 18.12±2.03 vs 4.45±0.39ng/mg,Plt;0.001;1L-1 102.42±7.84 vs 66.75±9.50u/mg protein,Plt;0.05).These results suggest that the activited ΜΦ and increases of TNF,1L-1 may be closely related to the inflammatory reaction in gallbladders and the formation of cholesterol gallstones.
Objective To study the clinical effects of laparoscope combined with choledochoscope in patients with cholecystolithiasis and choledocholithiasis. Methods Clinical data of 74 patients with cholecystolithiasis and choledocholithiasis between Mar. 2009 and Feb. 2011 in our hospital were retrospectively analyzed. Among them， 37 cases underwent the laparoscope combined with choledochoscope operation （referred to as the double mirror operation group） and 37 cases underwent the conventional open operation （open operation group）. The intraoperative conditions， therapeutic effect， and complications of patients in 2 groups were compared. Results The stone clearance rates of the two groups were 100%. The recurrence rate of 2 groups in the follow-up process was no significantly difference （P＞0.05）. In the double mirror operation group， the operative time was significantly longer than that open operation group （P＜0.01）；the intraoperative bleeding was significantly less than that open operation group （P＜0.01）；the anal exhaust time after operation， get out of bed time after operation， and total duration of hospitalization were significantly shorter than that open operation group （P＜0.01）；and the incidence of postoperative complications was significantly lower than that open oper-ation group（P＜0.01）. Conclusion Laparoscope combined with choledochoscope in treatment of cholecystolithiasis and choledocholithiasis patients has exact effects， with minor trauma， quicker recovery， and fewer complications， and it’s worthy of promotion.
This study was designed to determine the effects of different anaesthesia on the postoperative gastrointestinal motility after cholecystectomy. Postoperative gastrointestinal motility were recorded continuously by means of gastrointestinal manometry in 20 patients subject to cholecystectomy (general anaesthesia 10, epidural anaesthesia 10). Normal migrating motor complex (MMC) was abolished during the early postoperative period in all patients. The time of reappearance of intestinal MMC varied from 0.5 to 2 hours . Gastric MMC recurred 5.5 to 14 hours postoperatively and the normal MMC completely recovered 22 to 43 hours after the operations. Ingestion of food changed the MMC into a fed pattern during the early postoperative period. There was no difference between the general anaesthesia group and epidural anaesthesia group in terms of gastrointestinal motility. The results indicate that postoperative gastrointestinal motility recovers faster than that was thought conventionally. Cholecystectomy under general anaesthesia or under epidural anaesthesia makes no difference in postoperative gastrointestinal motility.
Objective To investigate the possibility of laparoscopic cholecystectomy （LC） on porcelain gallbladder. Methods Twenty-four cases of porcelain gallbladder， who were operated in China Medical University， including 13 LC cases， from 2006 to 2008 were retrospectively reviewed. Results Of 24 porcelain gallbladder cases (0.48%) in 4964 cholecystectomy patients， calcification of gallbladder in 87.50%(21/24) patients was diagnosed by ultrasonography. Of 13 patients who were cured by LC, one suffered from postoperative leak bile, no metastasis were found by following up 12 or 14 months in two gallbladder carcinoma cases. Conclusion There’s specificity of ultrasonographic image in porcelain gallbladder, in which LC is safe to be performed and routine frozen pathology during operation is necessary.
Objective To study glutamine (GLN) and cholecystokinin (CCK) effects on prevention of cholestasis in total parenteral nutrition (TPN). Methods White rabbits were choosed as TPN models, which were divided into four groups, group 1, TPN only (n＝10); Group 2, TPN plus GLN administration (n＝10); Group 3, TPN plus CCK (n＝10); Group 4, TPN plus GLN and CCK administration. Bile components were assayed and the structural change in gallbladder and liver were observed under light and election microspes at the forth and eighth week. Results Increasing of bilirubin and cholesterol was observed in the 1st and 2nd groups at the forth week, but increasing in the 3rd group was observed at the eighth week. The 4th group was normal. Changes of gallbladder and liver structure in 1st and 3rd group occured at the forth week. Changes of 2nd group occured at the eighth week. No structural change was found in the 4th group. Conclusion The test prove that cholestasis would occure during TPN and become serious with time prolonging. Integrity and function of gallbladder-wall tissue cell could be defended and sustained by applying GLN, but there is no direct preventing action. There is apparent cholecy stokinetic and cholagogic fundations by applying CCK. But CCK would lose its function if gallbladderwall was damaged. The test prove that TPN+GLN+CCK is the best way to prevent cholestasis during TPN.
Injury of the gallbladder beds on the liver during laparoscopic cholecystectomy of 178 cases for the last year waas analysed. Reoperations in 6 cases with one death due to major postoperative complications. These injuries could be classified into 3 degrees according to extent of liver parenchyma denuded in the bed . Degree Ⅰ, no liver was denuded in the bed with the fibromembranous lining intact (49 cases);Degree Ⅱ, liver denuded area was less than one half of the bed (90 cases);Degree Ⅲ, liver denuded area was greater than half of the bed ( 39 cases). There was close relationship between grade of the bed injury and the postoperative complication. Leaving the lining intact of the bed was most important during the lapatoscopic cholecystectomy in order to prevent complication from the bed. The method was discussed. Drainage of the subhapatic space was suggested when liver bed is denuded.
Objective To summarize the experiences in learning laparoscopic cholecystectomy （LC） and discuss young surgeons how to learn LC scientifically. Method The clinical data of 198 patients received LC by myself since I got the qualification of LC were analyzed retrospectively. Results LC was performed successfully in 187 patients with an average operation time of 68 min. Eleven patients were converted to laparotomy. In these 11 patients， 10 patients because of unclear anatomy in Calot triangle and 1 patient because of uncontrollable bleeding due to pathologic anatomy in Calot triangle caused by gallstone. All 198 patients did not suffer from complications such as severe hemorrhage or injury of biliary duct. Liquid therapy and antibiotics therapy were applied in patients with cholecystitis after LC. Food intake and ambulation were recovered at 12-24h after operation. All the patients were discharged from hospital with anaverage of 2.8d after LC. There was no complications related bile duct injury in all of the patients. Conclusion Managed by hierarchical operations management system， mastering regional physiological and variant anatomy， making use of other open cholecystectomy and laparoscopic simulative learning system well， complying with the learning curve， controlling the indications， contraindications and timing of conversion to laparotomy， young surgeons are able to master LC scientifically， safely， and solidly.
ObjectiveTo summarize the clinical experience on primary suture after common bile duct exploration and to investigate its clinical indications and curative effects. MethodsThe clinical data of 137 patients underwent primary closure of common bile duct between February 2006 and June 2010 were analyzed retrospectively. ResultsAll operations were successful. The operative time ranged from 65-213 min (mean 129 min) and the blood loss ranged from 50-350 ml with an average of 148 ml. One hundred and twenty-four patients (90.5%) were discharged from hospital without complications within 7 d after operation. Postoperative bile leakage occurred in 13 patients (9.5%) consisted of 10 early stage cases (18.5%, 10/54) and 3 later stage cases (3.6%, 3/83), which were discharged with improvement by conservative treatment within 3 weeks after operation. Totally 113 patients (82.5%) were followed up for 2-54 months with a median time of 14 months, no residual or retained stone and biliary duct stricture occurred. ConclusionOnly with the strict indication and proficient surgical technology, primary suture after common bile duct exploration is a safe and effective way to choledocholithiasis.