ObjectiveTo introduce the current study of the metastatic mode and operation methods in advanced gallbladder carcinoma. MethodsThe literatures about metastatic mode and operation methods of advanced gallbladder carcinoma in recent 5 years were reviewed.ResultsLymph node and hepatic invasion were the main mode of advanced gallbladder carcinoma. The Japanese Society of Biliary Surgery （JSBS） classification to gallbladder carcinoma was more reasonable than the UICC classification. The survival rate after radical resection was higher than that after cholecytectomy in patients with T2n1-2M0. In the patients that tumor extended adjacent organs but the lymph node metastatic localized within n2, extended radical resection provided a survival advantage. If the patients’ tumor was not resectable or who had lymph node metastasis beyond n3, the benefit of extended radical resection seemed limited.ConclusionIn the carefully selected patients, extended radical resection will improve the prognosis of advanced gallbladder carcinoma.
ObjectiveTo explore the suitable method for isolation and maintenance of primary cultures of human gallbladder epithelial cells (GECs) for establishing the basis of research works in physiological function of gallbladder and its related diseases.MethodsGECs were isolated with collagenase type Ⅳ and blunt separation.The dishes were coated with fibronectin, laminin and polyDlysine respectively.Additional 10 ng/ml epidermal growth factor was added to DMEM medium containing 20% fetal calf serum.The cells were studied under light and electron microscope to determine their shape and distribution.ResultsEach gallbladder yielded approximately (1-5)×107columnar epithelial cells,greater than 95% of which were viable by trypan blue exclusion.The cells grew vigorously within one week which was flat and multangular in shape. CK19 expressed positive.Electron microscope showed typical gallbladder epithelia with microvilli,tight junctions and mucus droplets.ConclusionCombination of collagenase type Ⅳ，mechanical blunt separation and twostep attachment is of great benefit for separating and harvesting GEC.Fibronectin coated culture dish and DMEM medium containing 20% calf serum and 10 ng/ml hEGF is of great benefit for culturing gallbladder epithelial cells.
Objective To study the relationship between the expression of apoptosisrelated gene bclx,bax and estrogen receptor (ER) in primary gallbladder carcinoma (PGC) and its clinical significance. MethodsImmunohistochemistry of labeled dextran polymer (LDP) with EnvisionTM system was used to detect ER and gene bclx and bax. ResultsThe positive rate of bclx,bax and ER were 72.3%,66.0% and 59.6% in 47 cases with primary gallbladder carcinoma and 40.0%,93.3% and 93.3% in 6 cases with gallbladder adenomahyperplastic. The expression of bax and ER in PGC was significantly lower than that in gallbladder adenomahyperplastic (P＜0.05),the expression of bclx was significantly higher in PGC than that in the latter (P＜0.05).The expression of bclx and ER in well differentiated PGC was significantly higher than that in moderately, poorly differentiated PGC (P＜0.05); bax expression in well differentiated PGC was lower. ER and bax expression in male PGC was significantly lower than that in female PGC （P＜0.01）, the expression of bclx in male PGC was higher (P＜0.05).ER was more highly expressed in smaller PGC than in larger one (P＜0.05). ER and bax, bclx were not different between various clinical stages and ages (P＞0.05,respectively). Conclusion The expression ER, apoptosisrelated gene bclx and bax have correlation with differentiation and sex in PGC, their levels shows significance in the prognosis of PGC.
ObjectiveTo discuss the relationship between angiogenesis and the clinical pathological characteristics, prognosis in primary gallbladder carcinoma (PGC ). MethodsThe specimens of 42 patients with PGC who underwent operation during 1993 and 1996 were collected. The immunohistochemical staining was performed in these specimens through SABC manner. Angiogenesis was represented by intratumor microvessel count (MVC ) and expression of vascular endothelial growth factor (VEGF ).ResultsIn all the patients, the average MVC was 70.4±20.7, and the VEGF positive expression rate was 69.0%. The mean MVC was 57.9±15.4 in the tumor of histograde Ⅰ and Ⅱ, and was 88.8±11.5 in another group of grade Ⅲ and Ⅳ respectively. The mean MVC was 45.0±17.0 in the cases of Nevin stage Ⅰ, Ⅱ and Ⅲ, and was 77.2±16.0 in the other cases of Nevin stage Ⅳ and Ⅴ. There were significant differences between two groups. VEGF expression positive rate was correlated with grade and stage, in the patients with poordifferentiated grade and late stage the MVC was significant higher. The expression of VEGF was markedly correlated with MVC. The 3year survival rate was significant lower in the group of high MVC or VEGF positive expression. Conclusion Manifold VEGF secretion in PGC may increase the MVC value, and accelerate the tumor advance and metastasis. Angiogenesis may be considered as an effective predictor to the prognosis of the primary gallbladder carcinoma.
