ObjectiveTo explore technical essentials and safety of laparoscopic cholecystectomy (LC) guided by gallbladder ampulla localization on an imaginary clock for cholecystitis.MethodsA retrospective study of 8 707 continuous patients with mild cholecystitis who underwent LC from July 1998 to February 2018 at a single institution was conducted. Among them, 3 168 patients were treated by the traditional LC from July 1998 to February 2007 (a traditional LC group), 5 539 patients were treated by the LC with the guidance of the gallbladder ampulla localization on an imaginary clock from March 2007 to February 2018 (a gallbladder ampulla localization group). The conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury, operative time, intraoperative blood loss, and postoperative hospital stays were compared between the traditional LC group and the gallbladder ampulla localization group.ResultsThere were no significant differences in the gender, age, course of disease, and type of cholecystitis between these two groups (P>0.050). The rates of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury and the operative time, intraoperative blood loss and postoperative hospital stays in the traditional LC group were 3.00% (95/3 168), 0.13% (4/3 168), 0.09% (3/3 168), 0.03% (1/3 168), (43.6±12.6) min, (18.7±3.3) mL, (3.6±2.7) d, respectively, which in the gallbladder ampulla localization group were 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), (32.2±10.5) min, (12.4±3.5) mL, (3.5±2.8) d, respectively. The differences of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding rates, and the operative time and intraoperative blood loss were statistically significant between these two groups (P<0.050). The differences of the bile leakage without bile duct injury rate and postoperative hospital stays were not statistically significant between the two groups (P>0.050).ConclusionThis study shows that gallbladder ampulla localization on an imaginary clock is useful for ductal identification so as to reduce bile duct injury and improve safety of LC in case of no conversion to open surgery.
ObjectiveTo explore the etiological agent, clinical manifestations, imaging findings, pathologic characteristics, diagnosis, treatment, and prognosis of xanthogranulomatous cholecystitis(XGC).
MethodThe clinical data of 48 patients with XGC diagnosed by postoperative pathology from January 2003 to December 2012 were collected and analyzed.
ResultsIn these 48 patients with XGC, the clinical manifestations included 40(83.3%)patients with upper right abdominal pain, 18(37.5%)patients with jaundice, 12(25.0%)patients with fever. B ultrasound examination was performed in 45 cases, in which 42 cases were diagnosed with cholecystitis, 38 cases together with cholecystolithiasis, 15 cases together with cholecystolithiasis and gallbladder neoplasm, and 3 cases together with choledocholith with bile duct dilatation. CT was performed in 30 cases, in which 25 cases were diagnosed with cholecystitis together with cholecystolithiasis, 11 cases were diagnosed with gallbladder neoplasm. MRI was performed in 22 cases, in which 18 cases were diagnosed with cholecystitis together with cholecystolithiasis, 4 cases were diagnosed with gallbladder carcinoma. Thirty-three cases were treated with open cholecystectomy, 9 patients with laparoscopic cholecystectomy, 4 patients with cholecystectomy plus choledocholithotomy and T-tube drainage, 2 patients with cholecystectomy plus partial hepatectomy. All the patients were diagnosed with XGC by postoperative pathology and recovered well without recurrence and canceration.
ConclusionsXGC is a kind of benign and invasive disease without specific clinical manifestation. Bultrasound, CT, or MRI play an important role in diagnosis, but final diagnosis is mainly based on pathological detection, and surgery is the most effective treatment. The prognosis of XGC is favorable if gallbladder is completely resected.
ObjectiveTo explore the clinical characteristic, operation time, and methods of elderly calculous cholecystitis.
MethodsThe data of 386 cases of elderly calculous cholecystitis in our hospital from January 2008 to April 2014 were retrospectivly analyzed.
ResultsIn 386 patients, 234 cases were chronic cholecystitis, 152 cases were acute calculous cholecystitis; there were preoperative complications in 174 cases (45.08%); 234 cases of chronic calculous cholecystitis patients underwent elective operation, 35 cases in 152 cases of acute phase underwent operation at 72 h, the remaining 117 cases underwent operation in within 2 weeks of onset. Laparoscopic cholecystectomy (LC) were in 283 cases, including transfer laparotomy operation in 8 cases; underwent conventional open cholecystectomy in 103 cases. Postoperative complications occurred in 49 cases, the complication rate was 12.69%, including incision infection, pulmonary infection, acute urinary retention, urinary tract infection, biliary fistula and so on. Three hundreds and eighty-four cases were cured, 2 cases died, for cholecystolithiasis complicated with severe acute cholangitis, died from multi organ failure in 3 days after operation.
ConclusionsThe clinical characteristics of elderly calculous cholecystitis is unique. To strictly grasp the operation indication, selection of operation time, take individual operation method with the disease, and strengthen treatment of perioperative period are the key to improve the cure rate and the operation success rate of elderly cholecystitis.
