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.
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.
Objective To explore the feasibility of single incision laparoscopic cholecystectomy in the treatment of acute cholecystitis, and to provide evidence based medicine for clinical treatment. Methods A total of 160 cases of acute cholecystitis who received treatment in our hospital from Jan. 2012 to Dec. 2015 were randomly divided into single incision group (n=80, received single incision laparoscopic cholecystectomy) and three incisions group (n=80, received three incisions laparoscopic cholecystectomy). The clinical and laboratory indexes were compared between the 2 groups. Results Compared with the three incisions group, there were statistically significant differences in the operation time, incision pain score, and subjective satisfaction, which were better in single incision group (P<0.05). But there was no significant difference in the blood loss, bed time, anal exhaust time, recovery time of intestinal peristalsis, hospitalization time, incidence of complication (including abdominal infection, bile duct injury, biliary fistula, and incision infection), ratios of T cell subsets (including CD3, CD4, and CD8 T cell), levels of immunoglobulin (including IgA, IgG, and IgM), and level of C reactive protein (P>0.05). Conclusions The effectiveness of single incision laparoscopic cholecystectomy is as good as three incisions laparoscopic cholecystectomy, but this single incision laparoscopic surgery is difficult, and its indications should be cautious. Single incision laparoscopic cholecystectomy is more suitable for patients undergoing elective cholecystectomy.
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.
【Abstract】Objective To analysis the clinical characteristics, pathogenesis, diagnosis and treatment of acute acalculous cholecystitis.Methods Seventy-nine cases of acute acalculous cholecystitis from January 1996 to January 2003 were retrospectively reviewed.Results Of those 79 cases, 13 cases were treated nonoperatively and 66 cases were treated operatively. Twentythree cases were suppurative, 43 cases were gangrenous with perforation in 18 cases，which were proved by postoperative pathology. Seventysix cases were cured and 3 cases were dead. Conclusion Keeping vigilant alert, observing dynamically as well as appropriate operative intervention are effective to improve the prognosis of acute acalculous cholecystitis.
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.
Objective To evaluate the diagnostic value of analyzing the pattern of gallbladder wall enhancement on MDCT to identify the different causes of acute cholecystitis. Methods In January 2009 to December 2012， 169 patients diagnosed with acute cholecystitis caused by various pathologic conditions were performed MDCT scans， the images of portal venous phase and clinical data were retrospectively reviewed by two blinded radiologists. There were 146 cases in non-hepatopathy cholecystitis group and 23 cases in hepatopathy cholecystitis group. The other 5 normal gallbladder cases diagnosed by MDCT scans were retrospectively reviewed as contrast group. Using five patterns according to the enhancement pattern of flat gallbladder wall thickening on MDCT. The study cases were then divided into five patterns and the thickness of the mucous membrane were measured. The occurrence rate of each pattern and the thickness of the mucous membrane between the groups were compared respectively. Results In the non-hepatopathy cholecystitis group， there were typeⅡin 102 cases （69.9%）， typeⅢin 5 cases （3.4%）， typeⅣ in 30 cases （20.5%）， and typeⅤ in 9 cases （6.2%）. In the hepatopathy cholecystitis group， there were typeⅡin 2 cases （8.7%）， typeⅢ in 11 cases （47.9%）， typeⅣin 5 cases （21.7%）， and typeⅤin 5 cases （21.7%）. The occurrence rate of typeⅡin the non-hepatopathy cholecystitis group was significialtly higher than that in the hepatopathy cholecystitis group （P＜0.005）. The occurrence rate of typeⅢ and typeⅤ in the hepatopathy cholecystitis group were significialtly higher than those in the non-hepatopathy cholecystitis group（P＜0.005， P＜0.05）. The occurrence rate of type Ⅳ between the two groups had no significant difference （P＞0.05）. TypeⅠonly present in the contrast group. The non-hepatopathy group’s mean mucous membrane thickness was （2.61±1.30） mm ， which was thicker than the hepatopathy group’s （2.02±0.52） mm（t=2.22， P＜0.05）. Conclusion Analyzing the enhancement pattern of a thickened gallbladder wall on MDCT is helpful in identifying the causes of acute cholecystitis， and the gallbladder perforation or not.
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.
ObjectiveTo investigate clinical value of magnetic resonance imaging (MRI) in differentiating xanthogranulomatous cholecystitis (XGC) with gallbladder cancer (GBC). MethodsMRI data of 7 patients with XGC and 13 patients with GBC proved by surgery and pathology were analyzed retrospectively. The main contents of the observation included:①Maximum thickness of gallbladder wall; ②Diffuse thickening or localized thickening of gallbladder wall; ③Enhancement pattern (uniform or nonuniform) of gallbladder wall; ④Gallbladder wall sandwiches enhancement; ⑤Gallbladder wall nodules; ⑥Completeness of gallbladder mucosa lines; ⑦Obstruction of biliary tract; ⑧Calculus in gallbladder or bile duct; ⑨Involvement of adjacent liver; ⑩Definition of surrounding fat layer; Lymphadenopathy. ResultsIn above 11 MRI comparing features, these features such as the gallbladder wall sandwiches enhancement, the gallbladder wall nodules, the completeness of gallbladder mucosa lines, the biliary obstruction, and the lymphadenopathy were statistically significant between the XGC and the GBC (P < 0.05), while the rest features such as the maximum thickness of gallbladder wall, the type of gallbladder wall thickening, the gallbladder wall enhancement pattern, the calculus in gallbladder or bile duct, the involvement of adjacent liver, and the definition of surrounding fat layer were not statistically significant between the XGC and the GBC (P > 0.05). ConclusionMRI has important values in differentiating XGC with GBC.