Objective To study the association and the effect of the expression of p16 and p53 protein on the occurence and development of gallbladder carcinoma. Methods The expression of p16 and p53 protein were detected in 40 cases of gallbladder carcinoma with immunohistochemical method. Results The expressions of p16 and p53 protein were closely correlated to the tumor pathological grade, lymph mode metastasis and prognosis. p16 protein was correlated to the Nevin classifications. Conclusion The results indicate that the low expression rate of p16 protein occurred in the advanced stage of gallbladder carcinoma. The expression of p16 and p53 protein are helpful in judging the malignant degree and prognosis of primary gallbladder cancer.
ObjectiveTo evaluate and analyze the clinical effect of ambulatory surgery applied to laparoscopic cholecystectomy (LC).MethodsThe patients who underwent LC in the First Affiliated Hospital of Xinjiang Medical University from June 2017 to February 2019 were collected, then were assigned to ambulatory surgery applied to LC group (ALC group) and conventional LC group (CLC group) according to the admission process mode. The patients in the ALC group received LC in the ambulatory ward and the patients in the CLC group received LC in the conventional ward. The preoperative waiting time, postoperative gastrointestinal recovery time, postoperative 6 h pain score, total hospitalization time, total hospitalization cost, patient satisfaction, and postoperative complications were compared between the two groups.ResultsA total of 433 patients underwent LC were included in this study, including 176 patients in the ALC group and 257 patients in the CLC group. There were no significant differences in the age, gender, type of gallbladder diseases, etc. between the two groups (P>0.05) except body mass index (P<0.05). There was no perioperative death in the two groups. One patient converted to laparotomy in the CLC group. Compared with the CLC group, the preoperative waiting time, postoperative gastrointestinal recovery time, and the total hospitalization time were shorter, the postoperative pain score was lower, the total hospitalization cost was less, and the satisfaction rate of patients was higher in the ALC group (P<0.05). There was 1 case of incision infection and 1 case of ascites in the operation area in the ALC group and CLC group, 1 case of fever in the ALC group and 3 cases of fever in the CLC group, respectively. There was no difference in the overall incidence of complications between the two groups (P>0.05). During the follow-up of 6 to 26 months, there was no readmission in both groups.ConclusionPatients who undergone LC based on ambulatory surgery mode recover quickly, and hospitalization cost is less, satisfaction rate is higher.
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.
ObjectiveTo investigate the effect of combined or non-combined liver resection for T2a gallbladder cancer. MethodsAccording to the established inclusion and exclusion criteria, the patients with T2a gallbladder cancer admitted to Peking Union Medical College Hospital from January 2016 to December 2021 were retrospectively collected, then were assigned into combined with liver resection group and non-combined with liver resection group. The general characteristics, perioperative information, and prognosis of the two groups were compared. ResultsA total of 58 patients were enrolled in this study, including 23 males and 35 females; aged (64.8±11.1) years. There were 43 cases in the combined with liver resection group and 15 cases in the non-combined with liver resection group. There were no statistic differences in the demographic data, lifestyle, onset symptoms, preoperative combined diseases, and preoperative tumor markers between the two groups (P>0.05). Compared with the combined with liver resection group, the proportion of patients received bile duct resection was higher (P=0.013) and the operation time was shorter (P=0.045) in the non-combined with liver resection group. There were no statistic differences in the other perioperative informations between the two groups (P>0.05). A total of 12 patients had postoperative complications, including 3 cases of grade Ⅰ, 8 cases of grade Ⅱ, and 1 case of grade Ⅲa by Clavien-Dindo classification. All patients improved after treatment and were discharged smoothly. No patient was readmitted within 30 d after discharge. All 58 patients were followed up with a median follow up time of 29 months. During the follow-up period, there were 47 cases (81.0%) of tumor-free survival, 2 cases (3.4%) of survival with tumor, and 9 cases (15.5%) of death. There were no statistic differences in the overall survival and disease-free survival between the two groups by log-rank test (χ2=3.418, P=0.064; χ2=1.543, P=0.214). ConclusionFromthe results of this study, for T2a gallbladder cancer, liver resection would not result in increased complications or longer hospital stay, but don’t obviously improve prognosis.
