This article aims to deepen the understanding of the role of Helicobacter pylori(H.pylori)infection in the development of cholelithiasis,initiated by the article by Yao et al,who investigated the potential link betwee...This article aims to deepen the understanding of the role of Helicobacter pylori(H.pylori)infection in the development of cholelithiasis,initiated by the article by Yao et al,who investigated the potential link between H.pylori infection and the development of cholelithiasis through a multicenter retrospective study on an Asian population of over 70000 participants.They also performed a compre-hensive analysis of previously published studies on H.pylori and cholelithiasis,finding a positive association therein[odds ratio(OR)=1.103,P=0.049].Patients positive for H.pylori also had lower levels of total and direct bilirubin,but higher levels of total cholesterol and low-density lipoprotein cholesterol compared to uninfected patients(P<0.05).Cohort studies have confirmed that H.pylori is a risk factor for cholelithiasis(P<0.0001),and aggregate analyses of case-control and cross-sectional studies have shown a positive association between H.pylori and cholelithiasis in Asia(OR=1.599,P=0.034),but not in Europe(OR=1.277,P=0.246).Moreover,H.pylori appears to be related to a higher ratio of choledocho-lithiasis/cholecystolithiasis(OR=3.321,P=0.033).The authors conclude that H.pylori infection is positively correlated with cholelithiasis,particularly with the choledocholithiasis phenotype,especially in Asia,and it is potentially related to bilirubin and cholesterol metabolism.展开更多
Dear Editor,Observational studies in epidemiology have identified a correlation between hypothyroidism and cholelithiasis[1–2].However,the causal relationship between the two diseases remains unclear.To investigate t...Dear Editor,Observational studies in epidemiology have identified a correlation between hypothyroidism and cholelithiasis[1–2].However,the causal relationship between the two diseases remains unclear.To investigate the potential causal relationship,we employed a two-sample bidirectional Mendelian randomization(MR)analysis.展开更多
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
BACKGROUND: Liver cirrhosis and cholelithiasis are both familiar diseases in China. However, the rates of operative complications and death are still high in patients with these diseases. This study was designed to de...BACKGROUND: Liver cirrhosis and cholelithiasis are both familiar diseases in China. However, the rates of operative complications and death are still high in patients with these diseases. This study was designed to determine the operative indications as well as suitable procedures in the treatment of patients with cholelithiasis and liver cirrhosis. METHODS: We studied retrospectively 60 patients with cholelithiasis and liver cirrhosis who had undergone operation from January 2000 to July 2006. We analyzed the loss of blood during operation, postoperative complications and death rate to determine the proper treatment. RESULTS: Fifty patients were cured and 10 (16.7%) died postoperatively, i.e., six patients died from hepatic-renal failure and multisystem organ dysfunction and 4 from massive bleeding in the gallbladder bed. The 10 patients were clearly correlated with the Child-Pugh classification: Child A (8%), Child B (20%) and Child C (30%). Postoperative bleeding occurred in 10 patients (16.7%), intraabdominal in 6 and gastrointestinal in 4. Seven of the 10 patients with bleeding died postoperatively. CONCLUSIONS: The proper perioperative management of patients with cholelithiasis and liver cirrhosis can decrease the mortality. Cholelithiasis should be managed first by emergency operation. It is safe for the patients of Child A to undergo laparoscopy. It is very safe for patients with cirrhosis and cholelithiasis to undergo devascularization and shunt operation followed by biliary tract surgery.展开更多
