p16基因产物表达与胆囊癌生物学行为和预后的关系

目的与方法:为了解p16基因与胆囊癌发生、生物学行为和预后的关系,采用免疫组化ABC法对36例胆囊癌和20例胆囊腺瘤中的p16蛋白进行了检测.结果:胆囊癌中p16蛋白的阳性率低于胆囊腺瘤(P<0.05);不同组织类型和分化程度不同的胆囊癌之间p16蛋白的阳性率无明显差别(P>0.05);p16蛋白的表达与胆囊癌有无浸润和淋巴结转移及病人的生存期密切相关(P<0.05).结论:p16基因失活与胆囊癌的发生有关,p16蛋白表达缺失与胆囊癌进展和预后不良有关.     

p53和p16在胆囊癌中的表达

目的探讨抑癌基因ｐ５３和ｐ１６改变对胆囊癌发生的作用。方法采用免疫组化方法检测３４例胆囊癌和２６例慢性胆囊炎标本中ｐ５３和ｐ１６的表达。结果慢性胆囊炎标本中ｐ５３１例阳性，阳性率为３．９％。胆囊癌中ｐ５３有１７例阳性，阳性率为５０％。两者表达差异有显著性（Ｐ＜０．００１）。ｐ１６在慢性胆囊炎标本中有１４例阳性，阳性率为５３．８％，胆囊癌中２９例阳性，阳性率为８５．３％，明显高于慢性胆囊炎（Ｐ＜０．０２）。结论ｐ５３过表达与胆囊癌发生之间存在一定的联系，但对胆囊癌的发展、侵袭影响不大。ｐ１６在胆囊癌发生中可能受某些癌基因的反馈调节而过度表达，其作用机制尚不十分清楚。     

胆囊癌与妊娠关系的全人群病例对照研究

目的探讨胆囊癌与妊娠的关系.方法采用全人群病例对照研究,研究对象为1997年6月1日～2001年5月31日期间确诊、年龄在35～74岁的上海市区女性胆囊癌269例以及按年龄(5岁一组)频数配对的538名人群对照,采用非条件lo-gistic回归模型分析妊娠与胆囊癌的关系.结果胆囊癌合并胆石症者中,与妊娠次数≤2次者比较,妊娠次数(3次,4次,5次及≥6次)的各组调整OR分别为1.33(95%CI:0.59-2.99),1.34(95%CI:0.58-3.11),1.39(95%CI:0.57-3.43)和2.67(95%CI:1.12-6.41),趋势检验P=0.03.结论多次妊娠可能通过胆石症影响胆囊癌的发生,生育因素导致的女性体内雌、孕激素水平的升高可能在胆囊癌病因学中起一定的作用.     

白藜芦醇抑制胆囊癌细胞生长与诱导细胞凋亡的实验研究

目的:探讨白藜芦醇(Res)对胆囊癌细胞(GBC)和正常成纤维细胞(3T3)体外增殖的影响,进而观察Res对GBC和3T3细胞凋亡的影响.方法:MTT法测定肿瘤细胞生长抑制率;流式细胞术分析细胞周期,检测细胞凋亡;SABC法检测细胞bcl-2、c-myc、p53蛋白表达.结果:Res呈浓度依赖性抑制GBC细胞的生长与增殖(P＜0.01),抑制率最高可达54%.Res能明显诱导GBC细胞凋亡,凋亡率最高为30.52%;处理组较对照组G1期细胞由34.88%上升至55.47±3.95%,S期细胞减少8.41%～17.54%,呈明显的G0/G1期阻滞现象.GBC细胞的bcl-2、c-myc基因蛋白表达降低,而p53基因蛋白表达增强.结论:Res能通过诱导GBC细胞凋亡而抑制其生长与增殖,但对3T3细胞无此作用.     

手术对Ⅳ期胆囊癌预后的影响

目的分析不同手术方式对Ⅳ期胆囊癌预后的影响.方法对1997年6月～2001年5月间上海市172例Ⅳ期胆囊癌病例进行临床病理分析,并对获得随访的164例的预后与手术方式的关系进行探讨.数据分析采用Kaplan-Meier法.结果 172例中未手术者44例(25.6%),手术者128例(74.4%),其中包括单纯胆囊切除术45例(35.1%)、胆囊癌根治性切除术17例(13.3%)、胆囊癌扩大根治性切除术5例(3.9%)和剖腹探查术61例(47.7%).在行根治性切除者中,Ⅳa和Ⅳb期的1年生存率分别为69.2%和40.7%,明显好于胆囊未切除或单纯切除者,在Ⅳa和Ⅳb期中各有2例存活期超过5年.结论有选择地进行Ⅳ期胆囊癌病例根治性或扩大根治性手术,有助于改善预后.     

