Abstract:

Objective: To explore the clinical effect of gallbladder and common bile duct stones treated by Laparoscopic Cholecystectomy(LC) and common bile duct exploration(LCBDE).
Methods: One hundred and thirty-two cases of gallbladder and common bile duct stones were divided into LC+LCBDE group(n=72) and LC + EST control group(n=60) randomly according to the treatment mothods. The clinical date of 2 groups was compared with the rate of success of operation, incidence of postoperative complications, incidence of residual calculus, time of defecation after operation.
Results: There were no statistical difference of the rate of success operation between LC+LCBDE group and EST+LC group(P＞0.05),but incidence of postoperative complications and residual calculus in LC+LCBDE group were  significant lower than those in LC+EST group.
Conclusions: Combining  LC with LCBDE is a feasible treatment for cholecystolithiasis and choledocholithiasis.

Abstract:

Objective: To investigate the feasibility and implementation value of fibercholangioscopic bile duct exploration guided by laparoscopy.
Methods: All patients who had indications for bile duct exploration underwent laparoscopic common bile duct (CBD) exploration.After CBD incision was made laparoscopically, the cholangioscope was introduced into CBD for examination and treatment. Placement of T-tube or primary suturing of CBD was applied after exploration.
Results: Among the 152 patients who underwent CBD exploration, 141 patients had extrahepatic bile duct stone(s) which were all successfully extracted; and 11 patients were without bile duct stones (negative exploration). The time spent on cholangioscopic exploration and, or stone extraction was about 8 to 35 min (average 15 min). All 152 cases were operated successfully without conversion to open surgery. The CBD incision was sutured endoscopically after exploration in 42 patients, and the other 110 patients had T-tube drainge. The T-tubes were removed after a T-tube cholangiogram, done 3-4 weeks posoperatively, showed no residual stones. Two cases of bile leakage were discovered; however, there was no biliary stricture or residual stones in this series. Postoperative hospital stay of the patients was  4 to 7 days (average5 days). One hundred and fifty-two patients were followed up for 1 to 17 months (average 8 months)  with B-mode ultrasonography or MRCP examination,and no biliary tract stricture or residual stone was found in these patients.
Conclusions: Fibercholangioscopic bile duct exploration guided by laparoscopy is safe and reliable. Mini-trauma is more effective if primary suturing of the CBD can be done after the bile duct stones are totally extracted.

Abstract:

Objective: To explore the curative effect and prevention of complications of emergency laparoscopic cholecystectomy(LC) for acute cholecystitis.
Methods: The clinical data of 1 278 patients with acute cholecystitis who were treated with emergency laparoscopic cholecystectomy from July 2004 to July 2010 in our haspital were collected and analyzed retrospectively.Among these patients, 471 cases had mild acute cholecystitis, 720 cases had acute suppurative cholecystitis and 87 cases had acute gangrenous cholecystitis. The impaction of stones in the neck of gallbladder was present in 823 cases. The impaction of stones in the cystic duct was present in 157 cases. In 96 cases emergency operation was performed within 48 hours after the synptoms occurred, in 799 cases operation was performed from 48 to 72 hours, and in 383 cases operation was undertaken after 72 hours.
Results: The mean operation time was 40min(20-90 min) and the mean blood loss was 80ml(20-300 mL). Early postoperative fever(38.0~39.5℃) developed in 375 cases. Temporary jaundice was found in 108 cases. Bile leakage occurred in 17 cases. No LC cases were converted to open cholecystectomy. No cases were complicated with bile duct injury and there was no mortality.
Conclusions: Emergency laparoscopic cholecystectomy for acute cholecystitis is difficult. The probable complication rate is quite high. Severe complications can be avoided with skillful surgical technique and rich operative experience.  Acute cholecystitis is not a contraindication for emergency laparoscopic cholecystectomy.

Abstract:

Objective: To summarize the clinical experience of managcment of Calot triangle in laparoscopic cholecystectomy (LC) for atrophic cholecystitis.
Methods: The clinical data of 125 cases of atrophic calculous cholecystitis treated by LC were analyzed retrospectively.
Results: LC was performed successfully in 117 of 125 cases (93.6%). Of the 8 unsuccessful cases which were converted into open surgery, 4 cases were caused by dense adhesions in Calot triangle which prevented dissection of the cystic duct; 1 case was caused by dense adhesion of cholecyst that was inseparable from surrounding tissue; 2 cases were caused by bleeding of cystic artery; and another case was caused by cholecystoduodenal fistula. All cases were treated successfully and without operative complications.
Conclusions: Dissection of Calot triangle is the key for success of LC in atrophic cholecystitis. There are two ways that can improve the success rate of LC in atrophic cholecystitis: (1)Use of B-mode ultrasound, CT, or MRI to judge the condition of Calot triangle preoperatively. (2) Correct management of cholecystic duct and cholecystic artery during operation.