AIM： To discuss about the perioperative problems encountered in patients with internal biliary fistula （IBF） caused by cholelithiasis.METHODS： In our hospital, 4 130 cholecystectomies were carried out for symptoma...AIM： To discuss about the perioperative problems encountered in patients with internal biliary fistula （IBF） caused by cholelithiasis.METHODS： In our hospital, 4 130 cholecystectomies were carried out for symptomatic cholelithiasis from January 2000 to March 2004 and only 12 patients were diagnosed with IBF. The perioperative data of these 12 IBF patients were analyzed retrospectively.RESULTS： The incidence of IBF due to cholelithiasis was nearly 0.3%. The mean age was 57 years. Most of the patients presented with non-specific complaints. Only two patients were considered to have IBF when gallstone ileus was observed during the investigations. Nine patients underwent emergency laparotomy with a pre-operative diagnosis of acute abdomen. In the remaining three patients, elective laparoscopic cholecystectomy was converted to open surgery after identification of IBF. Ten patients had cholecystoduodenal fistula and two patients had cholecystocholedochal fistula. The mean hospital stay was 23 d. Two wound infections, three bile leakages and three mortalities were observed.CONCLUSION： Cholecystectomy has to be performed in early stage in the patients who were diagnosed as cholelithiasis to prevent the complications like IBF which is seen rarely. Suspicion of IBF should be kept in mind, especially in the case of difficult dissection during cholecystectomy and attention should be paid in order to prevent iatrogenic injuries.展开更多
Objective:To investigate the distribution of pathogens and drug resistance in bile and the association between the pregane X receptor(PXR) gene polymorphisms,traditional Chinese medicine(TCM) syndromes and the risk of...Objective:To investigate the distribution of pathogens and drug resistance in bile and the association between the pregane X receptor(PXR) gene polymorphisms,traditional Chinese medicine(TCM) syndromes and the risk of cholesterol gallstone disease(CGD).Methods:A total of 392 samples were enrolled in this study from January 2014 to February 2015.among which 192 patients were with CGD.and 200 samples were healthy.Strains were isolated and susceptibility testing was the disk diffusion method susceptibility testing.The patients were divided into hepatochlic hygropyrexia.stagnation of liver-qi.and the accumulation of damp.The PXR gene polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphism.The association between the PXR gene polymorphisms and the risk of CGD was examined by logistic regression analysis.Results:A total of 192 cases were detected in 230 of bile culture pathogens,including Grain-negative bacteria 133(57.83%),Gram-positive bacteria76(33.04%),and fungi 21(9.13%).The top five pathogens were Escherichia coli,Klebsiella pneumoniae.Enterococcus faecalis,Candida albicans,and Enterococcus feces,ot which 110 cases was of single infection.48 cases of mixed infection of two strains,eight cases of mixed infection of three bacteria.Among 59 Escherichia coli,the yield extended-spectrum beta-laetamases had 40(67.80%).The hepatochlic hygropyrexia was the most TCM syndrome,followed by stagnation of liver-qi.and the accumulation of damp was least.Different pathogens and the rs6785049 genotypes distributed differently in cholelithiasis patients with different TCM syndromes(P<0.05).In hepatochlic hygropyrexia patients the Gram-negative bacteria was most.There was significant differences between CGD group and control group in rs6785049(P<0.001).Comparison with wild-type portable GG.GA genotype increased the risk of the occurrence of gallstones(OR=0.40.95%CI:0.16-0.79);likewise,carrying the GA + AA genotype also increased the risk(OR=0.38,95%CI:0.19-0.81).There was no significant differences in rs2276707,rs3814055 site polymorphic loci alleles in CGD group and control group.Conclusions:In the treatment of cholelithiasis,bile samples should be collected for bacterial culture and sensitivity test,and drugs should be strictly chosen based on the results.The rs6785049 polymorphisms in PXR gene may increase the risk of gallstones ontogeny,and gallstones can he early detected and prevented by detecting genotypes.rs6785049 polymorphisms in PXR gene may has relationship with TCM syndromes.展开更多
