【Abstract】ObjectiveTo study the relationship between the bacterial spectrum difference of gallbladder mucosa and choledochus bile and clinical prognosis of gallstone pancreatitis. MethodsA synchronic bacterial culture and drug sensitivity test were carried out on 48 patients with gallstone pancreatitis. ResultsThe cases of positive gallbladder mucosa and choledochus bile were 13 (27.1%) and 31 (64.6%) respectively. The cases of double positivity were 12 (25.0%). The cultural strains of gallbladder mucosa and choledochus bile were significantly different. Some strains were only found in choledochus bile，whereas in gallbladder mucosa L-form bacteria predominated.ConclusionThe most common causative strain of gallstone pancreatitis is Bacterium coli. The drug-resistant strain emerges maybe due to bacterium immigration and delitescence in gallbladder mucosa. L-form bacteria should be considered when using antibiotics, because L-form bacteria have close relationship with the prognosis of gallstone pancreatitis.
Objective To explore the expression of tumor necrosis factor (TNF) mRNA, TNF and TNFR in the gallbladder mucosa which developed from hyperplasia, dysplasia to carcinoma, and to further discuss the relationship between TNF and pathogenesis of gallbladder carcinoma. Methods In situ hybridization and immunohistochemistry were used to determine TNF mRNA, TNF protein and TNFR protein expression in hyperplasia, dysplasia and carcinoma of gallbladder. Results ①No one of 20 cases of gallbladder hyperplasia was found to express TNF mRNA, while 4 of 20 (20%) cases of dysplasia and 18 of 20 (90%) cases of carcinoma were found to express TNF mRNA (P＜0.05). ②For the expression of TNF mRNA in mononuclear cells (MNC), positive staining was found in 15% of gallbladder hyperplasia, 85% of dysplasia and 90% of carcinoma, respectively (P＜0.05). The cell numbers of positive staining MNC were 4.85±1.50, 6.00±2.71 and 9.33±3.07, respectively (P＜0.05). ③In gallbladder carcinoma, the cell number of carcinoma and MNC with positive TNF mRNA expression was correlated with clinical stage (P＜0.05). The higher the clinical stage, the more the positive staining cell numbers. The positive staining cell numbers of carcinoma in stage Ⅰ-Ⅲ and Ⅳ-Ⅴ were 9.13±4.39 and 14.80±4.02, respectively (P＜0.01), and the positive staining cell numbers of MNC were 7.13±2.53 and 11.10±2.23, respectively (P＜0.05). ④The cell numbers of carcinoma and MNC with TNF mRNA expression increased with tumor size. In tumors with diameter over 2 cm and less than 2 cm, the positive staining cell numbers of carcinoma were 14.00±4.20 and 8.83±4.96, respectively (P＜0.05), and that of MNC were 10.50±2.54 and 7.00±2.83, respectively (P＜0.05). ⑤The region of TNF protein expression was similar to that of TNF mRNA, but TNF protein expression was more frequent and wider than that of TNF mRNA. ⑥The tumor necrosis factor receptor was expressed in tumoral vascular endothelial cells and MNC in all cases of carcinoma, but was negatively stained in mucosa epithelial cells and tumor cells of all cases. ⑦There was positive linear correlation in TNF mRNA between tumor cell and MNC (r=0.687, P＜0.01), same as that in TNF protein expression (r=0.742, P＜0.01); and there was positive linear correlation in tumor cell between TNF mRNA and TNF protein expression (r=0.847, P＜0.01), same as that in MNC (r=0.643, P＜0.01). Conclusion The TNF mRNA and TNF protein expression are increasing during the development of gallbladder mucosa epithelial from hyperplasia, dysplasia to carcinoma, and increasing with tumor stage. It suggests that TNF may contribute to carcinogenesis of gallbladder carcinoma induced by gallstone, and related to the progression of gallbladder carcinoma.
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.
The conectration of cholecystokinin infasting serum was determined by radioimmunoessay in 30 patients with gastric antrum cancer before and after radical sbutotal gastrectomy.It was 119.6±142.2pmol/L before the operation and 78.5±149.2pmol/L after the operation,which was significantly lower than that before the operation,P=0.022. The result suggests that the reduction of cholecytokinin secretion after gastrectomy was one of the important causes in the bile stasis,the disturbance of gallbladder emptying funcion and the formation of gallstone.
