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1.
C. Avgerinos D. Kelgiorgi Z. Touloumis L. Baltatzi C. Dervenis 《Journal of gastrointestinal surgery》2009,13(3):498-503
Introduction Bile duct injuries have been substantially increased after the introduction of laparoscopic cholecystectomy (LC). They are
accompanied by major morbidity, occasional mortality, lengthening of hospital stay, additional health costs, and deterioration
of patients’ quality of life and life expectancy. The aim of this study was to present the method of “critical view of safety”
(CVS) as safe and feasible for the prevention of bile duct injuries during laparoscopic cholecystectomy.
Patients and Methods During a 6-year period from January 2002 till December 2007, 1,046 LCs (369 men and 677 women) were performed mainly for symptomatic
gallstone disease. The CVS technique recommends clearing the triangle of Calot of fat and fibrous tissue and taking the gallbladder
off the lowest part of its attachment to the gallbladder bed. The “infundibular” technique (identification of cystic duct
and gallbladder junction) was used whenever CVS was not possible to perform.
Results The CVS was performed in 998 patients (95.4%). Overall, 27 patients needed conversion to the open approach (2.6%). This rate
was higher in patients with acute inflammation undergoing early operation (nine of 128, 7%) compared with patients operated
later or electively (18 of 914, 1.9%). There was no bile duct injury in the 1,046 cholecystectomies. Postoperatively, five
patients had bile leaks which were transient and stopped spontaneously after 2–14 days. Two reoperations were performed because
of severe bleeding.
Conclusion CVS clarifies the relations of the anatomic structures that should be divided, and therefore, it should be ideally and routinely
applied in all LCs because of its highly protective role against bile duct injuries. 相似文献
2.
Naoki Matsumura Hiromi Tokumura Akihiro Yasumoto Hiroyuki Sasaki Mitsuo Yamasaki Hiroaki Musya Shoji Fukuyama Kenichi Takahashi Takashi Toshima Yuji Funayama 《Surgery today》2009,39(3):252-255
A 75-year old woman was admitted to our hospital with right upper quadrant pain, vomiting, and jaundice. Laboratory findings
showed elevated total bilirubin, alkaline phosphatase, γ-glutamyl transpeptidase, and Creactive protein levels. Abdominal
ultrasonography (US) and drip infusion cholangiographic computed tomography (DIC-CT) showed not only cholecystocholedocholithiasis,
but a gallbladder located left of the round ligament and close to the lateral segments of the liver. We performed laparoscopic
cholecystectomy (LC) with choledocholithotomy for suspected cholecystocholedocholithiasis with a left-sided gallbladder. Routine
ports were inserted in the American configuration for LC. The gallbladder was normogradely separated from the gallbladder
fossa, and the fundus of the gallbladder was lifted ventrally and toward to the patient’s right shoulder. These procedures
provided the usual view for laparoscopic choledochotomy. The patient recovered uneventfully and was discharged on postoperative
day 10. To our knowledge, this is the first report of laparoscopic common bile exploration in a patient with a leftsided gallbladder. 相似文献
3.
