ObjectiveTo explore the efficacy of the technique of reticular basket through cystic duct stone removal during laparoscopic common bile duct exploration.MethodsFrom January 2008 to February 2011,185 patients received laparoscopic bile duct exploration in our hospital.These patients underwent intraoperative cholangiography (IOC) through the cystic duct with a reticular basket.With the help of a choledochoscope,a reticular basket was used to take out stones for patients who were shadow-positive.Re-cholangiography was then performed to ascertain that no stone was retained in the biliary tract.ResultsOf the 185 patients,60 were found to be positive on IOC.Stones were successfully removed by using a reticular basket through the cystic duct in 45 patients,and through the cystic duct and common bile duct after a micro-incision was made under choledochoscopic assistance in 10 patients.After laparoscopic common bile duct exploration re-cholangiography found no residual stones in these patients. In 5 patients,stones were removed after conversion to open surgery. Conclusions During laparoscopic common bile duct exploration,using reticular baskets via the cystic duct for intraoperative cholangiography (IOC) and removing stones is of great value.

Objective To evaluate the effect of improving microcirculation and preventing cell Ca 2+ overload in preventing the development of acute pancreatitis (AP).Methods 278 AP patients admitted from 1990 to 1994 and from 1995 to 1999 were retrospectively analyzed. Routine conservative managements were performed in the first stage,improving microcirculation and preventing cell Ca 2+ overload were performed in the second stage.Results During the first period,there were 124 patients with AP.The conversion of mild AP to severe AP developed in 28 of 120 patients with mild AP.18 of 32 patients with severe AP developed systemic complications,24 patients developed local complications,there were 9 deaths.During the second period,154 cases were treated ,the conversion of mild AP to severe AP presented in 16 of 149 patients with mild AP. 4 of 21 patients with severe AP presented systemic complications,19 patients presented local complications, 3 patients died.Conclusion Improving pancreatic microcirculation and preventing pancreatic cell Ca 2+ overload are helpful not only to prevent the conversion of mild pancreatitis to severe pancreatitis,but also to prevent progressive pancreatic necrosis, and improve the prognosis of acute pancreatitis.

Objective To discuss the nonoperative management strategy to prevent the conversion of acute pancreatitis to the severe form.Methods In recent 4 years,286 patients with mild acute pancreatitis admitted to our hospital were divided into control group and treatment observation group;routine conservative management was performed in control group,and the strategy of improving pancreatic microcirculation and preventing cell Ca~2+ overload and inhibiting pancreatic protease was added to the treatment observation group.Results Among the 144 patients with mild acute pancreatitis in control group,conversion to severe acute pancreatitis occurred in 20 patients,and 14 of the 20 patients with severe acute pancreatitis developed systemic complications.Among the 142 cases in treatment observation group,the conversion of mild to severe acute pancreatitis occurred in 8 patients,and 2 of the 8 patients developed systemic complications.Serum C-reactive protein levels and Balthazar CT severity index were significantly decreased at each time point in treatment observation group compared to control group.Conclusions In addition to routine management,improving pancreatic microcirculation,preventing cell Ca~2+ overload and inhibiting pancreatic protease might serve as a benificial strategy for preventing the progression of mild acute pancreatitis to the severe form.

Objective To investigate the effects of preoperative selective gastric arterial chemoembolization on the tumor vasculature in patients with gastric carcinoma.Methods 40 patients with gastric cancer were divided into two groups :(1)gastric arterial influsion(GAI)group;and (2)gastric arterial chemoembolization(GAE)group.The peripheral vein plasma tumor necrosis factor(TNF ?) and thrombomodulin(TM)were determined before radiologic intervention(RI),and1d,3d after R1;and the gastric vein plasma TNF ? and TM were also determined during operation.The curative surgical resection of gastric cancer was performed between 7 and 10 days after treatment.Stomach histological alterations were observed postoperatively.Results Compared with GAI group ,the plasma TNF ? levels increased markedly at all the time points,and gastric vein plasma TM levels decreased siginificantly in GAE group (P

Objective To investigate the function of mucin 2,mucin 4 on formation of lithogenic bile in patients with calculus of intrahepatic duct.Methods Bile duct mucosa,bile duct wall,bile and plasma were collected from 56 patients with calculus of intrahepatic duct (CID group) and 17 individuals without calculus of intrahepatic duct (control group).The bile duct wall was stained with mucin 2 (MUC2) and mucin 4 (MUC4).Reverse-transcription polymerase chain reaction (RT-PCR) was applied to study the mRNA expressions of MUC2 and MUC4 in the bile duct mucosa.The correlation of the bile duct and serum lipid index was analyzed.Results Serum lipid index in the CID group was significantly higher than control group (all P＜0.05).Biliary total bile acids and bile acids mol percentage were lower in the CID group than control group (both P＜0.05).The expressions of MUC2 was not increased significantly in CID group than the control group (all P＞0.05).The expressions of MUC4 were more significantly increased in CID group than the control group (P＜0.05).The mRNA of MUC4 in the CID group was also more significantly increased than in control group (P＜0.01).There were no correlations between MUC4 expression and the level of biliary total bile acid in the CID group (r=-0.374,P＜0.05).Conclusion The expression of MUC4 in patients with CID was enhanced,which promoted the absorption of bile acid by the mucosal epithelium of the bile duct,and caused a large amount of mucin to be secreted into bile,which may be related to the formation of stony bile.

