Combined endo‐laparoscopic approach in managing patients with gallstones and common bile duct stones: An early experience

Gallstones with common bile duct stones is a common condition in Hong Kong. Management still remains a challenge nowadays. Laparoscopic cholecystectomy with intraoperative endoscopic retrograde cholangiopancreatography (ERCP) is a single‐stage approach which improves patient comfort and is associated with less post‐ERCP pancreatitis. With the new endo‐laparoscopic operating theatre in service, the combined endo‐laparoscopic approach becomes simple and practical. We report here our two early experiences using this approach.     

Nonvisualized gallbladder on oral cholecystography: Implications for lithotripsy

Currently, most protocols evaluating the efficacy of gallstone lithotripsy require a visualized gallbladder on oral cholecystography (OCG). The primary purpose of the OCG is to establish that the cystic duct is patent. When the gallbladder is visualized on OCG, it can also be used to number and size gallstones accurately. Patients with nonvisualization of the gallbladder on OCG are excluded from consideration for lithotripsy. The purpose of this study was to evaluate retrospectively the ultrasonographic findings (i.e., number and sizes of stones in 32 patients with nonvisualization on the OCG). In 11 patients (34%) ultrasound (US) did not detect any stone, and it is presumed that the gallbladder failed to visualize for other reasons. Six patients (19%) had one or two stones and 15 (47%) patients had more than three stones. This suggests that 20% of patients with nonvisualization of the gallbladder on OCG would otherwise be eligible for lithotripsy provided that patency of the cystic duct can be demonstrated by other means, such as computed tomographic (CT) examination with oral biliary contrast or cholescintigraphy.     

胆囊颈管部结石嵌顿腹腔镜胆囊切除手术治疗的研究

目的探讨胆囊颈管部结石嵌顿对腹腔镜胆囊切除术的影响及手术处理对策。方法对该院265例合并胆囊颈管部结石嵌顿者行腹腔镜胆囊切除术的临床资料及文献进行总结分析。结果共完成260例手术，中转开腹5例，占1．92％，术后无早期并发症，全组无死亡。结论思想上重视，准确掌握手术时机及适应证，灵活运用腹腔镜胆囊切除术的基本原则及策略处理术中特殊情况是处理好腹腔镜胆囊切除术术中胆囊颈管部结石嵌顿的关键。     

电子腹腔镜下手术治疗胆囊结石的系统护理

目的探讨系统护理干预对电子腹腔镜下手术治疗胆囊结石围术期患者的临床效果。方法收集68例胆囊结石患者按是否接受系统护理分为2组,每组34例,对照组患者给予常规护理,实验组患者加施系统护理,比较2组患者术后临床指标、住院期间依从性、住院时间、医疗费用与护理满意度等。结果实验组患者首次洗漱时间、首次进食时间、首次如厕时间、首次活动时间、术前住院时间、术后住院时间与医疗费用均显著少于对照组,实验组患者住院期间依从性与护理满意度均显著高于对照组,差异均具有统计学意义(P0.05)。结论系统护理干预对电子腹腔镜下手术治疗胆囊结石围术期患者临床效果显著,可提高依从性与满意度。     

胆固醇结石成因的基因研究进展

胆囊胆固醇结石病是消化系统的一种常见病和多发病,但其确切的病因和发病机制尚不十分清楚。因此,研究其病因及发病机制,对有效的预防和治疗本病具有重要的意义。目前随着基因研究的发展,对胆固醇成因的研究也已进入基因水平。本文将对已经进行的胆囊胆固醇结石易感基因作一综述。     

急性结石性胆囊炎手术时机的选择

目的探讨急性结石性胆囊炎的手术时机的选择。方法120例急性结石性胆囊炎分为急诊手术组（组Ⅰ,n=40）、延期手术组（组Ⅱ,n=40）、择期手术组（组Ⅲ,n=40）,对并发症,治疗结果进行统计学分析。结果急诊手术组和择期手术组的术后并发症发生率均低于延期手术组,择期手术组治愈率高,（P〈0．05）,且LC术式明显高于前两组（P〈0．05）,LC术式成功率显著高于前两组。结论急性结石性胆囊炎急诊早期手术和择期手术优于延期。急性胆囊炎发病后72h内均可进行安全的胆囊切除手术。病程超过一周者宜采取保守治疗,6～8周后行择期手术。     

Apolipoprotein AI-CIII-AIV gene cluster polymorphisms in relation to cholesterol gallstone

OBJECTIVE: To investigate the frequency of variants at Xmn I, Msp I sites of apolipoprotein (Apo), A I‐CIII‐AIV gene cluster, and its relation to cholesterol gallstones in Chinese patients. METHODS: Restriction fragment length polymorphisms (RFLP) at Xmn I, Msp I sites of ApoAI‐CIII‐AIV gene cluster were studied using a polymerase chain reaction (PCR) in 161 patients with cholesterol gallstones and 94 healthy subjects from a Chinese population in Sichuan Province. RESULTS: In both the cholesterol gallstone group and the healthy control group, X1 and M1 alleles were the major alleles and homozygous X₁X₁ and M₁M₁ genotypes were the most frequent. However, the frequency of X2 allele mutation in female patients of the cholesterol gallstones group was significantly higher than that in women in the healthy control group (P < 0.05), but no difference was found in the frequency of M2 alleles mutation (P > 0.05). CONCLUSION: The data showed that Xmn I RFLP of ApoAI‐CIII‐AIV gene cluster is associated to some extent with cholesterol gallstones in female Chinese patients.     

Validation of Gastrointestinal Quality of Life Index in Swedish for Assessing the Impact of Gallstones on Health-Related Quality of Life

Objective:  The aim of the present study was to validate a Swedish translation of the Gastrointestinal Quality of Life Index (GIQLI) questionnaire in patients with gallstone disease.
Methods:  Sensitivity to change, internal consistency, and test–retest stability were tested in 187 consecutive patients who underwent planned cholecystectomy. Construct validity was assessed by comparing the GIQLI score with the bodily pain scale of SF-36 and four single-item questions in a separate group of 104 patients.
Results:  A significant increase in all five domains as well as in the overall GIQLI score 6 months after surgery (all P  < 0.05) was seen. All five domains correlated significantly with other measures of gallstone-related symptoms except one single-item question. Intraclass correlations ranged from 0.62 to 0.87. Cronbach's alpha ranged from 0.77 to 0.89.
Conclusion:  The Swedish translation of GIQLI has a high validity and reliability for assessing the impact of gallstones on quality of life.