AIM:To determine the efficacy and safety benefits of performing intraoperative cholangiography(IOC)during laparoscopic cholecystectomy(LC)to treat symptomatic cholelithiasis.METHODS:Patients admitted to the Minimally ...AIM:To determine the efficacy and safety benefits of performing intraoperative cholangiography(IOC)during laparoscopic cholecystectomy(LC)to treat symptomatic cholelithiasis.METHODS:Patients admitted to the Minimally Invasive Surgery Center of Tianjin Nankai Hospital between January2012 and January 2014 for management of symptomaticcholelithiasis were recruited for this prospective randomized trial.Study enrollment was offered to patients with clinical presentation of biliary colic symptoms,radiological findings suggestive of gallstones,and normal serum biochemistry results.Study participants were randomized to receive either routine LC treatment or LC+IOC treatment.The routine LC procedure was carried out using the standard four-port technique;the LC+IOC procedure was carried out with the addition of meglumine diatrizoate(1:1 dilution with normal saline)injection via a catheter introduced through a small incision in the cystic duct made by laparoscopic scissors.Operative data and postoperative outcomes,including operative time,retained common bile duct(CBD)stones,CBD injury,other complications and length of hospital stay,were recorded for comparative analysis.Inter-group differences were statistically assessed by theχ2 test(categorical variables)and Fisher’s exact test(binary variables),with the threshold for statistical significance set at P<0.05.RESULTS:A total of 371 patients were enrolled in the trial(late-adolescent to adult,age range:16-70 years),with 185 assigned to the routine LC group and 186 to the LC+IOC group.The two treatment groups were similar in age,sex,body mass index,duration of symptomology,number and size of gallstones,and clinical symptoms.The two treatment groups also showed no significant differences in the rates of successful LC(98.38%vs97.85%),CBD stone retainment(0.54%vs 0.00%),CBD injury(0.54%vs 0.53%)and other complications(2.16%vs 2.15%),as well as in duration of hospital stay(5.10±1.41 d vs 4.99±1.53 d).However,the LC+IOC treatment group showed significantly longer mean operative time(routine LC group:43.00±4.15 min vs 52.86±4.47 min,P<0.01).There were no cases of fatal complications in either group.At the one-year follow-up assessment,one patient in the routine LC group reported experiencing diarrhea for three months after the LC and one patient in the LC+IOC group reported ongoing intermittent epigastric discomfort,but radiologicalexamination provided no abnormal findings.CONCLUSION:IOC addition to the routine LC treatment of symptomatic cholelithiasis does not improve rates of CBD stone retainment or bile duct injury but lengthens operative time.展开更多
The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one-or two-stage procedure.It basically includes either laparoscopic cholecystectomy(LC)with laparoscopic common bile duct(CBD)...The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one-or two-stage procedure.It basically includes either laparoscopic cholecystectomy(LC)with laparoscopic common bile duct(CBD)exploration(LCBDE)in the same operation or LC with preoperative,postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy(ERCP-ES)for stone clearance.The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC,preferably on the next day.In cases where preoperative ERCP-ES is not feasible,the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated.The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES.However,there is no consensus on the superiority of laparoendoscopic rendezvous.This is equivalent to a traditional two-stage procedure.Endoscopic papillary large balloon dilation reduces recurrence.LCBDE and intraoperative ERCP have similar good outcomes.The risk of recurrence after ERCP-ES is greater than that after LCBDE.Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones.The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage,but the transcystic approach must be used where possible.LCBDE is a safe and effective choice when performed by an experienced surgeon.However,the requirement of specific equipment and advanced training are drawbacks.The percutaneous approach is an alternative when ERCP fails.Surgical or endoscopic reintervention for retained stones may be needed.For asymptomatic CBD stones,ERCP clearance is the firstchoice method.Both one-stage and two-stage management are acceptable and can ensure improved quality of life.展开更多
