黏蛋白和表皮生长因子受体在病变胆囊组织中的表达及意义

探讨黏蛋白(MUC)、表皮生长因子受体(EGFR)在胆囊结石和胆囊息肉患者胆囊组织中的表达及意义。选取2015年2月—2017年12月收治的胆囊结石患者56例(胆囊结石组),胆囊息肉患者40例(胆囊息肉组),同时选取正常胆囊标本50例作为对照组,采用半定量PCR检测各组胆囊组织MUC和EGFR mRNA的相对表达。胆囊结石组MUC1、MUC2、MUC5AC和MUC5B mRNA相对表达量分别为80.02±12.03、70.27±11.37、110.02±23.29和167.20±22.11,明显高于胆囊息肉组和对照组(P0.05);胆囊结石组MUC3 mRNA相对表达为20.04±9.11,明显低于胆囊息肉组(P0.05),而与对照组比较差异无统计学意义(P0.05);胆囊结石组MUC6 mRNA相对表达为60.04±17.17,明显高于对照组(P0.05),而与胆囊息肉组比较差异无统计学意义(P0.05);胆囊结石组EGFR mRNA相对表达为48.10±11.26,明显高于胆囊息肉组和对照组(P0.05);胆囊结石患者EGFR mRNA与MUC5AC mRNA相对表达呈正相关(r=0.562,P0.05),与MUC1、MUC2、MUC3、MUC5B和MUC6 mRNA相对表达无相关性(P0.05)。MUC和EGFR基因可能与胆囊结石的发生有一定关系,其中MUC5AC与EGFR存在一定的相关性。     

胆囊黏膜ABCA1的表达和胆囊胆固醇息肉发病关系的研究

目的：研究ABCA1在胆囊黏膜的表达及其表达与胆囊胆固醇息肉发病的关系。方法：收集因胆囊疾患而行腹腔镜胆囊切除术病人的胆石、胆汁、胆囊黏膜及胆囊壁全层组织共计42例,其中胆囊胆固醇息肉15例,胆囊胆固醇结石15例,对照组12例（胆囊腺瘤5例,非胆固醇胆囊结石7例）。分别测定胆石胆固醇含量、胆汁胆固醇、胆汁酸、磷脂的浓度;实时PCR定量检测胆囊黏膜ABCA1、LXRα、RXRα的mRNA表达：胆囊壁全层组织做病理切片;免疫组化显示ABCAl蛋白在胆囊黏膜的表达．结果：胆固醇息肉组胆汁胆固醇饱和指数为1．0±0．2,较对照组胆固醇饱和指数0．6±0．3明显增高,其差别有统计学显著性（P〈0．01）。免疫组化显示ABCA1在胆囊黏膜上皮细胞有明显表达。息肉组、结石组和对照组胆囊黏膜ABCAI、LXRa、RXRα mRNA相对表达量比较,各组之间差异无统计学意义。结论：胆囊黏膜ABCA1的表达可能并不是导致胆囊胆固醇息肉发病的重要原因。     

胆固醇结石病人胆囊黏蛋白基因表达差异的研究

目的研究胆固醇结石病人胆囊黏蛋白基因表达差异,以探讨胆石病发生的分子生物学机制。方法对21例胆囊收缩功能良好的胆囊胆固醇结石病人和12例无胆石的对照组,采用RT-PCR 法测定胆囊 MUC1,MUC2,MUC3,MUC4,MUC5AC,MUC5B,MUC6 mRNA 的表达,以GAPDH 作为内参照。结果胆石组胆囊 MUC1,MUC5AC,MUC5B 和 MUC6表达增高(胆石组 vs对照组:MUC1:67.17±14.06vs36.84±10.00,P>0.05;MUC5AC:90.33±10.24vs53.51±9.38,P<0.05;MUC5B:175.19±7.21vs107.54±23.19,P<0.01;MUC6:71.62±14.36vs44.29±12.35,P>0.05)。MUC3表达在两组间差异无统计学意义。本研究在两组间均未检测到 MUC2和 MUC4基因表达。结论胆囊黏蛋白特别是 MUC5表达增加是胆石病的另一个发病因素。     

MUC5AC,EGFR在结石胆囊中的表达及意义

目的研究胆囊结石胆囊组织中粘蛋白5AC(mucin 5AC,MUC5AC)和表皮生长因子受体(epidermalgrowth factor receptor,EGFR)的表达,探讨胆囊结石的形成。方法采用免疫组化法和图像分析检测54例胆囊结石胆囊组织、24例对照胆囊组织(来自于壶腹部癌或胰头癌手术切除胆囊)MUC5AC,EGFR的表达情况。结果 MUC5AC和EGFR在胆囊结石胆囊组织中的表达较对照胆囊组织显著增高(P0.05)。EGFR阳性表达区域和MUC5AC阳性表达区域呈正相关(rs=0.978,P0.001)。结论 MUC5AC,EGFR可能与胆囊结石形成有关。     