Objective To investigate the relationship between Pst-Ⅰ polymorphism of mucin 4 gene and primary hepatolithiasis in the Chinese population.Methods Venous blood of 96 healthy controls and 56 patients with hepatolithiasis were collected,and DNA was extracted.Polymerase chain reaction combined with restriction enzyme (PCR-RFLP) digestion was used to detect Pst-Ⅰ polymorphism of mucin 4 gene in the two groups.The genotype and gene frequency between the two groups were then compared.Results The genotype frequencies of GC,GT,TT in the control and the hepatolithiasis groups were 21.3％,12.7％,55.6％ and 53.2％,41.2％,19.8％,respectively.The alleles C and T gene frequencies in the control and the hepatolithiasis groups were 21.5％,72.7％ and 66.3％,30.2％,respectively.There were significant differences in Pst-Ⅰ polymorphism of mucin 4 genotype frequency and gene frequency between the two groups.Conclusion The data showed Pst-Ⅰ polymorphism of mucin 4 gene was associated with primary hepatolithiasis in Chinese patients.

Objective:To explore the expression and clinical significance of mucin 5B in patients with primary intrahepatic bile duct stones (PHL) after hepatectomy.Methods:Collected the bile duct mucosa of 48 patients with intrahepatic bile duct stones (PHL group) and 16 patients with non-calculous benign liver disease (control group) who underwent hepatectomy in the Third Affiliated Hospital of Wenzhou Medical University from January 2014 to January 2019, Bile duct wall, bile and venous blood. The preoperative bile and serum indexes of the two groups were compared. Immunohistochemical staining was used to examine the expression of mucin 1 and mucin 5B in the bile duct wall, and the bile duct wall was examined pathologically by HE routine staining. With mucin 1 as a positive control and β-actin as an internal reference gene, real-time PCR was used to examine the mRNA expression levels of mucin 1 and mucin 5B in the bile duct mucosa. Pearson correlation analysis was used to analyze the correlation of variables within the PHL group.Results:The preoperative serum lipid indexes in the PHL group were higher than those in the control group, while the total bile acid concentration [(181.5±18.2) mmol/L vs. (192.1±22.5) mmol/L] and the molar percentage of bile acid [(80.7±1.6)% vs. (89.7±1.0)%] is lower than the control group, the difference is statistically significant ( P<0.05). The expression of mucin 1 mRNA in the PHL group was higher than that in the control group, but the difference was not statistically significant ( P>0.05). The expression of mucin 5B mRNA in the PHL group was significantly higher than that in the control group [(0.94±0.12) vs. (0.73±0.24)], the difference was statistically significant ( P<0.05); The increased expression of bile duct mucin 5B mRNA was negatively correlated with the level of total bile acids in bile ( r=-0.4, P<0.05). Conclusions:The increased expression of mucin 5B is closely related to PHL, which may be related to the promotion of bile acid absorption by the bile duct mucosal epithelium, which causes mucin to secrete into the bile in large quantities, leading to the formation of stone-causing bile.

Objective:To study the roles of hepatoma-derived growth factor (HDGF), vascular endothelial growth factor (VEGF) and mucin 5B (MUC5B) in hepatolithiasis associated with intrahepatic cholangiocarcinoma (HICC).Methods:The clinical data and tissue specimens of 116 patients who underwent hepatectomy at the Third Affiliated Hospital of Wenzhou Medical University from October 1999 to October 2019 were retrospectively analyzed. There were 41 patients with HICC (the HICC group), 38 patients with intrahepatic cholangiolithiasis (the intrahepatic cholangiolithiasis group), and 37 patients with benign liver tumor who underwent hepatectomy (the control group). There were 47 males and 69 females, with age of (66.1±3.2) years old. The positive expressions of HDGF, VEGF and MUC5B in the three groups were compared. In 41 patients with HICC, the correlation between positive expressions of HDGF, VEGF and MUC5B with patients’ clinical characteristics were studied.Results:Compared with the control group, the positive expression rates of HDGF, VEGF and MUC5B in the HICC group and the intrahepatic cholangiolithiasis group were significantly increased, ( P<0.05). Compared with the intrahepatic cholangiolithiasis group, the positive expression rates of HDGF, VEGF and MUC5B in the HICC group were significantly increased ( P<0.05). Positive expression of VEGF in HICC patients was correlated with tumor differentiation, tumor local invasion, tumor length, tumor stage, tumor carbohydrate antigen CA19-9 level and lymph node metastasis ( P<0.05). Spearman correlation analysis showed that HDGF was positively correlated with VEGF expression in HICC tissues specimens ( r=0.935, P<0.01). Survival analysis showed that the cumulative survival rates (36.7%, 17.1%, 7.3%) of patients with positive expression of VEGF were significantly lower than that of patients with negative expression (51.2%, 26.8%, 19.5%) at 1, 3, 5 years after surgery ( P<0.01). The cumulative survival rate (34.1%, 17.1%, 4.9%) of patients with MUC5B positive expression were significantly lower than that of patients with negative expression (53.7%, 31.7%, 17.1%) at 1, 3, 5 years after surgery ( P<0.01). Conclusion:HDGF can be used as a reference indicator for early assessment of HICC. Overexpressions of VEGF and MUC5B can be used as important indicators for HICC in evaluating disease progression and prognosis.