AIM： To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis.METHODS： The medical records of patients with cholelithiasis who und...AIM： To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis.METHODS： The medical records of patients with cholelithiasis who underwent cholecystectomy between July 2003 and June 2007 were retrospectively reviewed. Imaging studies to detect common bile duct （CBD） stones were performed in 186 patients, who constituted the study population. Biochemical liver tests before and after surgery, and with the presence or absence of CBD stones were analyzed.RESULTS： In 96 patients with cholelithiasis and cholecystitis without evidence of CBD stones, 49 （51.0%） had an alanine aminotransferase level elevated to 2-3 times the upper limit of normal, and 40 （41.2%） had an elevated aspartate aminotransferase level. Similar manifestations of hepatocellular injury were, as would be expected, even more obvious in the 90 patients with CBD stones. These markers of hepatocellular injury resolved almost completely within 2 wk to 1 mo after cholecystectomy. Compared to 59 patients with histologically less severe cholecystitisin the group undergoing urgent surgery （total 74 patients）, the 15 patients with a gangrenous gallbladder had a higher mean level of total bilirubin （2.14 ± 1.27 mg/dL vs 2.66 ± 2.97 mg/dL, P 〈 0.001） and white cell count （9480 ± 4681/μL vs 12840 ± 5273/μL, P = 0.018）.CONCLUSION： Acute hepatocellular injury in cholelithiasis and cholecystitis without choledocholithiasis is mild and transient. Hyperbilirubinemia and leukocytosis may predict severe inflammatory changes in the gallbladder.展开更多
AIM:To evaluate the management of Italian children with cholelithiasis observed at Pediatric and Surgical Departments linked to Italian Society of Pediatric Gastroenterology Hepatology and Nutrition. METHODS: One-hund...AIM:To evaluate the management of Italian children with cholelithiasis observed at Pediatric and Surgical Departments linked to Italian Society of Pediatric Gastroenterology Hepatology and Nutrition. METHODS: One-hundred-eighty children (90 males, median age at diagnosis 7.3 years; range, 0-18 years) with echographic evidence of cholelithiasis were enrolled in the study; the data were collected by an anonymous questionnaire sent to participating centers. RESULTS: One hundred seventeen patients were treated with ursodeoxycholic acid; in 8 children dissolution of gallstones was observed, but the cholelithiasis recurred in 3 of them. Sixty-five percent of symptomatic children treated became asymptomatic. Sixty-four patients were treated with cholecystectomy and in only 2 cases a postoperative complication was reported. Thirty- four children received no treatment and were followed with clinical and echographic controls; in no case thedevelopment of complications was reported. CONCLUSION: The therapeutic strategies were extremely heterogeneous. Ursodeoxycholic acid was ineffective in dissolution of gallstones but it had a positive effect on the symptoms. Laparoscopic cholecystectomy was confirmed to be an efficacy and safe treatment for pediatric gallstones.展开更多
文摘This article aims to deepen the understanding of the role of Helicobacter pylori(H.pylori)infection in the development of cholelithiasis,initiated by the article by Yao et al,who investigated the potential link between H.pylori infection and the development of cholelithiasis through a multicenter retrospective study on an Asian population of over 70000 participants.They also performed a compre-hensive analysis of previously published studies on H.pylori and cholelithiasis,finding a positive association therein[odds ratio(OR)=1.103,P=0.049].Patients positive for H.pylori also had lower levels of total and direct bilirubin,but higher levels of total cholesterol and low-density lipoprotein cholesterol compared to uninfected patients(P<0.05).Cohort studies have confirmed that H.pylori is a risk factor for cholelithiasis(P<0.0001),and aggregate analyses of case-control and cross-sectional studies have shown a positive association between H.pylori and cholelithiasis in Asia(OR=1.599,P=0.034),but not in Europe(OR=1.277,P=0.246).Moreover,H.pylori appears to be related to a higher ratio of choledocho-lithiasis/cholecystolithiasis(OR=3.321,P=0.033).The authors conclude that H.pylori infection is positively correlated with cholelithiasis,particularly with the choledocholithiasis phenotype,especially in Asia,and it is potentially related to bilirubin and cholesterol metabolism.