胆囊黏膜ABCG5和ABCG8与胆囊胆固醇息肉关系的研究

目的:研究胆囊黏膜ABCG5和ABCG8的基因表达与胆囊胆固醇息肉发病的关系.方法:收集63例因胆囊疾患而行腹腔镜胆囊切除术患者的胆石、胆汁及部分胆囊黏膜组织,其中胆囊胆固醇息肉32例,胆囊胆固醇结石18例,对照13例(胆囊腺瘤6例,非胆固醇胆囊结石7例),分别测定胆石胆固醇含量,胆汁胆固醇、胆汁酸、磷脂的浓度,实时定量PCR检测胆囊黏膜ABCG5和ABCG8的mRNA表达.结果:胆固醇息肉组胆汁胆固醇饱和指数较对照组明显增高(P<0.01),结石组胆囊黏膜ABCG5和ABCG8的表达量较息肉组和对照组显著增高,息肉组和对照组ABCG5和ABCG8的表达量差异无统计学意义(P>0.05).结论:胆囊黏膜ABCG5/ABCG8 mRNA的相对低水平表达,可能是导致胆囊胆固醇息肉发病的重要因素之一.     

胆囊胆固醇息肉和胆囊结石发病关系的研究

目的 探讨胆囊胆固醇息肉和胆囊结石的发生关系.方法 选择2008年4～9月上海交通大学医学院附属瑞金医院外科微创中心行腹腔镜胆囊切除术病人62例,分别收集病人的胆石、胆汁及胆囊壁全层组织,其中胆固醇息肉31例,胆固醇胆囊结石18例,对照组13例.入院后上午餐前及餐后1h行B超胆囊三径测量,计算胆囊排空率对比显示胆囊功能.测定结石胆固醇含量及胆汁胆固醇、磷脂、胆汁酸浓度,胆囊壁组织做病理检查.结果 胆固醇息肉组病人平均胆囊排空率为(47.3±18.6)%.较健康成人平均胆囊排空率(71.7±8.1)%明显降低,其差异有统计学意义(P<0.01),而胆固醇息肉组和胆固醇结石组病人平均胆囊排空率(47.6±23.7)%比较,差异无统计学意义.胆固醇息肉组胆汁胆固醇饱和指数为(1.0±0.2),较对照组胆固醇饱和指教(0.6±0.3)明显增高,其差异有统计学意义(P<0.01),而胆固醇息肉组和胆固醇结石组胆固醇饱和指数(1.0±0.2)比较,差异无统计学意义.31例胆固醇息肉病人中,合并胆囊结石13例,结石发病率为41.9%.结论 胆囊胆固醇息肉的存在可以促使胆囊结石形成.     

胆固醇息肉病人胆囊黏膜ABCG1表达的研究

目的:探讨ABCG1基因在胆囊黏膜中的表达与胆固醇息肉病的关系。方法:采集15例胆囊胆固醇息肉病病人和8例无息肉无结石之对照组的胆囊黏膜和胆汁。测定胆汁胆固醇、胆汁酸和磷脂含量;real-time PCR测定胆囊黏膜中ABCG1 mRNA的表达;Western印迹法检测胆囊黏膜ABCG1之蛋白表达。结果:胆固醇息肉组胆汁胆固醇饱和指数、ABCG1mRNA表达均较对照组升高(P<0.05);息肉组中胆囊黏膜ABCG1在蛋白水平较对照组同样存在高表达。结论:胆固醇息肉病人之胆囊黏膜ABCG1基因及蛋白高表达,可能在胆固醇息肉疾病的发生、发展中起一定作用。     

