ObjectiveTo explore the relationship between the -2548 G/A functional polymorphism in the 5′ promoter region of the leptin gene and gallstones. Methods The -2548 G/A polymorphisms of leptin gene were determined by polymerase chain reactionrestriction fragment length polymorphism technology (PCRRFLP) in 118 patients with cholesterol gallstones and 53 normal control subjects. Then the allele and genotype distribution were studied. Results The distribution of leptin2458 G/A in two groups was statistically significantly different: the genotype frequency of AA+GA of patients in gallstone group was higher than that in control group (χ2=4.251, P=0.039). AA+AG genotype had 2.813 times greater risk for gallstone disease compared with GG genotype (OR=2.813, 95% CI=1.020-7.757). Allele frequency distribution in the two groups was different: the allele frequency of A of patients in gallstone group was higher than that in control group (χ2=5.791, P=0.016). The risk of gallstone disease in the A alleles carriers was 1.777 times as higher as the carriers of G alleles (OR=1.777, 95% CI=1.110-2.844). ConclusionThe -2548 G/A polymorphism in the 5′ promoter region of leptin gene is significantly correlated with the gallstones. The A alleles of leptin may be a genetic factor which contributes to individual susceptibility for gallstone, while the G alleles of leptin may be a genetic factor that prevents people from gallstone.
【摘要】目的 探讨十二指肠镜、腹腔镜联合治疗胆囊结石合并胆总管结石的治疗效果。 方法 采用十二指肠镜取出胆总管结石后，再用腹腔镜切除胆囊治疗胆囊结石合并胆总管结石病例的方法。 结果 51例患者的治疗均获得成功。 结论 胆囊结石合并胆总管结石的病例，通过十二指肠镜取出胆总管结石后，再行腹腔镜胆囊切除术，可避免开腹或腹腔镜胆总管探查等操作较复杂、创伤较大的手术方式。
Objective To explore the expression of tumor necrosis factor (TNF) mRNA, TNF and TNFR in the gallbladder mucosa which developed from hyperplasia, dysplasia to carcinoma, and to further discuss the relationship between TNF and pathogenesis of gallbladder carcinoma. Methods In situ hybridization and immunohistochemistry were used to determine TNF mRNA, TNF protein and TNFR protein expression in hyperplasia, dysplasia and carcinoma of gallbladder. Results ①No one of 20 cases of gallbladder hyperplasia was found to express TNF mRNA, while 4 of 20 (20%) cases of dysplasia and 18 of 20 (90%) cases of carcinoma were found to express TNF mRNA (P＜0.05). ②For the expression of TNF mRNA in mononuclear cells (MNC), positive staining was found in 15% of gallbladder hyperplasia, 85% of dysplasia and 90% of carcinoma, respectively (P＜0.05). The cell numbers of positive staining MNC were 4.85±1.50, 6.00±2.71 and 9.33±3.07, respectively (P＜0.05). ③In gallbladder carcinoma, the cell number of carcinoma and MNC with positive TNF mRNA expression was correlated with clinical stage (P＜0.05). The higher the clinical stage, the more the positive staining cell numbers. The positive staining cell numbers of carcinoma in stage Ⅰ-Ⅲ and Ⅳ-Ⅴ were 9.13±4.39 and 14.80±4.02, respectively (P＜0.01), and the positive staining cell numbers of MNC were 7.13±2.53 and 11.10±2.23, respectively (P＜0.05). ④The cell numbers of carcinoma and MNC with TNF mRNA expression increased with tumor size. In tumors with diameter over 2 cm and less than 2 cm, the positive staining cell numbers of carcinoma were 14.00±4.20 and 8.83±4.96, respectively (P＜0.05), and that of MNC were 10.50±2.54 and 7.00±2.83, respectively (P＜0.05). ⑤The region of TNF protein expression was similar to that of TNF mRNA, but TNF protein expression was more frequent and wider than that of TNF mRNA. ⑥The tumor necrosis factor receptor was expressed in tumoral vascular endothelial cells and MNC in all cases of carcinoma, but was negatively stained in mucosa epithelial cells and tumor cells of all cases. ⑦There was positive linear correlation in TNF mRNA between tumor cell and MNC (r=0.687, P＜0.01), same as that in TNF protein expression (r=0.742, P＜0.01); and there was positive linear correlation in tumor cell between TNF mRNA and TNF protein expression (r=0.847, P＜0.01), same as that in MNC (r=0.643, P＜0.01). Conclusion The TNF mRNA and TNF protein expression are increasing during the development of gallbladder mucosa epithelial from hyperplasia, dysplasia to carcinoma, and increasing with tumor stage. It suggests that TNF may contribute to carcinogenesis of gallbladder carcinoma induced by gallstone, and related to the progression of gallbladder carcinoma.
