Objective: To investigate the effect of interleukin 6 (IL-6) on the biological behaviors in gallbladder carcinoma cells and its association with JAK/STAT3 signaling pathway. Methods: The gallbladder carcinoma GBC-SD cells were treated with IL-6 orIL-6 plus AG490 (an inhibitor of JAK/STAT3 pathway); the cell proliferation and invasive ability, the matrix metalloproteinase 9 (MMP-9) activity, and protein expressions of the phosphorylated STAT3 (p-STAT3) and vascular endothelial growth factor (VEGF) in the cells were determined by MTT assay, Transwell migration assay, gelatin zymography and Western blot analysis, respectively. Results: The proliferation of GBC-SD cells was significantly increased in a concentration-dependent manner after treatment with IL-6 (10,50 and 100ng/mL), but the proliferative effect of IL-6 was abolished by AG490 treatment. Further, in GBC-SD cells after IL-6 treatment, the invasive ability and MMP-9 release were significantly elevated (both P<0.05), and both p-STAT3 and VEGF protein expressions were remarkably up-regulated, and all above effects of IL-6 were abolished by AG490. Conclusion: IL-6 can promote the growth and enhance the invasive ability of gallbladder cancer cells and these actions may be associated with its activation of the JAK/STAT3 signaling pathway, leading to the downstream MMP9 and VEGF expressions.

Objective: To investigate the let-7a microRNA (miRNA) expression in cholangiocarcinoma tissue and its significance. Methods: The let-7a expressions in tissues of cholangiocarcinoma and normal bile duct specimens were determined by Real-time PCR technique. The cholangiocarcinoma HuCCT-1 cells were divided into let-7a overexpression group (transfected with let-7a mimics), negative control group (transfected with negative control sequence) and blank control group (without any transfection), and then the let-7a expression, apoptosis and cell cycle in each group of cells were determined by Real-time PCR and flow cytometer, respectively. Results: The let-7a expression was significantly down-regulated in cholangiocarcinoma tissue than that in normal bile duct tissue (P<0.01). Both let-7a expression and apoptotic rate in cells of let-7a overexpression group were all significantly increased compared with blank control group (both P<0.01), while no such differences were noted between the negative control group and blank control group (both P>0.05). The difference in cell cycle showed no statistical significance among groups (P>0.05). Conclusion: The let-7a expression is down-regulated in cholangiocarcinoma tissue and inhibits cell apoptosis and, may thereby promote the occurrence and development of cholangiocarcinoma.

Objective: To study the expression of blood vessel epicardial substance (BVES) in human gallbladder cancer tissue and its clinical significance. Methods: The BVES expressions in gallbladder tissue specimens form 65 patients with gallbladder cancer and 55 cases with benign gallbladder diseases were determined by immunohistochemical staining, and the relations of BVES expression with clinicopathological profiles of gallbladder cancer were analyzed. Results: The high expression rate and low expression rate of BVES in gallbladder cancer tissues was 20.0% (13/65) and 80.0% (52/65), which was 74.5% (41/55) and 25.5% (14/55) in benign gallbladder tissues respectively, and the difference between the two groups had statistical significance (χ2=35.811, P<0.05). The univariate analysis indicated that the BVES expression was closely associated with the degree of differentiation, clinical stage and lymph node metastasis of the gallbladder cancer, as showed by the statistical differences of these three factors between the two groups (all P<0.05). Conclusion: The low or lack of BVES expression may be closely connected to the occurrence and development of gallbladder cancer.

Objective: To evaluate the methods and efficacy of surgical treatment for type III and IV hilar cholangiocarcinoma. Methods: The clinical data of 16 patients with type III or IV hilar cholangiocarcinoma undergoing surgical treatment from April 2011 to February 2013 were retrospectively analyzed. Results: Surgical resection was performed in 13 of the 16 patients, and the resection rate was 81% (13/16), with radical resection (R0 resection) in 7 cases and non-radical resection in 6 cases. Three patients underwent left hepatectomy plus caudate lobectomy with reconstruction of the right hepatic duct and Roux-en-Y hepatojejunostomy, 3 patients received right hepatectomy plus caudate lobectomy with reconstruction of the left hepatic duct and Roux-en-Y hepatojejunostomy, and 7 patients received quadrate lobectomy plus perihilar resection with basin-type cholangiojejunostomy, and two of them with total bilirubin level more than 400 mmol/L were subjected to percutaneous transhepatic cholangio-drainage (PTCD) before surgical resection. Surgical resection could not be performed in 3 patients, of whom 2 cases had involvement of the left and right branches of the portal vein, one case was found having multiple intrahepatic metastases, and all the 3 patients underwent dilatation of the intrahepatic bile ducts and tube placement for drainage. The postoperative serum total bilirubin levels in all patients were markedly decreased or even returned to normal after surgery, and the effective rate of drainage was 100%. One death occurred during the perioperative period. Conclusion: For type III and IV hilar cholangiocarcinoma, tumor resection and relief of biliary obstruction should be strongly considered. A solid knowledge of biliary anatomy in the porta hepatis, skillful surgical technique and meticulous dissection are essential for improving the resection rate.