Abstract:

Objective: To study the causes of mis diagnosis and the experience of diagnosis and management for cholelithiasis complicated with abdominal tumors.
Methods: Clinical data of 36 cases of cholelithiasis complicated with abdominal tumors were analyzed retrospectively. Among them, 24 were male,12 female. The age ranged from 48 to 82 year old. Each case was diagnosis as cholelithiasis and admitted to our hospital.
Results: In 36 patients, 18 was diagnosed as complecated with abdominal tumors preoperatively; 12 was diagnosed intraoperatively, while in 6 cases the tumor was misdiagmosed for 5 days to 3 months, finally the tumor was comfirmed by reoperation and pathology. Among the 36 cases, the tumors cluding 5 of carcinoma of gallbladder（13.9%）, 4 of cholangiocarcinoma（11.1%）, 3 of hepatoma（8.3%）, 6 of pancreatic carcinoma（16.7%）, 6 of gastric carcinoma（16.7%）, 7 of colon carcinoma（19.4%）, 2 of rectal carcinoma（5.5%）. Of them, 2 cases refused operation, 2 cases underwent intervention operation, the others reseived operation. During primary operation, radical resection of the tumor and cholecystectomy and/or common bile duct (CBD) exploration was performed in 18 patients, palliation resection and cholecystectomy and/or CBD exploration performed in 4 patients, exploratory laparotomy performed in 4 patients, and only LC and/or CBD exploration performed in 6 patients. Of the latters,  reoperation was performed 5 days to 3 months after primary operation. 4 patients had tumor radical resection, 1 had palliation resection, and 1 had interventional therapy. 
Conclusions: Cholelithiasis may complicated with abdominal tumor, especially with digestive tract tumor. For cholelithiasis patient  the history-taking need to be done carefully before operation. For the senile patient and the patient without typical symptoms or physical signs, the systems checking shoud be done carefully preoperatively, and abdominal cavity should be checked carefully intraoperatvely to find the tumor, which may exist in abdominal cavity.  the patient with syndrome of post-cholecystectomy shoud  be carefully followed up to avoid the mis diagnosis and mistreatment of the tumor.

Abstract:

Objective: To analyze the clinical risk factors for inducing acute suppurative cholangitis (ASC) in patients with bile duct stones.
Methods: Clinical data of 436 cases with bile duct stones from June 1998 to March 2009 in the Second Pepole′s Hospital of Qinzhou City were analysed retrospectively. Patients were divided into two groups: (1) ASC group, 74 cases. (2) Non-ASC group, 362 cases. Single and mutiple factors analysis were adopted to analyze the risk factors,such as age, sex, liver function, number of bile duct stones, stone diameter, site of bile duct obstruction, gallbladder stones, previous cholecystectomy, bile duct diameter, previous cholangitis, previous biliary surgery, diabetes mellitus, cardiovascular disease, and respiratory disease.
Results: There were 74 cases of ASC, accouting for 16.74% of bile duct stone. The univariate analysis showed that age, liver function, site of bile duct obstruction, previous cholangitis, previous biliary surgery and diabetes mellitus were the high risk factors for inducing ACS. Meanwhile, the mutivariate analysis indicated that age, previous choledochotomy and diabetes mellitus were the independent factors for ACS.
Conclusions: Age, previous biliary surgery and diabetes mellitus are the main high risk factors for inducing ACS in patients with bile duct stones. An understanding of the high risk factors for ACS in patients with bile duct stone serves as a guide for better treatment of bile duct stone and preventon of ACS.

Abstract:

