Cholelithiasis has a complex pathogenesis,necessitating better therapeutic and preventive strategies.We recently read with interest Wang et al’s study on lysine acetyltransferase 2A(KAT2A)-mediated adenosine monophos...Cholelithiasis has a complex pathogenesis,necessitating better therapeutic and preventive strategies.We recently read with interest Wang et al’s study on lysine acetyltransferase 2A(KAT2A)-mediated adenosine monophosphate-activated protein kinase(AMPK)succinylation in cholelithiasis.Using mouse models and gallbladder mucosal epithelial cells,they found that KAT2A inhibits gallstones through AMPK K170 succinylation,thereby activating the AMPK/silent information regulator 1 pathway to reduce inflammation and pyroptosis.This study is the first to connect lysine succinylation with cholelithiasis,offering new insights and identifying succinylation as a potential therapeutic target.Future research should confirm these findings using patient samples,investigate other posttranslational modifications,and use structural biology to clarify succinylationinduced conformational changes,thereby bridging basic research to clinical applications.展开更多
背景与目的:临床中复杂的结石性胆管炎常合并Vater壶腹部狭窄,从而增加治疗的难度和复杂性。若只取除胆管内结石而不处理壶腹部狭窄问题,后期疾病容易反复发作。既往大多采取的方法主要是经内镜逆行胆胰管造影(ERCP)入路导丝顺向引导十...背景与目的:临床中复杂的结石性胆管炎常合并Vater壶腹部狭窄,从而增加治疗的难度和复杂性。若只取除胆管内结石而不处理壶腹部狭窄问题,后期疾病容易反复发作。既往大多采取的方法主要是经内镜逆行胆胰管造影(ERCP)入路导丝顺向引导十二指肠乳头括约肌切开、取石术联合后期腹腔镜胆囊切除的方式处理。然而,ERCP在处理复杂情况时仍有一定局限性。为此,笔者团队首创了一种新型经腹腔入路治疗结石性胆管炎合并Vater壶腹部狭窄的方法。本研究探讨该方法的可行性与疗效,以期为临床提供新的治疗选择。方法:采用随机对照研究的方法,将2021—2023年因胆囊结石、胆管结石伴Vater壶腹部狭窄于成都市第二人民医院治疗的120例患者分为观察组和对照组,每组各60例,观察组行腹腔镜胆囊切除+胆管切开取石,并顺势从切开的胆管中插入导管逆向引导十二指肠乳头切开,同时处理胆囊、胆管结石及Vater壶腹部狭窄;对照组行传统ERCP入路乳头切开、胆管取石+腹腔镜胆囊切除术。收集两组患者围手术期相关指标,比较两组手术效果。结果:120例患者中,男性54例,女性66例。两组在胆道取石成功率、术中出血量、术后24 h总胆红素、直接胆红素、转氨酶、白细胞计数、黄疸缓解时间及胆汁漏、腹膜后出血/感染、重症胰腺炎发生率等方面,差异无统计学意义(均P>0.05)。观察组平均手术时间、术后住院时间均明显短于对照组(98.67 min vs. 110.8 min,P<0.05;3.81 d vs. 5.61 d,P<0.05),并且观察组术后高淀粉酶血症和(或)高脂肪酶血症、轻型胰腺炎发生率均明显更低(1.67%vs. 25.00%,P<0.001;0 vs. 10%,P=0.027)。结论:新型经腹腔入路在缩短手术时间、住院时间方面明显优于ERCP入路,术后发生轻症胰腺炎及高淀粉酶血症和(或)高脂肪酶血症的风险更低,并且胆管取石成功率不劣于ERCP入路,是一种可选择的治疗方式。展开更多
基金Supported by Wenzhou Science and Technology Bureau,No.Y20240207.
文摘Cholelithiasis has a complex pathogenesis,necessitating better therapeutic and preventive strategies.We recently read with interest Wang et al’s study on lysine acetyltransferase 2A(KAT2A)-mediated adenosine monophosphate-activated protein kinase(AMPK)succinylation in cholelithiasis.Using mouse models and gallbladder mucosal epithelial cells,they found that KAT2A inhibits gallstones through AMPK K170 succinylation,thereby activating the AMPK/silent information regulator 1 pathway to reduce inflammation and pyroptosis.This study is the first to connect lysine succinylation with cholelithiasis,offering new insights and identifying succinylation as a potential therapeutic target.Future research should confirm these findings using patient samples,investigate other posttranslational modifications,and use structural biology to clarify succinylationinduced conformational changes,thereby bridging basic research to clinical applications.
文摘背景与目的:临床中复杂的结石性胆管炎常合并Vater壶腹部狭窄,从而增加治疗的难度和复杂性。若只取除胆管内结石而不处理壶腹部狭窄问题,后期疾病容易反复发作。既往大多采取的方法主要是经内镜逆行胆胰管造影(ERCP)入路导丝顺向引导十二指肠乳头括约肌切开、取石术联合后期腹腔镜胆囊切除的方式处理。然而,ERCP在处理复杂情况时仍有一定局限性。为此,笔者团队首创了一种新型经腹腔入路治疗结石性胆管炎合并Vater壶腹部狭窄的方法。本研究探讨该方法的可行性与疗效,以期为临床提供新的治疗选择。方法:采用随机对照研究的方法,将2021—2023年因胆囊结石、胆管结石伴Vater壶腹部狭窄于成都市第二人民医院治疗的120例患者分为观察组和对照组,每组各60例,观察组行腹腔镜胆囊切除+胆管切开取石,并顺势从切开的胆管中插入导管逆向引导十二指肠乳头切开,同时处理胆囊、胆管结石及Vater壶腹部狭窄;对照组行传统ERCP入路乳头切开、胆管取石+腹腔镜胆囊切除术。收集两组患者围手术期相关指标,比较两组手术效果。结果:120例患者中,男性54例,女性66例。两组在胆道取石成功率、术中出血量、术后24 h总胆红素、直接胆红素、转氨酶、白细胞计数、黄疸缓解时间及胆汁漏、腹膜后出血/感染、重症胰腺炎发生率等方面,差异无统计学意义(均P>0.05)。观察组平均手术时间、术后住院时间均明显短于对照组(98.67 min vs. 110.8 min,P<0.05;3.81 d vs. 5.61 d,P<0.05),并且观察组术后高淀粉酶血症和(或)高脂肪酶血症、轻型胰腺炎发生率均明显更低(1.67%vs. 25.00%,P<0.001;0 vs. 10%,P=0.027)。结论:新型经腹腔入路在缩短手术时间、住院时间方面明显优于ERCP入路,术后发生轻症胰腺炎及高淀粉酶血症和(或)高脂肪酶血症的风险更低,并且胆管取石成功率不劣于ERCP入路,是一种可选择的治疗方式。