基金by grants from the Jiangsu Province 333 High-level Talent Training Project(Grant No.LGY2016010)the Nanjing Science and Technology Development Plan(Grant No.201715003)the Jiangsu Province Six Talent Peaks(Grant No.WSN-030).
文摘Dear Editor,Observational studies in epidemiology have identified a correlation between hypothyroidism and cholelithiasis[1–2].However,the causal relationship between the two diseases remains unclear.To investigate the potential causal relationship,we employed a two-sample bidirectional Mendelian randomization(MR)analysis.
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BACKGROUND: Liver cirrhosis and cholelithiasis are both familiar diseases in China. However, the rates of operative complications and death are still high in patients with these diseases. This study was designed to determine the operative indications as well as suitable procedures in the treatment of patients with cholelithiasis and liver cirrhosis. METHODS: We studied retrospectively 60 patients with cholelithiasis and liver cirrhosis who had undergone operation from January 2000 to July 2006. We analyzed the loss of blood during operation, postoperative complications and death rate to determine the proper treatment. RESULTS: Fifty patients were cured and 10 (16.7%) died postoperatively, i.e., six patients died from hepatic-renal failure and multisystem organ dysfunction and 4 from massive bleeding in the gallbladder bed. The 10 patients were clearly correlated with the Child-Pugh classification: Child A (8%), Child B (20%) and Child C (30%). Postoperative bleeding occurred in 10 patients (16.7%), intraabdominal in 6 and gastrointestinal in 4. Seven of the 10 patients with bleeding died postoperatively. CONCLUSIONS: The proper perioperative management of patients with cholelithiasis and liver cirrhosis can decrease the mortality. Cholelithiasis should be managed first by emergency operation. It is safe for the patients of Child A to undergo laparoscopy. It is very safe for patients with cirrhosis and cholelithiasis to undergo devascularization and shunt operation followed by biliary tract surgery.
文摘AIM： To discuss about the perioperative problems encountered in patients with internal biliary fistula （IBF） caused by cholelithiasis.METHODS： In our hospital, 4 130 cholecystectomies were carried out for symptomatic cholelithiasis from January 2000 to March 2004 and only 12 patients were diagnosed with IBF. The perioperative data of these 12 IBF patients were analyzed retrospectively.RESULTS： The incidence of IBF due to cholelithiasis was nearly 0.3%. The mean age was 57 years. Most of the patients presented with non-specific complaints. Only two patients were considered to have IBF when gallstone ileus was observed during the investigations. Nine patients underwent emergency laparotomy with a pre-operative diagnosis of acute abdomen. In the remaining three patients, elective laparoscopic cholecystectomy was converted to open surgery after identification of IBF. Ten patients had cholecystoduodenal fistula and two patients had cholecystocholedochal fistula. The mean hospital stay was 23 d. Two wound infections, three bile leakages and three mortalities were observed.CONCLUSION： Cholecystectomy has to be performed in early stage in the patients who were diagnosed as cholelithiasis to prevent the complications like IBF which is seen rarely. Suspicion of IBF should be kept in mind, especially in the case of difficult dissection during cholecystectomy and attention should be paid in order to prevent iatrogenic injuries.