Objective To investigate the diagnostic value of CT scanning and MR imaging on acute cholecystitis. Methods The CT or MR imaging data of 21 patients with proved acute cholecystitis were retrospectively reviewed. Eleven patients were examined with contrast-enhanced multi-detector-row spiral CT scanning and other 10 cases underwent contrast-enhanced MR imaging. Results Nineteen patients showed obscure gallbladder outlines （90.5%）. The gallbladder wall demonstrated even thickening in 15 patients （71.4%） and irregular thickening in 6 cases （28.6%）. All patients showed inhomogeneous enhancement of the gallbladder wall （100%）. The bile was hyper-dense or hyper-intense on T1W image in 11 cases （52.4%）. Ten cases had free peri-cholecystic effusion （47.6%）, and 16 cases had peri-cholecystic adhesive changes or fat swelling （76.2%）. Patchy or linear-like transient enhancement of the adjacent hepatic bed in the arterial phase was seen in 16 cases （76.2%）. Twelve patients developed pleural effusion, or ascites, or both （57.1%）. Gallbladder perforation complicated with peritonitis was seen in one case, micro-abscess formation and pneumocholecystitis was observed in another case, and one case had gallbladder diverticulum. Conclusion Wall blurring, pericholecystic adhesion or fat edema, and transient enhancement of adjacent hepatic bed in the arterial phase are the imaging findings specifically associated with acute cholecystitis, which are readily appreciated on contrast-enhanced multi-phasic CT and MR scanning.
To study the expressions of CA19-9 and CA125 and their clinicopathologic significancesin gallbladder adenocarcinoma , pericancerous tissues and chronic cholecystitis. Methods EnVisionTM immunohistochemist ry was used for assaying the expressive levels of CA1929 and CA125 in the routinely paraffin2embedded sections of specimens f rom gallbladder adenocarcinoma ( n = 108) , pericancerous tissues ( n = 46) , and chronic cholecystitis ( n = 35) . Results The positive rates of CA19-9 and CA125 were significantly higher in gallbladder adenocarcinoma ( 49. 1 % , 51. 9 %) than those in pericancerous tissues ( 26. 1 % , 15. 2 %) and chronic cholecystitis(14. 3 % , 5. 7 %) , respectively ( Plt; 0. 01) . The positive rates of CA19-9 and CA125 were significantly lower in thecases of adenomatous canceration , maximal diameter lt; 2 cm , no-metastasis of lymph node and no-invasion of regional tissues than those in the ones of low-differentiated adenocarcinoma , maximal diameter ≥2 cm , metastasis oflymph node and invasion of regional tissues ( Plt; 0. 05 , Plt; 0. 01 ) . The consistence of CA19-9 and CA125 expressivelevels was found in gallbladder adenocarcinoma (χ2 = 44. 69 , Plt; 0. 01) . Conclusion The expressions of CA19-9 andCA125 may be important tumor markers to reflect the carcinogenesis , progression , biological behaviors and prognosis of gallbladder adenocarcinoma.
ObjectiveTo investigate the efficacy and safety of percutaneous transhepatic gallbladder drainage (PTGBD) combined with early laparoscopic cholecystectomy (LC) in the treatment of elderly patients with high-risk acute cholecystitis.MethodsThe clinical data of 128 elderly patients with high-risk acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to January 2019 were retrospectively analyzed. Among them, 62 patients underwent PTGBD combined with early LC treatment (PTGBD+early LC group), 66 patients underwent PTGBD combined with delayed LC treatment (PTGBD+delayed LC group). Comparison was performed on the operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, total hospitalization time, and complication.ResultsPTGBD was successfully performed in all patients, and the symptoms were relieved within 72 hours. There was no significant difference in operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, and total complication rate between the two groups (P>0.05), but the total hospitalization time of the PTGBD+early LC group was shorter than that of the PTGBD+delayed LC group (P<0.001). There was no second operation and death in both two groups. The 128 patients were followed-up for 2–50 months with a average of 19 months. Results of follow-up after operation showed that the patients did not complain of obvious abdominal pain, abdominal distension, chills, fever, jaundice, and other discomforts.ConclusionsFor elderly patients with high-risk acute cholecystitis, early LC is a safe and effective treatment for patients with good overall condition after PTGBD. It can not only shorten the total hospitalization time, but also significantly shorten the time of tube-taking and improve the quality of life of patients. It has important clinical application value.
Objective To study the suitable operation method of elderly patients with acute cholecystitis. Methods The clinical data of 149 elderly patients with acute cholecystitis were retrospectively analyzed. All patients were divided into two groups according to the operation: open cholecystectomy group (OC group, n=76) and laparoscopic cholecystectomy group (LC group, n=73). Some clinical data were compared in this paper such as operation time, blood loss, length of hospital stay, time of resumption of food, time of intestinal function recovery and complications. Results No marked difference was found between OC group and LC group about basic data except WBC count and examination of gallbladder by B ultrasound（P＞0.05）. But there were significant difference in operation time, blood loss, time of resumption of food, time of intestinal function recovery, length of hospital stay and complications between OC group and LC group （P＜0.01）. Conclusion Individualized treatment should be emphasized on elderly patients with acute cholecystitis. Selection of OC or LC to these patients should be based on the clinical condition and taken the safety as the first principle.