Yoshifumi Kawarada M.D. F.A.C.S. Shuji Isaji M.D. Hiroki Taoka M.D. Masami Tabata M.D. Bidhan Chandra Das M.B.B.S. Hajime Yokoi M.D. 《Journal of gastrointestinal surgery》1999,3(4):369-373
Recently we have been performing S4a + S5 with total resection of the caudate lobe (SI) by using a dome-like dissection along
the root of the middle hepatic vein at the pinnacle, which we refer to as the Taj Mahal liver parenchymal resection, for carcinoma
of the biliary tract. This procedure offers the following advantages: (1) It allows total resection of the caudate lobe, including
the paracaval portion (S9), and (2) because the cut surface of the liver is large, it allows intrahepatic jejunostomy to be
performed more easily with a good field of view. The indications for this procedure include hilar bile duct carcinoma, gallbladder
carcinoma, and choledochal cyst (type IVA). Because of the high rate of hilar liver parenchyma and caudate lobe invasion associated
with hilar bile duct carcinoma, the liver must be resected. The Taj Mahal procedure is indicated in cases where extended liver
resection is impossible. The dissection limits of this procedure are, on the left side, the B2 + 3 bifurcation at the right
margin of the umbilical portion of the portal vein and, on the right side, the B8 of the anterior branch and the B6+7 bifurcation
of the right posterior branch. This procedure could also be described as a reduced form of extended right hepatectomy and
extended left hepatectomy. For gallbladder carcinoma, this procedure is indicated to ensure an adequate surgical margin and
eradicate transvenous liver metastasis, particularly in cases of pT2 lesions. Hilar and caudate lobe invasion also occurs
in liver bed-type gallbladder carcinoma, and bile duct resection and caudate lobe resection are required for the surgery to
be curative. We performed this procedure in four cases of hilar bile duct carcinoma, five cases of gallbladder carcinoma,
and one case each of choledochal cyst (type IVA) with carcinoma of the bile duct and gallbladder adenomyomatosis. Curative
resection was possible in all except the patient with adenomyomatosis, and all of the patients are alive and recurrence free
10 to 37 months postoperatively. This procedure, in addition to preserving liver function, provides a wide field of view and
facilitates reconstruction of multiple intrahepatic bile ducts. Thus it can be said to be a curative operation not only in
patients considered high risk but also in those whose hilar bile duct carcinoma is limited to the bifurcation area (Bismuth
type IIIa and IIIb) and in gallbladder carcinoma up to pT2 with slight extension on the hepatic side.
Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20,
1998 (poster presentation). 相似文献
4.
J. Edward F. Fitzgerald Matthew J. White Dileep N. Lobo 《World journal of surgery》2009,33(4):886-891
Background Variously described as Courvoisier’s law, sign, or even gallbladder, this eponymous “law” has been taught to medical students
since the publication of Courvoisier’s treatise in 1890.
Methods We reviewed Courvoisier’s original “law,” the modern misconceptions surrounding it, and the contemporary evidence supporting
and explaining his observations.
Results Courvoisier never stated a “law” in the context of a jaundiced patient with a palpable gallbladder. He described 187 cases
of common bile duct obstruction, observing that gallbladder dilatation seldom occurred with stone obstruction of the bile
duct. The classic explanation for Courvoisier’s finding is based on the underlying pathologic process. With the presence of
gallstones come repeated episodes of infection and subsequent fibrosis of the gallbladder. In the event that a gallstone causes
the obstruction, the gallbladder is shrunken owing to fibrosis and is unlikely to be distensible and, hence, palpable. With
other causes of obstruction, the gallbladder distends as a result of the back-pressure from obstructed bile flow. However,
recent experiments show that gallbladders are equally distensible in vitro, irrespective of the pathology, suggesting that
chronicity of the obstruction is the key. Chronically elevated intraductal pressures are more likely to develop with malignant
obstruction owing to the progressive nature of the disease. Gallstones cause obstruction in an intermittent fashion, which
is generally not consistent enough to produce such a chronic rise in pressure.
Conclusion We hope that reminding clinicians of Courvoisier’s actual observations will reestablish the usefulness of this clinical
sign in the way he intended. 相似文献
5.
Nobuyasu Kano Tatsuo Yamakawa Yasuro Ishikawa Shigeru Sakai Hiraku Honda Hisashi Kasugai 《Journal of Hepato-Biliary-Pancreatic Surgery》1994,1(3):314-318
During the period May, 1990 to the end of December, 1992, 434 patients (203 males and 231 females; aged 16–87 years; mean
49.4 years) underwent laparoscopic cholecystectomy at our Department, Teikyo University Hospital, Mizonokuchi. Eleven out
of these 434 patients were converted to open cholecystectomy, due to uncontrollable bleeding from the cystic artery (n=1), venous bleeding due to portal hypertension (n=1), extensive adhesions of the omentum and the duodenum to the gallbladder (n=2), extensive adhesions around the gallbladder (n=4), and extensive adhesion between the gallbladder and the common duct (n=3). The time taken to complete the procedure ranged from 25 to 235 min, the mean being 74 min. Seventeen complications manifested
intra- or postoperatively. Three cases of bile duct injury which manifested after operation required laparotomy. In 1 patient,
injury to the right hemidiaphragm resulted in a right pneumothorax. One patient had periumbilical subcutaneous emphysema,
2 patients had mild bile leaks that cleared up within a few days, and 1 patient had considerable bile leaks which stopped
6 days later. Indications for laparoscopic cholecystectomy widened as our experience grew. Common bile duct stones and previous
gastrectomy are no longer contraindications for this procedure. Based on our experience with laparoscopic cholecystectomy,
we describe here our technique and the rules we consider important for the successful accomplishment of this procedure. 相似文献
6.