基金supported by the National Science Foundation of China(30672698). "The first two authors contributed equally to this work
文摘Objective:To investigate the distribution of pathogens and drug resistance in bile and the association between the pregane X receptor(PXR) gene polymorphisms,traditional Chinese medicine(TCM) syndromes and the risk of cholesterol gallstone disease(CGD).Methods:A total of 392 samples were enrolled in this study from January 2014 to February 2015.among which 192 patients were with CGD.and 200 samples were healthy.Strains were isolated and susceptibility testing was the disk diffusion method susceptibility testing.The patients were divided into hepatochlic hygropyrexia.stagnation of liver-qi.and the accumulation of damp.The PXR gene polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphism.The association between the PXR gene polymorphisms and the risk of CGD was examined by logistic regression analysis.Results:A total of 192 cases were detected in 230 of bile culture pathogens,including Grain-negative bacteria 133(57.83%),Gram-positive bacteria76(33.04%),and fungi 21(9.13%).The top five pathogens were Escherichia coli,Klebsiella pneumoniae.Enterococcus faecalis,Candida albicans,and Enterococcus feces,ot which 110 cases was of single infection.48 cases of mixed infection of two strains,eight cases of mixed infection of three bacteria.Among 59 Escherichia coli,the yield extended-spectrum beta-laetamases had 40(67.80%).The hepatochlic hygropyrexia was the most TCM syndrome,followed by stagnation of liver-qi.and the accumulation of damp was least.Different pathogens and the rs6785049 genotypes distributed differently in cholelithiasis patients with different TCM syndromes(P<0.05).In hepatochlic hygropyrexia patients the Gram-negative bacteria was most.There was significant differences between CGD group and control group in rs6785049(P<0.001).Comparison with wild-type portable GG.GA genotype increased the risk of the occurrence of gallstones(OR=0.40.95%CI:0.16-0.79);likewise,carrying the GA + AA genotype also increased the risk(OR=0.38,95%CI:0.19-0.81).There was no significant differences in rs2276707,rs3814055 site polymorphic loci alleles in CGD group and control group.Conclusions:In the treatment of cholelithiasis,bile samples should be collected for bacterial culture and sensitivity test,and drugs should be strictly chosen based on the results.The rs6785049 polymorphisms in PXR gene may increase the risk of gallstones ontogeny,and gallstones can he early detected and prevented by detecting genotypes.rs6785049 polymorphisms in PXR gene may has relationship with TCM syndromes.
文摘AIM:To determine the efficacy and safety benefits of performing intraoperative cholangiography(IOC)during laparoscopic cholecystectomy(LC)to treat symptomatic cholelithiasis.METHODS:Patients admitted to the Minimally Invasive Surgery Center of Tianjin Nankai Hospital between January2012 and January 2014 for management of symptomaticcholelithiasis were recruited for this prospective randomized trial.Study enrollment was offered to patients with clinical presentation of biliary colic symptoms,radiological findings suggestive of gallstones,and normal serum biochemistry results.Study participants were randomized to receive either routine LC treatment or LC+IOC treatment.The routine LC procedure was carried out using the standard four-port technique;the LC+IOC procedure was carried out with the addition of meglumine diatrizoate(1:1 dilution with normal saline)injection via a catheter introduced through a small incision in the cystic duct made by laparoscopic scissors.Operative data and postoperative outcomes,including operative time,retained common bile duct(CBD)stones,CBD injury,other complications and length of hospital stay,were recorded for comparative analysis.Inter-group differences were statistically assessed by theχ2 test(categorical variables)and Fisher’s exact test(binary variables),with the threshold for statistical significance set at P<0.05.RESULTS:A total of 371 patients were enrolled in the trial(late-adolescent to adult,age range:16-70 years),with 185 assigned to the routine LC group and 186 to the LC+IOC group.The two treatment groups were similar in age,sex,body mass index,duration of symptomology,number and size of gallstones,and clinical symptoms.The two treatment groups also showed no significant differences in the rates of successful LC(98.38%vs97.85%),CBD stone retainment(0.54%vs 0.00%),CBD injury(0.54%vs 0.53%)and other complications(2.16%vs 2.15%),as well as in duration of hospital stay(5.10±1.41 d vs 4.99±1.53 d).However,the LC+IOC treatment group showed significantly longer mean operative time(routine LC group:43.00±4.15 min vs 52.86±4.47 min,P<0.01).There were no cases of fatal complications in either group.At the one-year follow-up assessment,one patient in the routine LC group reported experiencing diarrhea for three months after the LC and one patient in the LC+IOC group reported ongoing intermittent epigastric discomfort,but radiologicalexamination provided no abnormal findings.CONCLUSION:IOC addition to the routine LC treatment of symptomatic cholelithiasis does not improve rates of CBD stone retainment or bile duct injury but lengthens operative time.