Objective To explore the feasibility， operation method， and clinical application value of transumbilical single-port laparoscopic cholecystectomy （TUSP-LC） in treatment for children patients with benign gallbladder diseases. Methods The clinical data of 64 patients with benign gallbladder diseases from June 2009 to June 2011 were analyzed retrospectively. The patients were divided into TUSP-LC group （n=41） and convention three-port LC （CTP-LC group， n=23）. The operative time， intraoperative blood loss， conversion to CTP-LC or laparotomy， operative complications， and hospital stay were recorded. The pains were registered at 3，6，12，24，48， and 72h postoperatively using visual analog scale （VAS）. The patients were given satisfaction questionnaires with surgery at 6 time points （1 week， 2 weeks， 1 month， 3 months， 6 months， 12 months） during a 12 months follow-up. Results A total of 64 pediatric LCs were performed successfully， no patients were converted to laparotomy. Except for one case of incision infection in the CTP-LC group 〔4.35%（1/23）〕 and one case of incision infection and one case of ecchymoma in the TUSP-LC group 〔4.88% （2/41）〕， no other complications such as bile duct injury， bile leakage， and incision hernia happened， the total complication rate was not significant difference in two groups （P＞0.05）. The operative time 〔（47.54±18.71） min versus（45.33±10.58） min〕， intraoperative blood loss 〔（18.56±13.34） ml versus （17.28±12.53） ml〕， and hospital stay 〔（1.67±0.36） d versus （1.81±0.38） d〕were not significant differences in two groups （P＞0.05）. The VAS score was not statisticly significant within 24h in two groups （P＞0.05）， but which in the TUSP-LC group was significantly lower than that in the CTP-LC group after 24h postoperatively （P＜0.05）. During a 12 months follow-up， the score of satisfaction in the TUSP-LC group was significantly higher than that in the CTP-LC group （P＜0.05）. Conclusions TUSP-LC is a safe and feasible method in the children patients with benign gallbladder diseases. It can be performed with the same technical exposure and outcomes as multi-port laparoscopy， with the added benefit of relieving postoperative pain and little no scarring.
ObjectiveTo evaluate the feasibility and surgical techniques of laparoscopic subtotal cholecystectomy （LSC) in treatment for patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy. MethodsThe clinical data of 83 patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy admitted to this hospital between January 2006 and April 2010 were analyzed retrospectively. ResultsEighty-one patients were performed LSC, 2 patients were converted to laparotomy. In which 39 patients with the part of wall residual of the fundus and (or) body of the gallbladder, 26 patients with residual of part of gallbladder neck, 18 patients with residual of part of gallbladder body and neck. Fifty-one cases were followed-up for 3 months to 4 years, there were 2 patients with the change like “mini gallbladder” by B ultrasound and no obviously clinical symptoms. There was no ostcholecystectomy syndrome in the patients with follow-up. ConclusionsLSC is a safe, effective, feasible procedure for severe gallstone gallbladder inflammation, adhesion, or atrophy, which can effectively prevent bile duct injury, bleeding, or other serious complications. While it can also reduce the rate of conversion to laparotomy.
ObjectiveTo understand the advance in research of high risk factors and diagnosis in primary carci-noma of gallbladder. MethodsThe literatures at home and abroad during recent years were reviewed, and the research progress of high risk factors and inchoate diagnosis about primary gallbladder carcinoma were summarized. ResultsCholecystolithiasis, cholecystitis, and other factors have a certain correlation with primary gallbladder carcinoma.The rate of early diagnosis of primary gallbladder carcinoma can be enhanced through the detailed history taking and physical examination, supplemented by a variety of imaging examination methods, and molecular biological technologies. ConclusionIt can enhance the rate of early diagnosis of primary gallbladder carcinoma that understand the risk factors and master various methods for early diagnosis of carcinoma of gallbladder.