黏蛋白Muc-1、Muc-3和Muc-5ac在胆囊结石形成的作用

目的 探讨黏蛋白(Mucin,Muc)Muc-1,Muc-3和Muc-5ac在胆囊结石形成中的作用及其关系.方法 应用免疫组织化学法检测Muc-1、Mac-3和Muc-5ac在36例胆囊结石患者、20例慢性胆囊炎患者和12例正常胆囊的胆囊黏膜中的表达.结果 Muc-1和Muc-5ac在胆囊结石和慢性胆囊炎的胆囊黏膜表达的阳性率分别为61.1%(22/36),66.7%(24/36)和40.0%(8/20).40.0%(8/12),均显著高于正常对照组25.0%(3/12),33.3%(4/12)(P＜0.01);胆囊结石组的阳性率(61.1%、66.7%)又显著高于慢性胆囊炎组(40%,40%,P＜0.05).Muc-1与Muc-5ac在结石性胆囊黏膜中的阳性表达呈正相关(r=0374,P＜0.01).Mac-3在胆囊结石和慢性胆囊炎的胆囊黏膜表达的阳性率分别为30.1%(11/36)和35.0%(7/20),显著低于正常对照组75.0%(9/12)(P＜0.01),但在胆囊结石和慢性胆囊炎的胆囊黏膜两组之间表达的阳性率差异无统计学意义(30.1%比35.0%)(P＞0.05).Muc-3分别与Muc-1和Muc-5ae在结石性胆囊黏膜中的阳性表达呈负相关(r=-0.407、-0.296,P＜0.01).结论 Muc-1、Muc-3和Muc-5ac参与了胆囊结石的成石过程,它们之间相互作用,共同促进胆囊结石的形成.     

胆囊黏膜ABCG5和ABCG8基因在胆固醇结石病中的作用

目的探讨ABCG5和ABCG8基因在胆囊黏膜中的表达与胆固醇结石病的关系。方法采集28例胆囊胆固醇结石病患者和10例无胆石对照的胆囊黏膜和胆汁、胆石。测定胆汁胆固醇、胆汁酸和磷脂含量;Real-time PCR测定胆囊黏膜中ABCG5和ABCG8的表达量。结果胆石组中胆固醇摩尔百分比和饱和指数均较对照组显著升高(P<0.01);ABCG5和ABCG8的表达呈显著正相关(r=0.55,P<0.01),胆石组中ABCG5和ABCG8的mRNA表达分别是对照组的2.8倍(P<0.01)和1.9倍(P<0.05)。结论胆固醇结石病患者的胆囊黏膜ABCG5和ABCG8基因表达增高,限制了胆囊上皮对胆固醇的吸收,使胆汁过饱和状态得以维持。     

胆囊壁胆固醇结晶与胆囊炎或胆囊结石相关性的初步观察

目的 初步探讨胆囊壁胆固醇结晶与胆囊炎或胆囊结石的关系。方法 对2009年7月起在我院体检的长兴县城镇居民2 957人进行3年的前瞻性观察,比较胆囊壁胆固醇结晶人群和对照组胆囊炎或胆囊结石的累计发病率。结果 胆囊壁胆固醇结晶组胆囊炎的发病率明显高于对照组（P＜0.01）,而胆囊结石的累计发病率与对照组无显著差别（P＞0.05）。结论 胆囊壁胆固醇结晶应与胆囊腔内胆汁中的胆固醇结晶相区别,该现象并不是胆囊结石的前期阶段,而是胆囊炎发生的高危因素之一。     

Consequences of intraperitoneal bile: bile ascites versus bile peritonitis

Recent experience with patients with bile ascites and bile peritonitis prompted a review of other case histories in the medical literature of these conditions. The clinical courses of 24 patients with bile ascites and 34 with bile peritonitis were reviewed. Bile ascites occurred most often as a postoperative complication of biliary tract operations and also occasionally after trauma. Clinical signs were minimal except for abdominal distention, and operations were delayed for an average of 30 days. Peritoneal fluid was sterile in the 11 patients studied. In contrast, bile peritonitis occurred most commonly after spontaneous perforation of the gallbladder or hepatic ducts but also after trauma. All patients had severe signs of peritoneal irritation, and operation was performed earlier, at a mean of 4 days after onset of symptoms. Of 11 patients with specimens of their peritoneal fluid cultured, 6 had sterile fluid and 5 had bacteria. Although both bile salt concentration and bacteria have been implicated in the development of bile peritonitis rather than bile ascites, our understanding of the mechanisms involved is still incomplete.     

The postoperative concentration of bile salts in human bile

The postoperative changes in the concentration of bile salts in the bile have been studied in a series of surgical patients following drainage of the common bile duct through a T-tube. When the patient has had no evidence of hepatic disease or the latter is minimal, there is a temporary reduction in the concentration of bile salts in the bile, followed after two to three days by a progressive return to normal levels. This drop is interpreted as due to such factors as the type and duration of anesthesia, the local and constitutional effects of operative trauma, the degree of preoperative biliary obstruction with hydrohepatosis, and the like.The rapidity of the postoperative return toward a normal concentration of the bile salts in the bile and the maximal concentration attained during the period of observation in general are inversely proportional to the degree of hepatic damage. Evidence is presented that such factors as systemic infection, cholangitis, depletion of bile salts from prolonged drainage, and an inadequate supply of carbohydrate will reduce the concentration of bile salts in the bile, presumably as a result of functional as contrasted to structural changes.The multiplicity of factors which apparently affect the functional ability of the liver and so the concentration of bile salts in the bile correspondingly increase the difficulty in determining the factors responsible for the changes in any individual case.Evidence was obtained suggesting that in some instances the common bile duct may concentrate the bile passing through it in the same manner as is done in a normal gall-bladder.The continued failure of the liver to secrete bile salts in the bile is evidence of severe functional disturbance and so of serious prognostic import.     