Objective: To evaluate the feasibility and the efficacy of medical diagnosis expert system, combined with preoperative magnetic resonance cholangiopancrcatography(MRCP), in predicting common bile duct(CBD) stones. 
Methods: The clinical data of 286 cases of cholecystolithiasis and cholecystitis admitted to our hospital during Jan 2009 to May 2009 were analysed prospectively. These cases were divided randomly into the control group (n=143) and the research group (n=143). The control group underwent routine MRCP before cholecystectomy, while the research group was screened by medical diagnosis expert system which had been established based on artificial neural network technique and proved to be stable. MRCP was performed in every patient of the research group when the screening result was positive. Then, the positive rate of MRCP, the mean hospitalization time and the average expenditure between this two groups were compared.
Results: CBD positive rate was 16.78%(24/143) of the control group, while the research group was 16.08% (23/143). The positive rate of MRCP of the research group was 95.24%（20/21）,significantly higher than 14.69%（21/143）of the control group（P＜0.01）. The mean hospitalization time of research group (8.83±3.59 d) was significantly shorter than that of the control group (10.10±3.66 d)  (P＜0.01).The average expenditure of the research group was (11 175.80±7 972.33) Yuan, evidently lower than (13 332.08±9 884.04) Yuan of the control group (P＜0.05). 
Conclusions: The medical diagnosis expert system has a remarkable performance in predicting CBD stones. It can be used routinely to select the appropriate cases to undergo MRCP, which could obviously reduce the hospitalization costs and shorten the hospitalization time.

Abstract:

Objective: To investigate the effct of PTTG gene on the growth and sensitivity to 5-FU of cholangiocarcinoma cell.
Methods: The pcDNA3.1-PTTGas that contained full-length antisense PTTG, and pcDNA3.1(+) was transfected into the cholangiocarcinoma cell line QBC939. We successfully established and identified cell sublines tQBC939(PTTG-), tQBC939(pcDNA3.1).  Cell growth curve was mapped out, cell proliferation rate was assessed by MTT assay and cell cycle percentage was counted by flow cytometry. After treatment with 5-FU, cell survival rate was assessed by MTT assay and IC50 was calculated. Flow cytometry and Hoechst staining were used to demonstrate discrepancy of cell apoptosis rates.
Results: Compared with other two groups, tQBC939 (PTTG-) grew more rapidly and had a higher proportion of cells in S phase, whereas less cells in G2/M phase（P＜0.05）. After treatment with 5-FU, IC50 of tQBC939(PTTG-) was significantly lower than that of other two groups, and increased rate of apoptosis was observed.
Conclusions: Anti-sense blocking PTTG enhances the growth of cholangiocarcinoma cell and sensitivity to 5-FU in vitro. The combination of anti-sense blocking PTTG with 5-FU can enhance the effect of chemotherapy in cholangiocarcinoma.

Abstract:

Objective: To detect the effect of exogenous IL-6 on the proliferation of cholangiocarcinoma cell line QBC939.
Methods: MTT was used to observe the proliferation of cell line QBC939 treated with exogenous IL-6. Following the annexin V/FITC and PI staining, FCM was used to detect the apoptosis of QBC939 treated with exogenous IL-6.
Results: The proliferation of cell line QBC939 was increased after treatment with IL-6 and was positively related with the concentration of IL-6（P＜0.01）. IL-6 could reduce the apoptosis rate of cell line QBC939 （P＜0.05）and upgrade the expression of  Bcl-2 mRNA.
Conclusions: IL-6, in a definite dose-range, could promote the proliferation of cell line QBC939, and this may be related with the upgrade of Bcl-2 mRNA.

Abstract:

Objective: To study the influence of siRNA targeting survivin  on chemotherapy sensitivity of HCC cells.
Methods: siRNA eukaryotic expression vector was generated. After the vector stablely transfected into HepG2 cells, the effects of chemotherapy drugs on HCC cells were observed.
Results: The recombinant plasmid Psilence(+)-survivin was successfully constructed. Survivin mRNA expression inhibition ratio reached 73% detected by RT-PCR. MTT methods detected that siRNA treated HCC cells were affected by MCC, the survival rate of HepG2, HepG2/Silence(-) cells was inhibited only at 48 h (0.505±0.015) compared to control groups untreated with MCC（0.824±0.322）(P＜0.05). When the survivin gene was inhibited, the survival rate of the HepG2/Silence(+) cells(0.520±0.017）was inhibited at 12 h compared to control groups(0.741±0.005) and reached peak at 48 h (P＜0.05). The Westen-blot detection indicated that OD value of survivin protein expression in untreated with MMC was 3 4273±323 and decreased to 2 1415±142, 1 6771±122, 1 3672±133 at 12 h, 24 h and 48 h after treated with MMC, the difference was significant(P＜0.05). The apoptosis ratio of HepG2/Silence(+)＋MMC groups at 12 h, 24 h and 48 h increased significantly compared to control groups.The caspase-3 activity detection indicated that the caspase-3 activity in HepG2/Silence(+) cells treated with MMC at 12h, 24h and 48 h was 0.19±0.05, 0.33±0.12, 3.79±0.27, 9.34±0.86 respectively, and the difference between the all time points were significant (all P＜0.05).
Conclusions: The siRNA targeting survivin can not only suppress the expression of survivin in HCC cells, but can also enhance the chemotherapy sensitivity. This effect is accomplished by enhancing the caspase-3 activity and increasing the apoptosis ratio in HCC cells.