Tanaka S Kubota D Oba K Lee SH Yamamoto T Uenishi T Tanaka H Kubo S Matsuyama M 《Journal of Hepato-Biliary-Pancreatic Surgery》2007,14(6):608-610
The patient was a 16-year-old boy who had turned to the right rapidly as he fielded a baseball that had come to him quickly.
Two days after this event, which occurred in July 2004, he was admitted to hospital with repeated vomiting and increasing
right hypochondralgia. Laboratory examination on admission showed elevation of the white blood count and of serum C-reactive
protein and total bilirubin. Computed tomography on admission demonstrated an enlarged gallbladder and a thickened wall without
gallstones, and magnetic resonance imaging performed 1 day later showed air within the gallbladder wall. His symptoms worsened,
with a positive Murphy's sign, and emergency laparotomy was performed, with a diagnosis of emphysematous cholecystitis. Intraoperatively,
the gallbladder was dark red, necrotic, distended, and enlarged. The cystic duct was attached only to the mesentery, and the
gallbladder was floating freely, with the neck of the gallbladder having rotated 180 ° counterclockwise, leading to a definitive
diagnosis of gallbladder torsion with emphysematous cholecystitis. Cholecystectomy was performed, and analysis of bile showed
Escherichia coli to be the causative organism. Histopathologic examination revealed necrotized cholecystitis. The patient is doing well 25
months after surgery, with an uneventful postoperative course. 相似文献
7.
Inagaki M Goto J Suzuki S Ishizaki A Tanno S Kohgo Y Tokusashi Y Miyokawa N Kasai S 《Journal of Hepato-Biliary-Pancreatic Surgery》2007,14(5):529-533
We herein report a case of gallbladder carcinoma associated with occult pancreatobiliary reflux (PR) in the absence of pancreatobiliary
maljunction. A 67-year-old woman was referred to our hospital for the evaluation and treatment of a gallbladder tumor. Ultrasonography
and computed tomography showed a nodular lesion in the fundus of the gallbladder, indicating the possibility of a gallbladder
carcinoma. Endoscopic ultrasonography showed the nodular tumor and thickness of the surrounding epithelium. Endoscopic retrograde
cholangiopancreatography revealed a normal pancreaticobiliary junction without the common channel and a slight dilatation
of the common bile duct (15 mm in diameter). An open cholecystectomy and partial resection of the liver bed of the gallbladder
with regional lymphadenectomy was performed. A C-tube was inserted from the cut end of the cystic duct into the common bile
duct to prevent bile stasis. Biliary amylase and lipase levels sampled in the gallbladder were 2604 IU/l and 775 IU/l, respectively.
Biliary amylase level in the bile collected from the C-tube in the common bile duct was 119 550 IU/l on postoperative day
(POD) 6 and 22 265 IU/l on POD 12. These observations suggested that PR was present in this patient. The histopathological
findings of the resected specimen showed a well-differentiated adenocarcinoma of the gallbladder with invasion to the muscle
layer and no metastasis of the resected lymph nodes. A high index of nuclear staining for MIB-I in the cancer cells (about
10%) was exhibited, and a few cells in the normal epithelium also stained positive. 相似文献
8.
Halit V Oktar GL Imren VY Iriz E Erer D Kula S Tunaoglu FS Gokgoz L Olgunturk R 《Surgery today》2008,38(11):999-1003
Purpose A variety of operative techniques has been used to repair complete atrioventricular (AV) canal defects and satisfactory outcomes
after single patch repairs have been reported. We report our comparative results of repairing complete AV canal defects between
1998 and 2006 using the traditional single patch and the “Australian” techniques.