ObjectiveTo explore the therapeutic effect and its possible mechanisms of somatostatin combined with antibiotics on acute cholecystitis through the detection of serum tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) in rabbits. MethodsForty-five rabbits were randomly averagely classified into three groups following the establishment of acute cholecystitis model: control group, blank group， and experimental group. The rabbits in control group received cefazolin sodium and metronidazoie by intravenous injection twice a day. The rabbits in experimental group got a hypodermic injection of somatostin (20 μg/kg) twice a day besides antibiotics, while these drugs were replaced by equal volume of normal saline for the rabbits in control group. The concentrations of serum TNFα and CRP were detected by enzyme-linked immunosorbent assay and histomorphological and electron microscopic changes of gallbladder in rabbits were observed on 3 d after administer. ResultsThe concentrations of serum TNF-α of rabbits in experimental group 〔(401.6±48.7) pg/ml〕 were significantly lower than those in control group 〔(767.3±67.4) pg/ml〕 and blank group 〔(806.7±61.2) pg/ml〕, P=0.000 and P=0.000, while the difference between the latter two groups was not significant (P=0.196). The concentrations of serum CRP of rabbits in experimental group 〔(16.2±1.1) mg/L〕 were significantly lower than those in control group 〔(55.4±1.2) mg/L〕 and blank group 〔(72.8±8.9) mg/L〕, P=0.000 and P=0.000, and which was higher in blank group compared with control group (P=0.018). The Histopathological results showed that gallbladder wall emerged mulifocality mucosal fluid necrosis, lamina propia hyperemia, bulk neutrophil infiltration and sequent alleviation of reaction in the rabbits of experimental group when compared with the rabbits of blank group and control group. Electron microscopic results demonstrated that the intercellular junction of gallbladder kept relative integrity and the swelling and vacuolar degeneration of mitochondria and endoplasmic reticulum obviously relieved. ConclusionsSomatostatin can significantly reduce the concentrations of serum TNF-α and CRP in the model of rabbits acute cholecystitis, which may protect the mucous membrane of gallbladder from the inflammation reaction.
Four hundred and twenty six laparoscopic cholecystectomy(LC)were peformed on patients with acute and subacute cholecystitis,including ①emergency LC(59 patients),②selected LC(215 patients following administration of antibiotic and antispasmotic drugs for 10-15days),and ③selected LC(152 patients with mild biliary colic without any medication).Operative findings were ①congestion and edema of the gallbladder(208cases,11 of them were achieved laparocystectomy),②impaction of stones in the cystic infundibulum or duct with hydrops of gallbladder(142 cases,14 of them were achieved by laparocystectomy),and ③gangrene or empyema of gallbladder(76 patients,20 of them were achieved by laparocystectomy).LC was done successfully on 377 cases,conversion to open surgery was 45 cases (10.6%),severe complication occured on 4 patients for LC(reoperation,0.9%).The quthors believe that LC for patients with acute and subacute cholecystitis issafe and suitable,but LC cannot replace the classical laparocystectomy.
ObjectiveTo systematically evaluation the efficacy and safety of laparoscopic cholecystectomy(LC) and open cholecystectomy(OC) for chronic atrophic cholecystitis.
MethodsStandard electronic database such as PubMed, Web of science, Cochrane library, CNKI, VIP, CBM, and Wanfang database were searched to retrieve relevant randomized controlled trials(RCTs) that comparing LC with OC, which were analyzed systematically using RevMan5.2.
ResultsSeven RCTs including 758 patients were brought into this Meta analysis. There were significant differences between two groups regarding operative time(MD=-27.70, 95% CI:-44.25--11.16, P=0.001), amount of blood loss during operation(MD=-113.25, 95% CI:-141.68--84.81, P < 0.000 01), the recovery time of gastrointestinal function(MD=-28.49, 95% CI:-29.80--27.18, P < 0.000 01), and length of hospital stay(MD=-3.83, 95% CI:-6.01--1.65, P=0.000 6), There were statistically significant difference in utilization rate of anodynes after operation(MD=0.12, 95% CI:0.06-0.23, P < 0.000 1) and terrible postoperative complications(MD=0.24, 95% CI:0.12-0.47, P < 0.000 01) between LC and OC.
ConclusionsIn both efficacy and safety, LC for chronic atrophic cholecystitis are significantly superior than the traditional OC. But now the clinical randomized controlled trials about LC is less and the quality is poor, so that its long-term safety evaluation still needs large sample quality RCTs to be further verified.
