Objective To study the etiology,diagnosis and treatment of xanthogranulomatous cholecystitis (XGC).Methods Clinical data of 78 cases with xanthogranulomatous cholecystitis (confirmed by postoperative pathology) from January 1985 to December 2012 were reviewed retrospectively.Results All 78 cases underwent ultrasonography,50 cases did CT scan.Preoperative diagnosis included chronic calculous cholecystitis in 60 cases,gallbladder carcinoma with cholelithiasis in 8 cases,gallbladder space-occupying lesions in 10 cases.Among those 68 cases of tentative gallstone disease,67 cases were with gallbladder neck incarcerated stones.Surgery were performed in all 78 cases including cholecystectomy in 48 cases,partial cholecystectomy or subtotal resection in 13 eases,cholecystectomy with partial hepatic wedge resection in 12 cases.Intraoperatively 5 cases were misdiagnosed as the carcinoma of the gallbladder and underwent partial liver resection along with cholecystectomy.17 cases underwent choledocholithotomy.2 cases suffered from hepatic duct injury and received Roux-en-Y hepatojejunal anastomosis.Conclusions XGC is a special type of chronic cholecystitis,and accompanied by yellow granuloma formation.Preoperative diagnosis of XGC is often difficult,the definite diagnosis depends on intraoperative fiozen and postoperative paraffin pathology.

Objectiye To evaluate the therapeutic efficacy and safety of (endoscopic sphincterotomy, EST) plus balloon dilation for difficult bile duct stones. Methods Patients with difficult common bile duct stones on endoscopic retrograde cholangiopancreatography (ERCP) from March 2008 to December 2009 were randomly divided into 2 groups to receive EST or EST plus balloon dilation ( EST + EPBD), respectively. The success rate of complete stone removal, number of endoscopic sessions, the rate of using mechanical lithotripsy and the complication rate related to the procedure were compared between the 2 groups. Results Compared with EST alone, EST plus balloon dilation resulted in similar outcomes in terms of overall successful stone removal rate (2/62 vs. 2/61 ) and early complication rate (4/62 vs. 6/61, P ＞0. 05). However,EST group needed more sessions ( EST 15/46 vs. EST + EPBD 5/57, P ＜0. 05) and use of mechanical lithotripsy to achieve complete removal of stones ( EST 12/61 vs. EST + EPBD 4/61, P ＜0. 05 ). Conclusion EST plus balloon dilation is as safe and effective as, but more convenient than EST, for endoscopic removal of common bile duct stones.

Objective To evaluate the efficacy and safety of fluoroscopy guided frequency-doubled double-pulsed laser lithotripsy for removing difficult bile duct stones. Methods From March 2008 to December 2009, patients with difficult bile duct stones were divided into cholangioscopy guided group ( n = 21 )and fluoroscopy guided group ( n = 19) to receive corresponding treatments. The success rate of complete stone removal and the complication rate related to the procedure were compared between the two groups.Results There are no significant differences between 2 groups in regarding of either success rate of complete stone removal ( 19/21, 90. 5% in cholangioscopy guided group vs. 17/19, 89. 5% in fluoroscopy guided group, P ＞0. 05 ) or rate of procedure related complication (4/21, 19. 0% in cholangioscopy guided group vs. 3/19, 15. 8% in fluoroscopic guided group, P = 0. 559 ). Conclusion Frequency-doubled doublepulsed laser lithotripsy guided by cholangioscopy or fluoroscopy are both safe and effective.

Objective To compare therapeutic efficacy and safety of covered and uncovered self-expandable metal stents for malignant biliary obstruction.Methods From October 2010 to August 2012,patients with unresectable malignant biliary obstruction were recruited and divided into 2 groups to receive covered metal stents (group A) or uncovered metal stents (group B).Efficacy and complication of the procedure were compared.Results A total of 81 patients were recruited,with 41 in group A and 40 in group B.Stents were placed successfully in all patients.The median patency time of stent in group A was 182.5 d,which was not significantly different from that of group B (195.0 d,P =0.616).Complications occurred in 3 patients of group A (7.3％) and 4 of group B (10％).Conclusion Covered and uncovered metal stents are both safe and effective for treatment of malignant biliary obstruction with same patency time.

ObjectiveTo explore the efficacy and safety of temporary placement of fully covered metal stent in the treatment of benign biliary strictures.MethodsFully covered metal stents were placed in 36 patients with benign biliary strictures.All patients were followed up every 1-2 months and the stents were removed when adequate biliary drainage was achieved.ResultsResolution of the benign biliary strictures was achieved in 28 of 36 patients (77.8％ ).All fully covered metal stents were removed successfully.Complications were observed in 3 patients (8.3％) after stent placement and in 1 (2.8％ ) after stent removal.ConclusionTemporary placement of fully covered metal stents for benign biliary strictures is safe and efficacious.Further investigation is required to longer follow-up.

Objective To evaluate the efficacy and safety of Spyglass single-operator cholangioscopy-guided laser lithotripsy for removing difficult bile duct stones.Methods A total of 39 patients with difficult bile duct stones were divided into Spyglass single-operator cholangioscopy-guided group (n =20) and fluoroscopy guided group (n =19) to receive corresponding treatments.The success rates of complete stone removal and the complication rates related to the procedure were compared between the two groups.Results There was no significant difference in success rate of complete stone removal between Spyglass single-operator cholangioscopy-guided group(17/20, 85.0％) and the fluoroscopy guided group(16/19, 84.2％ ,P =0.661) or in rates of procedure related complication (acute pancreatitis P =0.695, infection of bile duct P =1.000).Conclusion Both Spyglass single-operator cholangioscopy-guided laser lithotripsy and fluoroscopy are safe and effective.