Methods Fourteen patients underwent traditional AV canal repair with the single patch technique (Group 1) and 11 patients underwent
repair with the “Australian” technique (Group 2). All patients were examined with preoperative echocardiography and cardiac
catheterization, and were followed up with echocardiography to evaluate AV valve and ventricular function.
Results There were two early postoperative deaths in Group 1 and one in Group 2. One patient from each group had moderate left AV
valve regurgitation postoperatively, but none from either group had left ventricular outflow obstruction.
Conclusions The “Australian” technique is a simpler method requiring shorter aortic cross-clamping and total bypass times with good clinical
and functional results. The early postoperative results are as encouraging as those achieved by the traditional single patch
technique; however, long-term follow-up results are required to establish the efficacy of this simplified technique. 相似文献
9.
A large monoinstitutional series adopting the Kugel retroparietal technique for inguinal hernia surgery is analysed. Our aim
is to assess the “mini-invasiveness” of this technique. Six hundred and twenty patients (pts) affected by monolateral inguinal
hernia were treated with a preperitoneal alloplasty with a posterior approach (Kugel hernia repair, KHR) between January 2002
and September 2004. The surgical incision extension was 3.5 cm on average (range 2–4.5). The mean operation time was 33 min
(range 20–45). Spinal anaesthesia and ambulatory procedure were applied in 595 cases (96%). Postoperative complications affected
20 pts (3%). The postoperative pain was well controlled. No chronic neuropathic pain was registered at follow-up. Patients
resumed work after an average of 9 days (range 7–12) from operation. Recurrence rate was 0.8%. Conclusions. The Kugel hernia
repair satisfies the standards to be awarded as a “mini-invasive” technique. 相似文献
10.
Ram Elazary Abed Khalaileh Gideon Zamir Michael Har-Lev Gidon Almogy Avraham I. Rivkind Yoav Mintz 《Surgical endoscopy》2009,23(5):969-972
Introduction NOTES cholecystectomy, may eliminate complications related to abdominal incisions. However, the nonmandatory gastrotomy and
its safe closure is the main controversy accompanying this approach. Transvaginal access has minimal closure consequences
but the safety of inserting extralong instruments between the intestines and having the angle of approach from below rather
than from above is questionable. We conducted a study for performing cholecystectomy using a single laparoscopic trocar.
Methods The single-trocar cholecystectomy technique was developed on five porcine animal models weighing 35–40 kg each. A 15-mm trocar
was used, inserted transumbilicaly. Retraction of the gallbladder was achieved using an endoloop and transabdominal anchoring.
Hartman’s pouch was manipulated with an endoscopic grasper, which was passed through the working channel of the endoscope,
while dissection of the triangle of Callot was performed using articulating laparoscopic instruments.
Results Single-trocar cholecystectomy was successfully performed in four of five porcine models. Average surgery time was 90 min (35–180 min).
The technique was modified and improved throughout the study. No intraoperative complications occurred.
Conclusions Single-trocar cholecystectomy is feasible and offers safe approach to this procedure. We assume that a single incision at
the umbilicus generates minimal somatic pain, and achieves excellent cosmetic results. The translation of this technique to
human subjects seems straightforward and raises the question of whether NOTES is the preferred technique for cholecystectomy. 相似文献
11.
Catherine Hubert Laurence Annet Bernard E. van Beers Jean-François Gigot 《Surgical endoscopy》2010,24(10):2626-2632
Background
External dissection of Calot’s triangle and the gallbladder associated with complete cholecystectomy is considered the gold standard technique to achieve a safe cholecystectomy. However, in severe acute or chronic cholecystitis, the laparoscopic application of this standard technique may be technically difficult, with an increased risk of bile duct injury, even in the hands of an experienced surgeon. 相似文献12.