Objective The method of metabonomics based on nuclear magnetic resonance (NMR) imaging was used to explore the difference in metabolites of serum and bile, and to analyze the metabolic variation related to the pathogenesis of gallbladder stones between normal people/liver transplantation donors and patients with gallbladder stones. Methods Prospectively collected the serum samples (17 cases) and bile samples (19 cases) in 19 patients with gallbladder stones who underwent surgery in West China Hospital form March 2016 to December 2016, as well as the serum samples of 10 healthy persons and the bile samples of 15 liver transplantation donors at the same time period. The differences of metabolites in the blood and bile in these 3 groups were compared by using 1H-NMR metabonomics technology and chemometric methods. Results The concentrations of valine, alanine, lysine, glutamine, glutamate, pyruvate, creatinine, choline, alpha-glucose, beta-glucose, tyrosine, histidine, and hypoxanthine in serum of patients with gallbladder stones decreased significantly, comparing with those of healthy people without gallbladder stones (P<0.05), while 1, 2-propanediol, acetoacetate, and lactate increased significantly in the serum of patients with gallbladder stones (P<0.05). The concentrations of taurine conjugated bile acids, glycine conjugated bile acids, choline, and phosphatidylcholine decreased significantly in the bile of patients with gallbladder stones when compared with those of liver transplantation donors (P<0.05), while cholesterol increased significantly in the bile of patients with gallbladder stones (P<0.05). Conclusions There are significant differences of the serum and bile metabolites between patients with gallbladder stones and healthy men without gallbladder stones/liver transplantation donors. 1H-NMR metabonomics is helpful to investigate the pathogenesis of gallbladder stones.
ObjectiveTo review the latest advances in diagnosis and treatment of gallbladder carcinoma.MethodsThe recent literatures on diagnosis and treatment of gallbladder carcinoma at home and abroad were reviewed, and the diagnosis, staging and treatment progress of gallbladder carcinoma were systematically reviewed.ResultsThere are many methods to diagnose gallbladder carcinoma, among which imaging methods are commonly used, as well as various tumor markers and gallbladder carcinoma-related genes. Surgical resection is still the only possible cure for gallbladder carcinoma, but the scope and timing of surgical resection are still controversial. Radiotherapy, chemotherapy and gene therapy also play an important role in the treatment of gallbladder carcinoma.ConclusionsImaging examination is still the first choice for the diagnosis of gallbladder carcinoma. The tumor markers and gene diagnosis has broad prospects. Gallbladder carcinoma is mainly treated by surgery. Gene intervention and precise targeted therapy are the future development direction.
ObjectiveTo explore the related risk factors of polypoid lesions of gallbladder (PLG) in civil aviation flight cadets and the health management measures for the risk factors. MethodsRetrospective analysis of the 2022 flight annual medical students, according to the B ultrasound examination results have PLG, divided into PLG group (n=128) and non-PLG group (n=150), collect the basic data of the students, and establish a multivariate logistic regression equation model to analyze the related risk factors of gallbladder polypoid lesions. ResultsThe results of univariate analysis showed that there was no significant difference between groups with hypertension, hyperlipidemia and hyperglycemia (P>0.05), but with age and body mass index, high total bilirubin in serum and hyperuricemia, regular schedule and diet, and sufficient exercise (P<0.05). The results of multivariate logistic regression equation model analysis showed that age, high serum total bilirubin, hyperuricemia, irregular sleep and rest, irregular diet and lack of exercise were independent risk factors for PLG. ConclusionsAge, high serum total bilirubin, hyperuricemia, irregular work and rest, irregular diet and lack of exercise are the main reasons for PLG in civil aviation flight cadets. Intervention and prevention of risk factors can effectively ensure their health and flight safety.