Objective To analyse the nutrients of Acaudina leucoprocta and explore its hypolipidemic effect. Method The nutrients constituents of Acaudina leucoprocta were analyzed by high-performance liquid chromatography,and was compared with Apstichopus japonicus. The hyperlipidemia model was estabolished by feeding SD male mice with high fat feed. The change of liver index and fat coefficient as well as the effects on serum lipid,antioxidant capacity of serum in rats were observed. Results The fat content of Acaudina leucoprocta was only 0.43%,significantly lower than that of Apstichopus japonicus. The content of amino acids in Acaudina leucoprocta was higher than that of Apstichopus japonicus. Acaudina leucoprocta would decrease the liver index,fat coefficient and TC,TG,LDL-C,LDL-C/HDL-C in serum significantly,and increase HDL-C and HDL-C/TC. MDA and NEFA contents were effectively reduced. GSH-Px activitives were enhanced. Conclusion Acaudina leucoprocta is very rich in protein,and low in fat content. It has hypolipidemic and antioxidative effects,and may reduce the oxidative damage caused by high fat diet. Acaudina leucoprocta may be used as a functional food.

Objective To optimize the enzymolysis condition for Acaudina leucoprocta to research lencoprocta the antioxidant activity of its hyoholysate in vivo.Method Response surface methodology (RSM) was employed to optimize the hydrolysis conditions with protamex.The ICR mice were given ig the hydrolysate of Acaudina lencoprocta obtained under optimal conditions.The activity of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) and the content of MDA in blood serum and liver in mice were analyzed.Results and Conclusion The best hydrolysis conditions were:the amount of enzyme was 2.02%;enzymolysis temperature was 51.18 ℃;enzymolysis time was 127.81min,hydroxyl radical scavenging rate was 73.10%.The activities of SOD,GSH-Px in hydrolysate were significantly enhanced and the content of MDA was significantly lower,which showed that this hydrolysate had remarkable antioxidation activity.So the enzymolysis technology for Acaudina leucoprocta was optimal.

Objective To test the protective effect of a new Ringer's malate solution on intestine's apoptosis caused by hemorrhagic shock in rats.Methods Forty-eight Sprague-Dawley male rats, weighing 280-320 g, were randomly assigned into four groups: sham shock group (group SS), normal saline group (group NS), Ringer's lactate group (group RL) and Ringer's malate (group RM), n=12 each.The group SS was served as control group, the other groups were subjected to 60 min of hemorrhagic shock followed by crystalloid resuscitation.Those rats were sacrificed 3 h after resuscitation.Intestinal tissue was harvested to detect Bcl-2/Bax protein level, the bioactivity of superoxide dismutase (SOD) and malondialdehyde (MDA) level.The level of intestinal cell apotosis was measured using TUNEL method and apoptosis index was calculated.The intestinal histopathology was examined.Results Compared with group SS, the expression of Bcl-2 and the bioactivity of SOD were lower, the level of Bax protein, MDA and apoptotic index were higher in groups NS, RL and RM (P<0.05).Compared with groups NS and RL, the expression of Bcl-2 and the bioactivity of SOD was higher, the level of Bax protein, MDA and apoptotic index were lower in group RM (P<0.05).Histopathological examination showed that group RM was better than group NS and group RL.Conclusion Ringer's malate alleviated intestinal apoptosis caused by hemorrhagic shock in rats.The study suggests that Ringer's malate solution could be a potential new therapeutic agent for fluid resuscitation.

Objective To evaluate a method named “one-step procedure”,i.e.,combined duode-noscopy,laparoscopy and choledochoscopy for choledocholithiasis accompanied with cholecystolithiasis.Meth-ods Fifty-three cases with gallbladder stones combined with common bile duct stones diagnosed from February 2012 to February 2014 were assigned to two groups,29 cases in “one-step procedure”group,who underwent duodenoscopy,laparoscopy and choledochoscopy in one operation,and 24 cases in the control group,who first-ly underwent endoscopic sphincterotomy to remove common bile duct stones,and then LC was performed after several days.The rate of complications related to the procedure,success rate of complete stone removal,length of hospital stay and hospitalization expenses were compared between the two groups.Results All 53 patients underwent the surgery and ERCP procedure successfully.There were no significant differences between the“one-step procedure”group and the control group in complication rates[3.4%(1 /29)VS 12.5%(3 /24),P =0.21],complete stone removal rates[96.6%(28 /29)VS 100.0%(24/24),P =0.37].Differences were sig-nificant in length of hospital stay (6.7 ±1.3d VS 10.9 ±1.6d,P <0.01 )and hospitalization expenses (15 724 ±1 613 yuan VS 19 829 ±2 433 yuan,P <0.05)between the “one-step procedure”group and the control group.Conclusion The “one-step procedure”,the combined duodenoscopy,laparoscopy and chole-dochoscopy,is safe,effective,and has smaller length of hospital stay and lower hospitalization expenses.