Takayuki Hamada Yoshitsugu Tajima Junzo Yamaguchi Takashi Ueda Kunihide Izawa Hiroshi Ohtani Isao Shimokawa Takashi Kanematsu 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(2):234-237
A 3-year-old girl was admitted to hospital with complaints of severe upper abdominal pain and vomiting. On admission, a board-like
rigidity in the right hypochondrium was noted, along with a high white blood cell count and a high C-reactive protein value.
Abdominal ultrasonography (US) revealed a left-sided enlarged gallbladder with a thickened wall, without gallstones. Contrast-enhanced
computed tomography (CT) demonstrated an enlarged gallbladder without enhancement effects and a cystic duct located on the
right side of the gallbladder. The patient underwent an emergency operation following a diagnosis of torsion of the gallbladder.
The gallbladder appeared gangrenous, and 180° clockwise torsion was found at the neck of the gallbladder. The gallbladder
was straightened and then removed without difficulty because there was only slight inflammation around Calot’s triangle and
the gallbladder was not fixed to the liver. Histopathological examination revealed an acute bleeding infarction of the gallbladder.
The patient was discharged on the ninth day after surgery, without any complications. The present case suggested that abdominal
US and contrast-enhanced CT examinations are helpful in making a correct diagnosis of torsion of the gallbladder even in an
infant; in the event of this diagnosis, prompt cholecystectomy is necessary. 相似文献
13.
Hayder H. Al-Azzawi Attila Nakeeb Romil Saxena Mary A. Maluccio Henry A. Pitt 《Journal of gastrointestinal surgery》2007,11(7):835-843
Introduction Over the past decade, obesity has become epidemic, and the number of cholecystectomies as well as the percentage with acalculous
cholecystitis have increased. We have recently reported that congenitally obese mice and lean mice fed a high fat diet have
increased gallbladder wall lipids and poor gallbladder emptying. Therefore, we tested the hypothesis that compared to patients
with a normal gallbladder, patients with both acalculous and calculous cholecystitis would have increased gallbladder wall
fat.
Methods Sixteen patients who underwent cholecystectomy for acalculous cholecystitis were identified. Sixteen nondiseased controls
who underwent incidental cholecystectomy during surgery for liver or pancreatic disease and 16 diseased controls whose gallbladder
was removed for chronic calculous cholecystitis were chosen to match the acalculous patients for gender and Body Mass Index.
Pathology specimens were reviewed in a blinded fashion for gallbladder wall fat, thickness, and inflammation.
Results Acalculous cholecystitis patients were younger (p < 0.01) than nondiseased or diseased controls. Gallbladder wall fat was significantly increased (p < 0.02) in the acalculous and calculous cholecystitis patients compared to the nondiseased controls. Gallbladder wall thickness
(p < 0.02) and inflammatory score (p < 0.01) were highest in the calculous cholecystitis patients.
Conclusions These data suggest that compared to nondiseased controls, (1) patients with acalculous cholecystitis are younger and have
increased gallbladder fat and (2) patients with calculous cholecystitis have increased gallbladder fat and inflammation. We
conclude that increased gallbladder fat may lead to poor gallbladder emptying and biliary symptoms. Thus, cholecystosteatosis
may explain, in part, the increased need for cholecystectomy and the higher percentage of these patients with acalculous cholecystitis.
Presented at the 2006 SSAT (DDW) annual meeting, May 20–25, 2006, Los Angeles, CA 相似文献
14.
Shinichiro Magata Keita Kai Michito Mori Genichiro Edakuni Osamu Tokunaga Kohji Miyazaki 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(6):874-877
Fibroadenoma of the gallbladder is extremely rare tumor, with only two cases reported in the world. It is characterized by
abundant loose edematous connective tissue, glandular structure, polypoid structure covered by epithelia, and a filamentous
pedicle. We report a case of 78-year-old woman histopathologically diagnosed after surgery. Macroscopically, the tumor was
a dark-greenish solid mass with a short stalk, filling the gallbladder cavity, and it measured 11.5 × 4.0 × 3.5 cm in diameter.