Abstract:

Objective: To explore the effect of hepatitis B virus X protein on malignant transformation of hepatocytes and its mechanism.
Methods: The total protein content of CCL13-HBx and CCL13-pcDNA3.1 cells was extracted and separated by two-dimensional electrophoresis with immobilized pH gradients (2-DE). The silver-stained 2-DE was scanned with digital image scanner and analyzed with Image Master 2-DE Elite 4.01 software. To obtain peptide mass fingerprint(PMF) of differential protein spots，matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was used. PMF was searched in SWISS-PROT database by Mascot software to identify differential expression proteins.
Results: The clear background, well-resolved and reproducible 2-DE maps  were obtained. from CCL13-HBx and CCL13-pcDNA3.1 cells. Twenty-six protein spots were found as differentially expressed proteins，of which 14 protein spots were identified successfully. The identified proteins were correlated with cell metabolism, cell cycle and signal transduction.
Conclusions: The well- resolved， reproducible 2-DE maps of CCL13-HBx and CCL13 cells have been established and 14 differentially expressed proteins are identified. They provide new clues for the study of hepatocarcinogenesis at protein level.

Abstract:

Objective: To construct siRNA recombinant expression vector targeting HIF-1α gene.
Methods: Genome sequences of HIF-1α gene were retrieved from gene bank, and four pairs of oligonucleotides were synthesized and inserted into plasmid pGensil-1. Then, DH5α strains were transformed, and plasma was extracted and identified by restriction endonuclease and sequence analysis.
Results: It was confirmed by sequence analysis that siRNA recombinant expression vector targeting HIF-1α gene coincided completely with the designs.
Conclusions: The siRNA recombinant expression vector targeting HIF-1α gene has been constructed successfully and lays a foundation for furher study on the biological behavior of tumors.

Abstract:

Objective: To investigate the clinicopathological features, surgical treatment and prognosis of incidental gallbladder carcinoma (IGC).
Methods: The clinical data of 37 IGC cases admitted to our hospital were retrospectively analysed, and the data were compared with other gallbalder carcinoma cases (GC group) admited over the same period of time.
Results: In both IGC and GC groups, the main symptom was abdominal pain located in the upper right quadrant (94.6% vs. 93.3%) and some patients had jaundice (16.2% vs. 31.5%). There were no significant differences between the two groups in several aspects, such as age (56±12 vs. 57±9）, proportion of female patients（78.4% vs. 62.9%）, positive  ratio  of CEA （25% vs. 32.8%）and CA19-9（30% vs. 68.3%）,tumor location,  pathological type, pathological grade, and postoperative complication rate （2.7% vs. 6.7%）（All P＞0.05）. However,  the percentage of patients with cholecystolithiassis was 86.5% in IGC group, and 50.6% in GC group (P=0.000). Besides the percentage of IA stage in IGC  group (29.7%) was relatively higher than that (9.0%)in GC group (P=0.03); the surgical resection rate of tumor in IGC group was 56.8% and 32.6% in GC group (P=0.01). Nevertheless, the percentage of advance stage in IGC group (43.2%) was relatively lower than that in GC group (74.2%) (P=0.001). The overall 1, 3, and 5-year survival rate of IGC group was 70.0%, 31.2% and 26.8% repectively, and the mean survival time was17 months (51±13); which were significantly higher than those in GC group, in  which the 1, 3, 5-year survival rate was 27.0%, 17.7% and 15.1%  repectively and the mean survival time was （25±8）,5 months (all P=0.006). Single factor analysis showed that the survival time in IGC patients was influenced by the TNM stage(P=0.000), pT-category (P=0.000), operation-category(P=0.008); however, postoperative pathological grade(P=0.080), age (P=0.188) and sex(P=0.234) had no influence on survival rate. According to multivariate analysis, pT-category（P=0.000）was an independent factor for the survival time of IGC.
Conclusions: Comparing with GC group, IGC has a higher percentage of cholecystolithiassis, IA tumor stage and surgical resection rate, and thus, it has relatively better progonosis. pT-category is the vital independent prognostic factor in IGC. If a patient in ICG has been misdiagnosed during the primary operation, the patient should be re-operated for radical excision as soon as possible, except when the tumor is in stage Tis or T1a.