腹腔镜再次胆道探查术治疗胆管结石

目的：探讨腹腔镜再次胆道探查术治疗胆管结石的方法和临床应用价值。方法：回顾分析为31例复发性胆管结石患者施行腹腔镜胆道探查取石术的临床资料。结果：31例中2例因腹腔粘连致密,胆道周围组织充血水肿严重而中转开腹。29例完成腹腔镜手术,其中1例因胆总管结石大,1例胆总管下端结石嵌顿,1例肝内胆管结石较多,胆道镜和取石钳取石困难,剑突下切口延长至3~4 cm,直视下用取石钳联合胆道镜取石。行胆总管一期缝合5例,24例行胆总管T管引流术。手术时间平均170 min。术后均无腹腔出血和肠漏等并发症发生。3例出现少量胆漏,未出现腹膜炎和腹内感染征象,腹腔引流管分别于术后第6,9,10天拔除。2例剑突下切口感染均是切口延长者,通过局部换药愈合。胆总管一期缝合5例,术后5~7 d出院。24例行胆总管T管引流的患者中,10例于术后7 d带T管出院,14例于术后14 d夹闭T管后带管出院。术中19例结石取净,10例胆道残余结石患者于术后2个月经胆道镜取出。结论：腹腔镜再次胆道探查术安全,患者创伤小,康复快。胆管炎症严重及肝内外结石较多、胆总管下端结石嵌顿者需慎重选择腹腔镜手术。     

经验值得注意——再论胆管损伤与损伤性胆管狭窄

自腹腔镜胆囊切除术普遍开展之后,胆囊切除的病例很快增多,而胆管损伤发生率也随之升高,胆管损伤与胆管狭窄又重新成为本世纪的热门话题。医源性胆管损伤重在预防,预防手术中胆管损伤的基本点仍然是强调外科手术的基本要求,认真细致地施行手术,必要时中转开放手术。在专科中心及有经验的外科医生手中,修复手术结果优良者一般可达到90％,初期修复的效果优于再次修复。恢复胆道生理功能是修复手术的最终目的,当前广泛应用的仍然是肝管Roux-en-Y空肠吻合术。     

An unusual bile collection after postcholecystectomy bile leakage

Leakage from the cystic duct stumps accounts for the majority of postlaparoscopic cholecystectomy leaks. It commonly presents with a localized bile collection in the gallbladder fossa and endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting is a common method of treatment. However, bile may collect in other intra-abdominal locations away from the gallbladder fossa. We present here a case of a patient who developed upper abdominal pain with distension, anorexia, and vomiting a week after laparoscopic cholecystectomy. Ultrasonography and computed tomography scans showed an intra-abdominal collection and ERCP showed a cystic duct stump leak. A biliary stent was inserted and the collection was percutaneously drained. His symptoms, however, recurred 2 weeks later, with fever, anorexia, and weight loss. Abdominal computed tomography scan showed 9.3x8.5 cm cystic mass in the left hypochondriac area and ERCP showed persistent leakage from the cystic duct stump. The stent was changed to a larger size Fr12 and the collection was again drained percutaneously. His clinical condition improved dramatically. The biliary stent was removed after 8 weeks and remained well at 9-month follow-up.     

腹腔镜胆总管切开取石方法探讨

目的 :探讨腹腔镜下胆总管探查胆道取石的方法。方法 :于腹腔镜下对胆总管结石 4 5例按由简单到复杂 ,由损伤轻到损伤重的原则应用冲洗、挤压及分离钳、胆道镜、改良取石钳取石。结果 :用冲吸法取净结石 3例 ,占 6 .6 % ;挤压和分离钳取净结石 13例 ,占 2 8 9% ;胆道镜取净结石 11例 ,占 2 4 % ;取石钳取净结石 18例 ,占 4 0 %。结论 :腹腔镜下胆总管取石应遵循由简到繁的原则 ,用取石钳取石较为可靠     

腹腔镜下胆总管切开探查在胆管结石中的应用

目的 :总结腹腔镜下胆总管切开探查取石术的临床应用经验 ,探讨其手术方法 ,术中注意事项及临床应用的优缺点。方法 :腹腔镜下胆总管切开取石 ,T管引流或一期缝合。结果 :2 3例胆总管结石手术2 1例成功 ,2例中转开腹。结论 :腹腔镜下胆总管切开取石术应掌握适应证 ,才能使创伤减小 ,康复快且安全。