文摘The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one-or two-stage procedure.It basically includes either laparoscopic cholecystectomy(LC)with laparoscopic common bile duct(CBD)exploration(LCBDE)in the same operation or LC with preoperative,postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy(ERCP-ES)for stone clearance.The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC,preferably on the next day.In cases where preoperative ERCP-ES is not feasible,the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated.The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES.However,there is no consensus on the superiority of laparoendoscopic rendezvous.This is equivalent to a traditional two-stage procedure.Endoscopic papillary large balloon dilation reduces recurrence.LCBDE and intraoperative ERCP have similar good outcomes.The risk of recurrence after ERCP-ES is greater than that after LCBDE.Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones.The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage,but the transcystic approach must be used where possible.LCBDE is a safe and effective choice when performed by an experienced surgeon.However,the requirement of specific equipment and advanced training are drawbacks.The percutaneous approach is an alternative when ERCP fails.Surgical or endoscopic reintervention for retained stones may be needed.For asymptomatic CBD stones,ERCP clearance is the firstchoice method.Both one-stage and two-stage management are acceptable and can ensure improved quality of life.
文摘AIM： To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis.METHODS： The medical records of patients with cholelithiasis who underwent cholecystectomy between July 2003 and June 2007 were retrospectively reviewed. Imaging studies to detect common bile duct （CBD） stones were performed in 186 patients, who constituted the study population. Biochemical liver tests before and after surgery, and with the presence or absence of CBD stones were analyzed.RESULTS： In 96 patients with cholelithiasis and cholecystitis without evidence of CBD stones, 49 （51.0%） had an alanine aminotransferase level elevated to 2-3 times the upper limit of normal, and 40 （41.2%） had an elevated aspartate aminotransferase level. Similar manifestations of hepatocellular injury were, as would be expected, even more obvious in the 90 patients with CBD stones. These markers of hepatocellular injury resolved almost completely within 2 wk to 1 mo after cholecystectomy. Compared to 59 patients with histologically less severe cholecystitisin the group undergoing urgent surgery （total 74 patients）, the 15 patients with a gangrenous gallbladder had a higher mean level of total bilirubin （2.14 ± 1.27 mg/dL vs 2.66 ± 2.97 mg/dL, P 〈 0.001） and white cell count （9480 ± 4681/μL vs 12840 ± 5273/μL, P = 0.018）.CONCLUSION： Acute hepatocellular injury in cholelithiasis and cholecystitis without choledocholithiasis is mild and transient. Hyperbilirubinemia and leukocytosis may predict severe inflammatory changes in the gallbladder.
文摘AIM:To evaluate the management of Italian children with cholelithiasis observed at Pediatric and Surgical Departments linked to Italian Society of Pediatric Gastroenterology Hepatology and Nutrition. METHODS: One-hundred-eighty children (90 males, median age at diagnosis 7.3 years; range, 0-18 years) with echographic evidence of cholelithiasis were enrolled in the study; the data were collected by an anonymous questionnaire sent to participating centers. RESULTS: One hundred seventeen patients were treated with ursodeoxycholic acid; in 8 children dissolution of gallstones was observed, but the cholelithiasis recurred in 3 of them. Sixty-five percent of symptomatic children treated became asymptomatic. Sixty-four patients were treated with cholecystectomy and in only 2 cases a postoperative complication was reported. Thirty- four children received no treatment and were followed with clinical and echographic controls; in no case thedevelopment of complications was reported. CONCLUSION: The therapeutic strategies were extremely heterogeneous. Ursodeoxycholic acid was ineffective in dissolution of gallstones but it had a positive effect on the symptoms. Laparoscopic cholecystectomy was confirmed to be an efficacy and safe treatment for pediatric gallstones.