To study the red cell′s deformation and the immune adhesion functions to tumor cell in patients with primary gallbladder carcinoma (PGC)， twenty-seven patients with PGC and twenty normal persons were investigated by means of BL88B type laser diffraction RBC deformation instrument and agglutinate method of tumor cell. The result showed that the RBC deformation index was lower in patients with PGC than that in the normal persons (Ｐ＜0.01). Also was the enhance factor of RBC immune adherent functions lower than that in the normal persons. While the inhibitory factor was higher than that in the normal persons. The result suggests that the decrease of RBC immune function be related with change of serum modulating factors in patient with PGC.
Expression of bcl-2 in 45 cases of primary gallbladder carcinomas and 39 cases of gallbladder adenomas were detected by streptavidin-biotin-peroxidase complex (SABC) methods. The results revealed that the positive rate of bcl-2 in primary gallbladder carcinomas was 71.1% and that in gallbladder adenomas was 87.2%, there was no obvious difference between them (Ｐ＞0.05). Expression of bcl-2 in well, moderately and poorly differentiated primary gallbladder carcinomas were 82.8%, 82.4% and 50.0% respectively with significant statistical difference (Ｐ＜0.01). The positive rate of bcl-2 in stages Ⅰ,Ⅱ and Ⅲ of primary gallbladder carcinomas were 81.3% and 55.2% respectively with no significant differnce. The result suggests that expression of bcl-2 in primary gallbladder carcinomas has no correlation with clinic stages.
Objective To explore the feasibility， operation method， and clinical application value of transumbilical single-port laparoscopic cholecystectomy （TUSP-LC） in treatment for children patients with benign gallbladder diseases. Methods The clinical data of 64 patients with benign gallbladder diseases from June 2009 to June 2011 were analyzed retrospectively. The patients were divided into TUSP-LC group （n=41） and convention three-port LC （CTP-LC group， n=23）. The operative time， intraoperative blood loss， conversion to CTP-LC or laparotomy， operative complications， and hospital stay were recorded. The pains were registered at 3，6，12，24，48， and 72h postoperatively using visual analog scale （VAS）. The patients were given satisfaction questionnaires with surgery at 6 time points （1 week， 2 weeks， 1 month， 3 months， 6 months， 12 months） during a 12 months follow-up. Results A total of 64 pediatric LCs were performed successfully， no patients were converted to laparotomy. Except for one case of incision infection in the CTP-LC group 〔4.35%（1/23）〕 and one case of incision infection and one case of ecchymoma in the TUSP-LC group 〔4.88% （2/41）〕， no other complications such as bile duct injury， bile leakage， and incision hernia happened， the total complication rate was not significant difference in two groups （P＞0.05）. The operative time 〔（47.54±18.71） min versus（45.33±10.58） min〕， intraoperative blood loss 〔（18.56±13.34） ml versus （17.28±12.53） ml〕， and hospital stay 〔（1.67±0.36） d versus （1.81±0.38） d〕were not significant differences in two groups （P＞0.05）. The VAS score was not statisticly significant within 24h in two groups （P＞0.05）， but which in the TUSP-LC group was significantly lower than that in the CTP-LC group after 24h postoperatively （P＜0.05）. During a 12 months follow-up， the score of satisfaction in the TUSP-LC group was significantly higher than that in the CTP-LC group （P＜0.05）. Conclusions TUSP-LC is a safe and feasible method in the children patients with benign gallbladder diseases. It can be performed with the same technical exposure and outcomes as multi-port laparoscopy， with the added benefit of relieving postoperative pain and little no scarring.
ObjectiveTo evaluate the feasibility and surgical techniques of laparoscopic subtotal cholecystectomy （LSC) in treatment for patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy. MethodsThe clinical data of 83 patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy admitted to this hospital between January 2006 and April 2010 were analyzed retrospectively. ResultsEighty-one patients were performed LSC, 2 patients were converted to laparotomy. In which 39 patients with the part of wall residual of the fundus and (or) body of the gallbladder, 26 patients with residual of part of gallbladder neck, 18 patients with residual of part of gallbladder body and neck. Fifty-one cases were followed-up for 3 months to 4 years, there were 2 patients with the change like “mini gallbladder” by B ultrasound and no obviously clinical symptoms. There was no ostcholecystectomy syndrome in the patients with follow-up. ConclusionsLSC is a safe, effective, feasible procedure for severe gallstone gallbladder inflammation, adhesion, or atrophy, which can effectively prevent bile duct injury, bleeding, or other serious complications. While it can also reduce the rate of conversion to laparotomy.
Objective To introduce the methods and the advancements of early diagnosis in primary carcinoma of gallbladder (PCG), and improve the early diagnostic rate of PCG. Methods Recent relevant literatures were reviewed. Results It was difficult in early diagnosis of PCG and with a poor prognosis. Comprehending case history and careful examination and being assisted by multiple imaging methods and molecular biology technology could markedly improve the early diagnostic rate. Conclusion Comprehending the progress will contribute a lot of improving the early diagnostic rate and selecting reasonable clinical methods to be used in early diagnosis of PCG.