Objective: To investigate the efficacy of ultrasound-guided percutaneous double-tract cholecystostomy and choledochoscopic gallbladder-preserving cholecystolithotomy for high-risk elderly patients with acute calculous cholecystitis. Methods: The clinical data of 30 patients with acute calculous cholecystitis, who underwent percutaneous cholecystostomy and choledochoscopic cholecystolithotomy from January 2012 to April 2013, were retrospectively analyzed. Results: Gallbladder punctures and tube placement were successfully performed in all the 30 patients. Bleeding occurred in one patient during the procedure, which was controlled by intraluminal injection of reptilase and catheter occlusion. The tube retention time was 14 d to 2 months with average of 30 d. After 4- to 8-week drainage, gallbladder stones in 28 patients were successfully removed via choledochoscope, one patient underwent open cholecystectomy because of failure of sinus tract formation, and another patient received laparoscopic cholecystectomy due to loose connection of the 16-F cholecystostomy pigtail tube. Twenty-eight patients were followed up for 3 to 19 months, and recurrence was found in one patient (3.6%) by B ultrasonic examination. Conclusion: Ultrasound-guided percutaneous double-tract cholecystostomy and choledochoscopic gallbladder-preserving cholecystolithotomy is a reliable and effective approach for high-risk elderly gallstone patients.

Objective: To study the feasibility, safety and efficacy of laparoscopic common bile duct exploration (LCBDE) for removal of common bile duct (CBD) stones in patients with concomitant type 2 diabetes. Methods: The clinical data of 58 CBD patients with type 2 diabetes (diabetic group), and another 58 non-diabetic CBD patients (non-diabetic group) undergoing LCBDE procedures from December 2009 to December 2012 were retrospectively analyzed. The pre-, intra- and postoperative conditions between the two groups were compared. Results: Results of the comparisons showed no signi?cant differences between the two groups in the operative time, intraoperative blood loss, time to liquid intake and length of postoperative stay (t/χ2=3.921, 6.940, 1.332, 1.270 and 0.342. all P>0.05), and also no signi?cant differences between the two groups in the incidences of postoperative electrolyte imbalance, cholangitis, bile leakage, wound infection and pulmonary infection (χ2=0.438, 0.537, 0.342, 1.036 and 0.342. all P>0.05). No residual stones, bile duct stricture or death were noted in either group after operation. Conclusion: LCBDE for CBD stone removal in patients with type 2 diabetes, based on the premise of preoperative glycemic control and meticulous surgical technique, is feasible, safe and effective.

Objective: To observe the changes of coagulation status in portal vein and peripheral blood in rabbits with chronic biliary infection. Methods: Twenty-four healthy adult New Zealand rabbits were equally randomized into model group and control group. All rabbits underwent indwelling cystic duct catheterization, and the rabbits in model group were subjected to E. Coli solution injection via the indwelling catheter, weekly for 3 weeks, while those in control group received normal saline instead in the same fashion. On the third day after the last injection, blood samples were taken from the marginal ear vein and portal vein of the rabbits in both groups, and liver tissues adjacent to the first porta were harvested; the blood clotting functions and D-dimer (DD) levels in the blood samples from the two sites were measured, and the pathological alteration in the portal veins were observed. Results: After model creation, rabbits in model group presented with decreased food intake, increased rectal temperature and reduced body weight, while these general conditions of those in control group showed no obvious change. Compared with control group, the blood from the marginal ear vein of model group showed that the DD level was significantly increased (P<0.01), but the indexes that included coagulation time (CT), prothrombin time (PT) and activated partial thromboplaslin time (APTT) were not significantly changed (all P>0.05), while the blood from the portal vein of model group showed significantly increased DD level, but the CT, PT and APTT levels were all significantly shortened (all P<0.01). The pathological findings showed that there was small thrombus formation in portal vein in model group, which was not noted in control group. Conclusion: Chronic biliary tract infection can result in local hypercoagulation status and microthrombosis in portal venous system, and detection of the peripheral blood DD level may have certain significance for diagnosis of biliary infection with portal vein thrombosis.

Objective: To investigate the feasibility of transumbilical single-port laparoscopic cholecystectomy (TUSPLC) through improved electric hook access. Methods: The clinical data of 517 patients undergoing TUSPLC by improved electric hook access from August 2009 to February 2013 were retrospectively analyzed. Results: Two patients were converted to open surgery due to severe adhesions of the gallbladder to neighboring tissues and Mirizzi’s syndrome, respectively. For the entire group, the operative time was 22–55 min, intraoperative blood loss was 10–30 mL, and the length of postoperative hospital stay was 1–2 d. No serious complications such as bile leakage, hemorrhage bile duct injury occurred. Follow-up was conducted in 428 patients for 1–18 months, during which no long-term complications or discomfort were noted in the patients; all scars were almost invisible, and the cosmetic results were satisfactory. Conclusion: TUSPLC using conventional laparoscopic instruments through improved electric hook access is feasible and safe, and also easy to implement in practice.

Objective: To investigate the management of biliary re-stricture after an initial repair of iatrogenic bile duct injury. Methods: The clinical data of 22 patients with biliary re-stricture after repair of bile duct injury in other hospital admitted from January 2001 to December 2011 were retrospectively analyzed. The bile duct injury in all the 22 cases was caused by cholecystectomy that included 8 cases of laparoscopic cholecystectomy and 14 cases of open cholecystectomy. Results: Reoperations were performed in all the 22 patients, of whom 21 cases underwent Roux-en-Y hepaticojejunostomy (one case underwent quadrate lobectomy due to high injury site of the bile duct, and then anastomosis of the left and right hepatic ducts to the jejunum), and one case received U-tube external biliary drainage. All patients were followed up for 1 year to 11 years. Except for one patient who died of liver failure caused by biliary infection, all the remaining patients showed relatively positive short-term outcomes. Conclusion: Bile duct injury should be treated as early as possible, and attention to detail during operation and proper selection of repair method is important. Roux-en-Y hepaticojejunostomy is a reliable procedure for biliary re-stricture after repair of the bile duct injury.

With the continuous development and improvement in equipment and technology, the diagnosis and therapy of common bile duct stones are evolving towards the direction that is to be safer, minimally invasive, and higher efficiency. Here, the authors, based on the literature review and extraction, present the current advances in diagnosis and treatment of choledocholithiasis.