Objective To investigate the relationship between the polymorphism of 7α-hydroxylase (CYP7A1) and cholestero1 cholecystolithiasis. Methods CYP7A-1 genotyping was performed by PCR-RFLP approach in 160 cholesterol cholecystolithiasis patients and 94 control subjects.Results The frequencies of C, A allele of CYP7A1 gene were 83.75%, 16.25% in cholesterol cholecystolithiasis patients and 81.91% and 18.09% in control group. There was no significant difference in frequencies of allele and genotype in A-204C polymorphism between two groups (Pgt;0.05). In control group and cholesterol cholecystolithiasis group， LDL-C levels in AA genotypes were lower than those in CC and CA genotype (Plt;0.05). Conclusion The results indicate that no direct association is found between CYP7A-1 gene and cholesterol cholecystolithiasis，but there is significant correlation between the polymorphism of the CYP7A-1 gene and the levels of LDL-C.
ObjectiveTo explore technical essentials and safety of laparoscopic cholecystectomy (LC) guided by gallbladder ampulla localization on an imaginary clock for cholecystitis.MethodsA retrospective study of 8 707 continuous patients with mild cholecystitis who underwent LC from July 1998 to February 2018 at a single institution was conducted. Among them, 3 168 patients were treated by the traditional LC from July 1998 to February 2007 (a traditional LC group), 5 539 patients were treated by the LC with the guidance of the gallbladder ampulla localization on an imaginary clock from March 2007 to February 2018 (a gallbladder ampulla localization group). The conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury, operative time, intraoperative blood loss, and postoperative hospital stays were compared between the traditional LC group and the gallbladder ampulla localization group.ResultsThere were no significant differences in the gender, age, course of disease, and type of cholecystitis between these two groups (P>0.050). The rates of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury and the operative time, intraoperative blood loss and postoperative hospital stays in the traditional LC group were 3.00% (95/3 168), 0.13% (4/3 168), 0.09% (3/3 168), 0.03% (1/3 168), (43.6±12.6) min, (18.7±3.3) mL, (3.6±2.7) d, respectively, which in the gallbladder ampulla localization group were 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), (32.2±10.5) min, (12.4±3.5) mL, (3.5±2.8) d, respectively. The differences of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding rates, and the operative time and intraoperative blood loss were statistically significant between these two groups (P<0.050). The differences of the bile leakage without bile duct injury rate and postoperative hospital stays were not statistically significant between the two groups (P>0.050).ConclusionThis study shows that gallbladder ampulla localization on an imaginary clock is useful for ductal identification so as to reduce bile duct injury and improve safety of LC in case of no conversion to open surgery.
ObjectiveTo explore the clinical value of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and LC combined with laparoscopiccommom bile duct exploration and primary sture (LBDEPS) in the treatment of cholecystolithiasis complicated with choledocholithiasis in the elderly (age more than 75 years old).MethodsThe elderly patients with cholecystolithiasis complicated with choledocholithiasis in the Tianyou Hospital Affiliated to Wuhan University of Science and Technology from March 1, 2018 to June 30, 2019 were retrospectively collected, then were designed into an ERCP combined with LC therapy group (ERCP+LC group) and a LC combined with LBDEPS therapy group (LC+LBDEPS group) according to the therapy methods. The operative indexes (total operation time, general anesthesia time, intraoperative bleeding volume, LC conversion to laparotomy) and postoperative indexes (conversion to ICU, use time of ventilator in the ICU, drainage tube indwelling time, ventilation time, time of getting out of bed, postoperative hospitalization time, total hospitalization time, total hospitalization costs, stone clearance rate, and complications) were compared between the two groups.ResultsIn this study, 67 patients were collected, including 35 patients in the ERCP+LC group and 32 patients in the LC+LBDEPS group. There were no significant differences between the two groups in the terms of baseline data, such as the patients’ gender, age, preoperative symptoms, preoperative complications, number of choledocholithiasis, maximum diameter of choledocholithiasis, and diameter of common bile duct, etc. (P>0.05). Compared with the LC+LBDEPS group, the ERCP+LC group had more advantages in the terms of the total operation time, general anesthesia time, intraoperative bleeding, rate of LC conversion to laparotomy, time of ventilator use in the ICU, postoperative ventilation time, postoperative time of getting out of bed, and drainage tube indwelling time (P<0.05). The others indexes had no significant differences between the two groups (P>0.05).ConclusionsAccording to the results of this study, therapeutic efficacy of ERCP+LC and LC+LBDEPS in treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis have no significant differences, but ERCP+LC therapy has more advantages than LC+LBDEPS in total operation time, general anesthesia time, intraoperative bleeding, LC conversion to laparotomy, postoperative recovery and so on, and appropriate operation mode might be selected according to specific situation of patients and local medical conditions.