Abstract:

Objective: To improve the level of diagnosis and treatment of hilar cholangiocarcinoma by investgating it′s clinical characteristics.
Methods: The clinical data of 98 patients with hilar cholangiocarcinoma were analyzed retrospectively.
Results: According to the  Bismuth-Corlitte grouping: typeⅠ, 8 cases; typeⅡ, 19 cases; type Ⅲ, 17 cases; type Ⅲb, 14 cases; and type Ⅳ, 40 cases. Radical resection(49), palliative operation(12), endoscopic retrograde biliary drainage(16), and PTCD(5) were performed The median survival time of radical resection group was 28.6 months and the survival rate at 1, 2, 3, and 5 years was 74.2%，65.3%，37.5%, and 3.9% respectively, while the median survival time of palliative operation group was 17.6 months and the survival rate at 1, 2, 3, and 5 years was 71.7%，26.8%，8.9%, and 0% respectively. The median survival time of endoscopic retrograde biliary drainage group was 4.5 months and the survival rate at 1, 2, 3, and 5 years was 21%，13%, and 0% respectively.
Conclusions: Early diagnosis by adjunctive examinations is vital to treatment of hilar cholangiocarcinoma. Radical resection is the sole procedure to improve the outcome and prognosis of hilar cholangiocarcinoma. Multiple therapeutic methods should be adopted and should be individualized.

Abstract:

Objective: To observe the efficacy of 3-dimensional image recombinant guidance in treatment of portal hypertension.
Methods: A total of 73 cases of portal hypertension were randomized into study and control groups: In study group (n=37), 3DCT or MRA imaging display of whole portal venous system was used as guide in selecting portoazygos vein disconnection (P-AVD) operation; in control group (n=36), the classic P-AVD operation was performed.The postoperative complication rate and the degree of amelioration of esophageal varices were cbserved.
Results: Compared with the control group, the short term rebleeding rate in observation group(0.00%, 0/37) was lower than that in control group(11.11%, 4/36),  improvement rate of esophageal varices  in observation group(100%, 37/37) was higher than that in control group(86.11%, 31/36), and the aggregate rate of portal hypertensive gastric disease and esophageal varices in observation group(0.00%, 0/36)was lower than that in control group(13.9%, 5/36). There was a statistical difference between the two groups (all P＜0.05).
Conclusions: The use of 3DCT or MRA imaging to display the whole portal venous system as guidance in selecting the operative procedure and the extension of P-AVD has the advantages of less surgical trauma and better prognsis than the classic P-AVD procedure.

Abstract:

Objective: To evaluate the feasibility of automatic tube current modulation (ATCM) in craniocervical artery CT angiography with 256-slice CT, while maintaining the image quality.
Methods:  Sixty patients undergoing craniocervical artery CTA were enrolled into this study, and were divided into conventional tube current group (250 mAs, group A, n=30) and low tube current group (ATCM, group B, n=30). The signal-to-noise ratio (SNR), contrast-to noise ratio (CNR), volume CT dose index (CTDIvol) and effective dose (ED) were evaluated respectively.
Results: The mean image SNR was (37.47±9.39) and (36.85±7.96) for group A and group B respectively, and was not significantly different (P=0.79). The mean image CNR was (32.13±9.06) and (31.86±7.66) for group A and group B respectively, and was not significantly different (P=0.90). The CT volume dose index (CTDI) was 16.5 mGy and 410.55±0.94mGy for group A and group B respectively, and was significantly different (P＜0.001). The radiation dose decreased 36.1% in ATCM.
Conclusions: Compared with 250 mAs tube current, ATCM craniocervical artery CTA can reduce radiation dose, while maintaining image quality.

Abstract:

Objective: To assess the clinical application value of capsule endoscopy in the diagnosis of small bowel bleeding.
Methods: Data of capsule endoscopic examination and related clinical features on 80 cases of suspected small bowel bleeding were retrospectively analyzed,  and the clinical features of the bleeding in old and young patients were compared. 
Results: Among the 80 patients, 77(96.3%) cases showed positive finding of capsule endoscopic examination. The most frequent findings were vascular abnormalities in both young (＜65 years) and old (≥65 years) groups, with increased ratio in the old group (59.5% vs. 37.2%, P＜0.05).  The occurrence of vascular tumor and neoplasm was more common in the young group compared with the old group. The mean hemoglobin concentration decreased more markedly（88 g/L vs. 72g/L, P＜0.05）and with shorter onset in the young group compared with the old group. More comorbidities were found in the old group compared with the young group. 
Conclusions: Capsule endoscopy examination is a non-invasive and safe method, that can be used as a first line diagnostic test in the diagnosis of small bowel bleeding.