ObjectiveTo observe the effects of oral Xiaoyan Lidan tablets(XYLDT) on the bile composition(total bile acids, cholesterol, phospholipids) in patients with intrahepatic duct stones after common bile duct exploration(CBDE) with T tube drainage, to explore its possible preventive effects on stone recurrence. MethodsForty consecutive patients with intrahepatic bile duct stones who underwent CBDE with T tube drainage were randomly divided into experi mental group and control group. XYLDT were administrated at day 4 after surgery in experimental group(n=20), while none of medication were given in control group(n=20). 2 mL of bile was collected through T tube in both groups at day 1, 2, 3, 7, 14, and 21 postoperatively. Total bile acids(TBA), cholesterol(CHO), and phospholipids(PLIP) in bile were measured, and TBA/CHO ratio and PLIP/CHO ratio were calculated respectively. The results were statistical analyzed. ResultsThe demographic data in both groups including age, gender, height, weight, preoperative concomitant diseases, operative time, postoperative complications, hospital stays, serum total bilirubin, direct bilirubin, alanine aminotransferase(ALT), aspartate aminotransferase(AST), and amylase were not significantly different(P > 0.05). The measurements of TBA, CHO, PLIP, and the ratio of TBA/CHO and PLIP/CHO in bile were not significant on day 1, 2, and 3 after surgery in both groups(P > 0.05). In experimental group, the TBA, CHO, and PLIP on day 7, 14, and 21 after surgery were significantly increased compared with the control group(P < 0.05). The ratio of TBA/CHO on day 7, 14, and 21 was 2.17±0.29, 2.29±0.44, and 2.59±0.58, the ratio of PLIP/CHO was 2.03±0.68, 2.84±0.64, and 2.86±0.77, respectively, which were also significantly increased compared with the control group(P < 0.05). ConclusionsOral XYLDT can increase the secretion of TBA, CHO, and PLIP, elevate the TBA/CHO and PLIP/CHO ratio, and change the bile composition which may increase the dissolution of cholesterol in the bile. Presumably, oral XYLDT may have preventive effects in the recurrence of intrahepatic bile duct stones.
ObjectiveTo investigate the effect of peroxisome proliferator-activated receptorγ(PPARγ) agonist on bile duct fibrosis induced by transforming growth factor-β1 (TGF-β1). MethodsPrimary cultures of bile duct fibroblast were treated with different concentrations of pioglitazone (PGZ) or 15-deoxy-Δ12, 14-prostaglandin J2 (15d-PGJ2) and then treated with TGF-β1. The mRNA levels of collagenⅠ(COLⅠ)、fibronectin (FN)、α-smooth muscle actin (α-SMA) and connective tissue growth factor (CTGF) were determined by RT-PCR. ResultsPGZ and 15-d-PGJ2 could down regulated the mRNA levels of COLⅠ, FN, α-SMA and CTGF induced by TGF-β1 (3 ng/mL). The same concentration of 15d-PGJ2 was a more potent inhibitor ofα-SMA and less potent inhibitor of COLⅠthan PGZ. But PGZ had the same effect as 15d-PGJ2 on CTGF. ConclusionPPARγagonist can prevent fibrosis induced by TGF-β1.
ObjectiveThe aim of this study was to evaluate the safety and feasibility of robot-assisted surgery in pancreatic cancer.MethodRecent literatures related to robot-assisted surgery in treatment of pancreatic cancer compared with traditional open surgery or traditional laparoscopic surgery were collected to make an review.ResultsCompared with the traditional laparoscopic surgery, the robot-assisted surgery was expensive, with the obvious advantages in terms of anastomosis and reconstruction. Compared with the open operation, both robot-assisted pancreaticoduodenectomy and robot-assisted distal pancreatectomy had longer operation time, but the length of hospital stay and intraoperative blood loss were obviously shortened, robot-assisted distal pancreatectomy also had higher spleen preservation rate. Compared with the traditional laparoscopic distal pancreatectomy, the number of lymph node retrieved, R0 resection rate, and splenic preservation rate were also higher in the robot-assisted group. Simultaneously, robot-assisted total pancreatectomy and midsection pancreatectomy were deemed as safe in some high-volume centers.ConclusionsRobot-assisted pancreatic cancer surgery is safe and feasible, but many surgeries are restricted to a small number of high-volume medical centers, and most cases selected to undergo robot-assisted surgery are often early stage patients with small tumor size. A lot of efforts should be made and problems should be solved.
目的探讨血清胆红素升高在急性阑尾炎坏疽、穿孔中的诊断价值。 方法回顾性分析2011年6月至2013年8月期间我院住院行手术治疗的急性阑尾炎患者的临床病理资料，比较多种指标诊断急性复杂阑尾炎的准确性。 结果复杂阑尾炎患者血清总胆红素（STB）水平明显高于非复杂阑尾炎患者（P＜0.001）。STB升高诊断复杂阑尾炎的敏感性及特异性分别为33.3%和86.2%，而血清直接胆红素(SDB）升高（≥6.65μmol/L）诊断复杂阑尾炎的敏感性及特异性分别为78.1%和63.5%。系统炎症反应（SIRS）评分与STB联合诊断具最佳诊断效能，受试者操作特征曲线下面积为0.741，而血清白细胞计数（特异性40.7%）诊断准确性相对较低。 结论SDB升高诊断急性阑尾炎坏疽、穿孔的准确性较佳，STB与SIRS评分联合诊断可作为早期鉴别诊断复杂阑尾炎的参考指标。