Objective To investigate the effect of cholecystolithiasis with cholecystitis and cholecystectomy on intestinal flora in patients with colorectal cancer. Methods A total of 168 patients with colorectal cancer who admitted to the Department of Anorectal Surgery in Gansu Provincial Hospital from June 2020 to March 2021 were selected, and 29 patients with colorectal cancer who met the criteria were selected as the research objects, including 10 colorectal cancer patients with gallstones and cholecystitis (cholecystolithiasis with cholecystitis+colorectal cancer group), 10 colorectal cancer patients after cholecystectomy (cholecystectomy+colorectal cancer group), and 9 colorectal cancer patients with normal gallbladder (normal gallbladder+colorectal cancer group). Clinical data of the patients in three groups were collected and compared. The fresh fecal samples of the patients included in the study were collected, and the 16S rDNA high-throughput sequencing method was used to determine and analyze the composition and distribution of the intestinal flora in the obtained samples. Results The interleukin-6 level in the cholecystolithiasis with cholecystitis+colorectal cancer group was statistically higher than that in the normal gallbladder+colorectal cancer group and the cholecystectomy+colorectal cancer group (P<0.05). At the phylum level of the fecal flora in three groups patients: ① In the samples of three groups, the relative abundances of Bacteroidetes, Firmicutes, Proteobacteria, Fusobacteria and Verrucomicrobia phylums were all high, accounting for almost more than 95% of the total intestinal bacteria. ② The relative abundance of Fusobacteria phylum in the cholecystolithiasis with cholecystitis+colorectal cancer group was statistically higher than that in the normal gallbladder+colorectal cancer group (P<0.05). ③ The relative abundance of Verrucomicrobia phylum in the normal gallbladder+colorectal cancer group was statistically higher than that in the cholecystolithiasis with cholecystitis+colorectal cancer group and the cholecystectomy+colorectal cancer group (P<0.05). ④ The relative abundance of Synergistetes phylum in the cholecystectomy+colorectal cancer group was statistically higher than that in the cholecystolithiasis with cholecystitis+colorectal cancer group and the normal gallbladder+colorectal cancer group (P<0.05). At the genus level: ① The relative abundances of Bacteroidetes and Roseburia genus were lower in the gallstone with cholecystitis+colorectal cancer group than those in the cholecystectomy+colorectal cancer group and the normal gallbladder+colorectal cancer group (P<0.05). ② The relative abundance of Shigella genus in the cholecystectomy+colorectal cancer group was higher than that in the cholecystolithiasis with cholecystitis+colorectal cancer group (P<0.05). ③ The relative abundance of the Lachnospira genus in the cholecystolithiasis with cholecystitis+colorectal cancer group was lower than that in the normal gallbladder+colorectal cancer group (P<0.05). ④ The relative abundances of Prevotella and Fusobacteria genus were higher in the cholecystolithiasis with cholecystitis+colorectal cancer group than that in the cholecystectomy+colorectal cancer group and the normal gallbladder+colorectal cancer group (P<0.05). ⑤ The relative abundances of Clostridium and Akkermansia genus were lower in the cholecystolithiasis with cholecystitis+colorectal cancer group and the cholecystectomy+colorectal cancer group than that in the normal gallbladder+colorectal cancer group (P<0.05). ⑥ The relative abundance of Enterococcus genus was higher in the normal gallbladder+colorectal cancer group than that in the cholecystectomy+colorectal cancer group (P<0.05).Conclusions ① Long-term occurrence of cholecystolithiasis with cholecystitis can cause obvious decrease in the abundances of Bacteroides, Roseburia, Lachnospira, etc. ② Cholecystectomy can cause changes in the relative abundances of Clostridium, Enterococcus, Verrucomicrobia, Synergistetes, etc. ③ The relative abundance of Fusobacterium is obviously increased in colorectal cancer patients with gallstones and cholecystitis, then promotes the release of inflammatory cytokines and causes intestinal inflammation, which is conducive to the growth of opportunistic pathogens, thus may affect the occurrence and development of colorectal cancer.