Microscopically, the tumor was composed of abundant loose stroma and a glandular component. Some of the glandular cells had
hyperchromatic nuclei with disturbed polarity and were positively stained by p53 (30%) and Ki-67 (30–40%). Part of the stromal
component revealed hypercellularity with an irregular nucleus, mitosis (2–3 cells/10 high-power fields), and positivity for
Ki-67 (20%) and p53 (50%). We diagnosed this peculiar tumor as “fibroadenoma of the gallbladder with borderline malignancy”.
We present the details of this extremely rare case and discuss the pathological findings, comparing them to those in the two
previously reported cases and to carcinosarcoma of gallbladder. 相似文献
15.
S E Velez R G Llaryora F A Lerda 《Journal of laparoendoscopic & advanced surgical techniques. Part A》1999,9(3):291-293
Laparoscopy in trauma is useful in diagnosing but limited in treatment. We report the case of a patient with a stab wound in the right upper quadrant and gallbladder perforation who underwent diagnostic and laparoscopic treatment. The therapeutic opportunities in abdominal trauma are scant for laparoscopic surgery; the isolated gallbladder injury is one of them, it being possible to apply the usefulness of this less invasive technique in this case. 相似文献
16.
Marco Bueter Joern Maroske Andreas Thalheimer Martin Gasser Theresa Stingl Johannes Heimbucher Detlef Meyer Karl-Hermann Fuchs Martin Fein 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2008,393(2):199-205
Background Today, gastric banding has become a common bariatric procedure. Weight loss can be excellent, but is not sufficient in a significant
proportion of patients. Few long-term studies have been published. We present our results after up to 9 years of follow-up.
Materials and methods One hundred twenty-seven patients (1997–2004) were analyzed retrospectively after laparoscopic gastric banding (perigastric
technique: n = 60; pars flaccida technique: n = 67) in terms of preoperative characteristics, weight loss, comorbidities, short- and long-term complications, and quality
of life.
Results Median follow-up was 63 months (range 2–104). Incidence of postoperative complications were: gastric perforation in 3.1%,
band erosion in 3.1%, band or port leak in 2.3%, port infection in 5.3%, port dislocation in 6.9%, and pouch dilatation in
16.9%. Total number of patients requiring reoperation was 34 (26.7%) [perigastric technique n = 23 (38.8%) versus pars flaccida technique n = 11 (16%), p = 0.039]. Mean excess body weight loss (%) was 50.6%. Most patients reported an increase in quality of life after surgery.
Conclusions Gastric banding is effective for achieving weight loss and improving comorbidity in obese patients. Obviously, gastric banding
can be performed more safely with the pars flaccida technique, although the complication rate remains relatively high. Nevertheless,
based on adequate patient selection, gastric banding should still be considered a valuable therapeutic option in bariatric
surgery. 相似文献
17.
Yoshitsugu Tajima Noritsugu Tsuneoka M.D. Ph.D. Tamotsu Kuroki M.D. Ph.D. Takashi Kanematsu M.D. Ph.D. 《American journal of surgery》2009,197(1):e9-392
An 82-year-old woman presented with a 5-day history of right upper quadrant pain. A physical examination showed a palpable tender mass in the right upper quadrant with Murphy's sign. The contrast-enhanced multidetector computed tomography (MDCT) scan clearly showed the twisted pedicle of the cystic duct and gallbladder mesentery on the right side of the gallbladder, thus showing a “whirl sign,” and a definitive diagnosis of gallbladder torsion was made. The patient underwent a cholecystectomy, resulting in a favorable outcome. Therefore, the whirl sign on MDCT imaging can be a key to making a definitive diagnosis of gallbladder torsion. 相似文献
18.
Masatoshi Makuuchi 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2008,393(2):227-230
Background Massive bleeding remains one of main factors of morbidity and death in liver resections. For this reason, the Pringle maneuver
or total vascular exclusion is commonly used during liver resection. However, ischemic damage is still a major problem. Some
surgeons used the “glissonean” approach for bleeding control, but the technique is tedious and also time consuming, with high
incidence of bile leaks in the postoperative period. The aim of this paper is to describe a new bleeding control technique,
rapid ligation of the corresponding inflow and outflow vessels without hilus dissection before the parenchyma transection
during anatomical left liver resection and to analyze the feasibility, blood loss, transfusion requirements, and postoperative
complications.