Lessons learnt from a case of extracorporeal shockwave lithotripsy for a residual gallbladder stone

IntroductionExtracorporeal shockwave lithotripsy (ECSWL) for gallstones is rarely used due to high recurrence rates, but has been reported to be effective in some circumstances.Presentation of caseWe describe a case of a failed attempt at laparoscopic cholecystectomy due to gallbladder contraction and complete obliteration of Calot’s triangle. Cholecystotomy was performed to remove all visible stones, and completed by a subtotal cholecystectomy and closure of the gallbladder remnant. The patient remained symptomatic due to a residual stone in the Hartmann’s pouch. ECSWL was attempted to fragment the stone; however, follow-up imaging showed persistence of the calculus.DiscussionLiterature review shows that ECSWL for multiple gallbladder stones has a low success rate. Even if a stone is successfully fragmented, a diseased gallbladder remnant seems incapable of expelling the fragments. Without completion endoscopic clearance, therefore, the treatment is considered incomplete.ConclusionOur case suggests that ECSWL is ineffective in management of residual gallbladder stones after failed cholecystectomy.     

23例胃癌合并胆囊结石的手术治疗分析

目的比较对胃癌合并胆囊结石患者进行同时摘除胆囊联合胃部手术的临床治疗效果。方法根据患者的病情将其分划为胃癌合并胆囊结石和单纯性胃癌两种类型,将上述两种类型的患者分为实验组和观察组,观察组由单纯性胃癌患者组成,实验组由胃癌合并胆囊结石患者组成,每组各23例;对观察组患者采用传统常规手术治疗方式,对实验组患者采用同时摘除胆囊的联合胃部手术治疗方式。结果两组患者在术后2d引流量,术后住院时间和不良反应发生率等指标比较,差异均不存在统计学意义(P>0.05)。结论同时摘除胆囊联合胃部手术治疗方式不会影响患者术后引流量,延长住院时间和增加术后不良反应发生率等异常事件,此方法安全可靠,值得在临床治疗过程中,大范围推广使用。     

基于预约患者优先就诊的医院信息系统功能改造

以预约挂号为抓手，不断优化门诊业务流程。在现有信息系统的基础上，重新修改、设计，省去了预约患者在就诊当日还需在窗口排队确认的过程，将人群有效分流至各分诊台。一方面有效解决了患者窗口排队等候时间长的问题，另一方面提高了医院的门诊服务质量。系统上线后，取得了良好效果。     

Diagnosis of Gallbladder Perforation—a Puzzle!

Gallstone disease is common and complications frequently encountered include acute cholecystitis, acute pancreatitis, and cholangitis, but gallbladder perforation (GBP) is rare. A definitive diagnosis is uncommon before surgery and morbidity and mortality associated with this condition are high. Reported incidence ranges between 2 and 10.6 % in patients with acute cholecystitis but is higher in patients managed conservatively. We report here five patients with GBP to show the difficulty in making an early diagnosis.     

Successful laparoscopic management of duplicate gallbladder: A case report and review of literature

IntroductionGallbladder duplication is a rare congenital anomaly. Recognition of this anomaly and its various types is important since it can complicate a simple hepatobiliary surgical procedure.Presentation of caseWe report a case of a 42 year old female who presented a 6 year history of intermittent right upper quadrant abdominal pain. Her basic blood investigations including liver function tests were normal. Pre-operative imaging revealed a cystic lesion communicating with biliary tree representing duplicated gallbladder. She subsequently underwent successful laparoscopic cholecystectomy. The operative challenges were more than those anticipated at the usual laparoscopic gallbladder procedures. After six months follow up the patient remained asymptomatic.DiscussionPreoperative diagnosis plays a crucial role in planning surgery, and preventing possible biliary injuries or re-operation if accessory gallbladder has been overlooked during initial surgery. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for suspected duplicate gallbladder. Laparoscopic cholecystectomy for duplicate gallbladder is a challenging operation and should be performed with meticulous dissection of the cysto-hepatic triangle.ConclusionGallbladder anomalies should be anticipated in the presence of a cystic lesion reported around the gallbladder. The laparoscopic cholecystectomy remains feasible for intervention and should be done by an experienced laparoscopic surgeon.