ObjectiveTo study the relationship between cholecystectomy and Helicobacter pylori （Hp） infection. MethodsOne hundred and eleven patients with cholecystolithiasis were chosen as the investigation group, while 577 patients with upper digestive tract symptoms without cholecystolithiasis as the control group. All the patients took the 13C breath test to determine whether they were infected by Hp. All the patients with Hp infection continued eradical therapy for Hp infection for one course after cholecystectomy and were followed up on outpatient basis. ResultsThe infection rate in the investigation group was 45.9%, while 27.4% in the control group. During the 3 to 6 months of followup for the patients undergoing eradical therapy for Hp infection, we found no patient complaining of epigastric pain, malaise, belching and nausea. ConclusionThe infection rate of Hp in patients with cholecystolithiasis is high, Hp may be one of the factors causing “postcholecystectomy syndrome”. Eradical therapy for Hp after cholecystectomy will help improve the effects of operation.
目的探讨Mirizzi综合征的诊断和治疗选择。方法对1982～2000年经手术证实的36例Mirizzi综合征进行回顾性分析。结果术前确诊仅8例(22.2%)，其中5例经ERCP确诊。36例分别选择性地施行了胆囊切除术、胆囊大部切除术、胆管瘘口修补术以及胆肠RouxenY吻合术。32例术后一期愈合，4例出现并发症，其中2例并发胆管狭窄而再次手术。结论B超结合ERCP检查可以提高Mirizzi综合征的术前确诊率， 手术治疗是其主要治疗方法，手术方式取决于局部病理损伤程度和解剖变异。
Objective To probe into disorder of plasma lipids and apolipoproteins in patients with gallstone,and their position and function in formation of gallstone. MethodsConcentration of plasma lipids and apolipoproteins in 94 healthy subjects and 161 patients with gallstones was investigated. ResultsThe gallstone group had a higher serum mean concentration of TG,Apo CⅡ,Apo CⅢ, and had a lower serum mean concentration of TC，HDLc，HDL2c，HDL3c and LDLc as compared with the control group (P＜0.01 or P＜0.05). Conclusion Higher serum mean concentration of TG，Apo CⅡ，Apo CⅢ, and lower serum mean concentration of TC, HDLc, HDL2c, HDL3c and LDLc, are characteristic of lipids metabolism and important cause of formation of gallstone.
目的探讨胆囊结石病引起胆道内瘘的原因，提高其诊断和治疗水平。方法收集我院1990～1999年收治的胆道内瘘患者46例，并对其病因、诊断与治疗进行分析。结果胆囊十二指肠瘘18例（39.1%），胆囊结肠瘘8例（17.4%），胆囊与胃、空肠内瘘各1例（4.3%）； 胆囊胆管瘘18例（39.1%）。术后出现并发症4例（8.7%），死亡1例（2.2%），治愈率为97.8%。结论重视本病的临床表现及术前、术中检查，选择恰当手术方式，可减少死亡与并发症的发生。
Objective To discuss the relationship between motilin, vasoactive intestinal peptide and the gallstone formation. Methods The level of motilin, vasoactive intestinal peptide in plasma, bile and gallbladder tissue of 48 cases of chololithiasis before operation and the first, third, seventh day after cholecystectomy were mesured by radioimmunoassay. Results The level of motilin in plasma was markedly increased in patients with chololithiasis before cholecystectomy and the first day after cholecystectomy. The level of motilin, vasoactive intestinal peptide in bile and gallbladder tissue were significantly increased in patients and motilin was positively correlated with vasoactive intestinal peptide in the gallbladder tissue. Conclusion Motilin, vasoactive intestinal peptide might affect the gallstone formation by affecting the motility of gallbladder.