Materials and methods During the past 18 years, we used the new hemorrhage control technique in left liver resection in 630 patients with malignant
or benign tumors.
Results The median blood loss in all 630 patients was 110 ± 250 ml (range 50–750), and no patient required blood transfusion. The
median total operative time was 77 ± 35 min (range 25–155). No bile leaks and liver failure of the patients occurred postoperatively.
There was no death within 30 postoperative days.
Conclusion The rapid ligation of the corresponding inflow and outflow vessels without hilus dissection before the parenchyma transection
is a feasible, safe, and bloodless technique during the left liver resection.
A commentary on this paper is available at 相似文献
19.
Hayder H. Al-Azzawi Abhishek Mathur Debao Lu Deborah A. Swartz-Basile Attila Nakeeb Henry A. Pitt 《Journal of gastrointestinal surgery》2007,11(1):95-100
Introduction Insulin resistance is associated with increased gallbladder volume and impaired gallbladder emptying. Resistin and resistin-like
molecule alpha (RELM-α) are adipose-derived hormones that are believed to mediate insulin resistance. Therefore, we tested
the hypothesis that administration of resistin or RELM-α would cause insulin resistance and diminish gallbladder contractility.
Methods In two sequential studies 40 eight-week-old nondiabetic lean mice were fed a chow diet for 4 weeks. In Study A, 10 mice received
20 μg of resistin IP, while in Study B 10 mice received 20 μg of RELM-α IP for seven days. In each study, 10 control mice
received an equal volume of saline IP for seven days. At 12 weeks animals were fasted and underwent cholecystectomy, and in vitro gallbladder response to neurotransmitters was determined. Serum resistin, RELM-α, glucose, and insulin levels were measured.
HOMA index, a measure of insulin resistance, was calculated.
Results RELM-α significantly increased HOMA index. RELM-α decreased gallbladder optimal tension, but did not alter responses to neurotransmitters.
Resistin had no effect on HOMA index or on gallbladder optimal tension or response.
Conclusion These data suggest that in nondiabetic lean mice: 1) resistin does not alter insulin resistance or gallbladder optimal tension,
but 2) RELM-α increases insulin resistance and reduces gallbladder optimal tension. Therefore, we concluded that RELM-α may
play a role in insulin-resistance mediated gallbladder dysmotility.
Presented at the 2006 AHPBA annual meeting, March 9–12, 2006, Miami Beach, FL. Supported by NIH grant R-01 DK44279 相似文献
20.
目的:探讨采用Ilizarov技术联合皮瓣即时扩张技术Ⅰ期矫正合并皮肤挛缩的胫骨成角畸形的临床疗效及安全性。方法:自2010年1月至2015年1月,采用Ilizarov外固定技术联合挛缩侧皮肤术中即时扩张技术Ⅰ期矫正合并皮肤挛缩的胫骨成角畸形患者30例,男21例,女9例;年龄25~60岁,平均(40.2±5.5)岁。定期复查X线片,去除Ilizarov外固定后采用美国特种外科医院(HSS)评分标准评定膝关节功能,并采用疼痛视觉模拟评分(VAS)评价其疼痛缓解程度。结果:术后所有患者获随访,时间6~35个月,平均22个月。其中29例患者切口均Ⅰ期愈合,1例患者出现切口感染并发骨髓炎,2例患者并发固定钉松动,扩张皮瓣区均无坏死,无神经血管牵拉损伤症状。术后4~7个月去除外固定架,平均(5.2±1.1)个月。矫正成角角度10°~35°,平均(25.5±3.5)°。术后根据HSS评分标准,总分92.5±6.6,其中优25例,良4例,中1例;VAS评分1.2±1.5。结论:采用Ilizarov技术联合皮瓣即时扩张技术能够Ⅰ期矫正合并皮肤挛缩的胫骨成角畸形,带架时间短,无皮肤坏死及神经症状,能够早期负重锻炼并改善患肢功能。 相似文献