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 evaluate the clinical effectiveness of ERCP/S+LC and LC+LCBDE in cholecystolithiasis and choledocholithiasis. Methods A fully recursive literature search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials in any language. By using a defined search strategy, both the randomized controlled trials (RCTs) and controlled clinical trials on comparing ERCP/ S+LC with LC+LCBDE in cholecystolithiasis and choledocholithiasis were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated. Meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.0.2 software. Results Fourteen controlled clinical trials (1 544 patients) were included. The results of meta-analyses showed that: a) There were no significant difference in the stone clearance rate between the two groups (RR=0.96, 95%CI 0.92 to 1.01, P=0.14); b) There were no significant difference in the residual stone rate between the two groups (OR=1.05, 95%CI 0.65 to 1.72, P=0.83); c) There were no significant difference in the complications morbidity between the two groups (OR=1.12, 95%CI 0.85 to 1.55, P=0.48); d) There were no significant difference in the mortality during follow-up visit between the two groups (RD= 0.00, 95%CI –0.03 to 0.03, P=0.84); e) The length of hospital stay in the LC+LCBDE group was shorter than that of the ERCP/S+LC group with significant difference (WMD= 1.78, 95%CI 0.94 to 2.62, Plt;0.000 1); and f) The LC+LCBDE group was superior to the ERCP/S+LC group in the aspects of procedure time and total hospital charges. Conclusion Although there aren’t differences in the effectiveness and safety between the ERCP/S+LC group and the LC+LCBDE group, the latter is superior to the former in procedure time, length of hospital stay and total hospital charges. For the influencing factors of lower quality and astable statistical outcomes of the included studies, this conclusion has to be verified with more strictly designed large scale RCTs.
In 100 patients with gallstone, blood glucose, insulin were measured and BT-PAMA test, amino acid consumption test were made. Result: 71 patients were found with symptoms of the gut disorders, 12 cases with hyperglycemia (among them, 6 cases had chronic hepatic disease), 14 with exocrine pancreatic insufficiency, 26 with induration of the head of pancrease. The authors consider that hyper glycemia is correlated with chronic hepatic disease and that the gallstone migration impaires the pancreatic structure and function might be one of the factors which induces the symptom of gut disorders in patients with gallstone.
Eighty two cases of acute gallstone pancreatitis on early operation are reported and the significance of the clinical picture and pathology are analysed. The data showed that gallstone was found in 85.5%, among the cases of them mulliple gallstone was 71.1%, dilated cystic duct was 26.4%, common bile duct stone 36.8%, distal bile ductal stricture was found in 9.3%, and anomalous conjunction of biliary and pancreatic duct was 20.1%. Sixteen cases with serious pancreatitis were determined on operation, but death rate was 3.7% only. The authors claim that early operation may be of value in patients of acute gallstone pancreatitis with or without jaundice espesially in bile duct obstruction.
To investigate the origin and releasing relation of motilin (MTL), vasoactive intestinal peptide (VIP) and somatostatin (SS) in guinea pig bile as well as its effects during gallstone formation. Guinea pig were divided into three groups: control group (50 animals), on normal diet; lithogenic group (70 animals), fed with lowprotein low fat; and recovering group (50 animals), fed with lowprotein low fat and recovering normal food after the experiment of gallstone formation. MTL, VIP and SS in the bile gallbladder tissue and portal vein plasma of the normal control group were measured with radioimmunoassay. Meanwhile the changes of the gut peptides in the bile and the bile components from different groups were also compared. Results: In control group the levels of MTL, VIP and SS in the bile were higher than those in the plasma, but, obviously lower than those in the tissues, the concentration relationship between in the bile and in the tissue was a positive correlation. In contrast to the control group, MTL concentration decreased but VIP and SS increased in the bile of the lithogenic group, the physicochemical nature of the bile also became lithogenic. In the recovering group the bile also became lithogenic, but, the concentration of those peptides and the nature of the bile all got normal. Conclusion: MTL, VIP and SS in guinea pig bile originate mainly form the gallbladder wall tissues. Food components affect the levels of the gut peptides in bile, which promote the bile lithogenic changes and gallstone formation.
Objective To probe into disorder of plasma lipids and apolipoproteins in patients with gallstone,and their position and function in formation of gallstone. MethodsConcentration of plasma lipids and apolipoproteins in 94 healthy subjects and 161 patients with gallstones was investigated. ResultsThe gallstone group had a higher serum mean concentration of TG,Apo CⅡ,Apo CⅢ, and had a lower serum mean concentration of TC，HDLc，HDL2c，HDL3c and LDLc as compared with the control group (P＜0.01 or P＜0.05). Conclusion Higher serum mean concentration of TG，Apo CⅡ，Apo CⅢ, and lower serum mean concentration of TC, HDLc, HDL2c, HDL3c and LDLc, are characteristic of lipids metabolism and important cause of formation of gallstone.
