ObjectiveTo observe the effect of rhubarb choleretic capsule on preventing gallstone recurrence after minimal invasive gallstone surgery. MethodsSixty patients with gallstone who received laparoscopic-choledochoscopy-assisted removal of cholecystolithotomy(LRCL) were divided into treatment group and control group.The treatment group was treated with rhubarb choleretic capsule after surgery,while the control group took no medicine.The patients were followed up and took B ultrasonic testing after surgery.The gallstonere currence rate,gallbladder wall thickness as well as gallbladder contraction efficiency were recorded. ResultsCompared with 2 days before operation,the gallbladder wall thickness were remarkably decreased in both groups (treatment group,t=16.391,P<0.01;control group,t=7.004,P<0.01),and the results were statistically significant.The gallbladder contraction ratios were markedly increased and there are statistically significant differences(treatment group,t=-42.817,P<0.01;control group,t=-23.066,P<0.01).Compared with the control group,the gallbladder wallthickness in rhubarb choleretic capsule treatment group decreased significantly (t=-7.813,P<0.01),while the gallbladder contraction ratio increased significantly(t=12.693,P<0.01) .The gallstone recurrence rate of the treatment group were obviously lower than the control group (χ2=4.32,P<0.05),the results were significant. ConclusionThere is a positive effect of taking rhubarb choleretic capsule after minimal invasive gallstone surgery to prevent the gallstone recurrence.
近年来,随着生活水平的逐渐提高,饮食结构发生了很大改变,胆囊结石的发病率也逐年升高,腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)是治疗胆囊结石的首选方法,但切除具有消化功能和免疫功能的胆囊后患者会出现腹胀、消化不良、腹泻、胃食管反流、结肠癌发病率增高、术中胆管损伤等并发症[1],极大影响了患者的生活质量。因此腹腔镜联合胆道镜保胆取石术(laparoscopic-choledochoscopy-assisted removal of cholecystolithotomy,LRCL)作为一种新的手术方式日益受到重视。然而保胆取石术后具有一定的结石复发率,因此预防保胆取石术后胆囊结石复发具有重要意义。大黄利胆胶囊具有清热利湿、解毒退黄的作用,是长期用于临床的中药制剂,对于胆汁淤积症、胆囊切除综合征的预防和治疗具有良好疗效[2-4],笔者通过临床对照研究,观察大黄利胆胶囊对微创保胆取石术后胆囊结石复发的影响。
GOLDACRE MJ,WOTTON CJ,ABISGOLDJ,et al.Ass-ociation between cholecystectomy and intestinal cancer-a national record linkage study[J].,2012,256(6):1068-1072.
To investigate the risk of intestinal cancer in a cohort of people who had undergone cholecystectomy for gallstones, and in a cohort of people who had been hospitalized for gallbladder disease but had not undergone cholecystectomy.Some investigators have suggested that cholecystectomy increases the risk of intestinal cancer. Despite extensive study, the evidence remains inconclusive. If there is doubt about safety, the question arises of whether patients considering the operation should be told of a possible risk. It is also increasingly clear that there are noncausal associations between gallstones and intestinal cancer.Analysis of record-linked hospital admission and mortality statistics for England from 1998 to 2008; calculation of ratio of rates of cancers in the cholecystectomy cohort and the gallbladder disease cohort compared with a control cohort.: In the first year after cholecystectomy, the rate ratios for cancer of the small intestine, colon, and rectum were significantly high at, respectively, 4.6 (95% confidence interval 3.9-5.5), 2.0 (1.9-2.1), and 1.7 (1.6-1.9). Rates of these cancers were also significantly high in people with gallstones without cholecystectomy. By 8 to 10 years after cholecystectomy, rate ratios had declined to nonsignificant levels.These cancers are associated with gallstones. The highest elevation of risk of cancer after cholecystectomy was at the shortest time interval after operation. Thereafter, the level of risk in the cholecystectomy and control cohorts gradually converged. The association in this study, between cholecystectomy and intestinal cancer, is very unlikely to be causal. Intestinal cancers are, on occasion, initially misdiagnosed as gallbladder disease.
CONSTANTINESCUT,HUWOODAL JABOURI A K,BR-ÃTUCU E,et al.Gallstone disease in young population incidence,complicatios,therapeutic approach[J].,2012,107(5):579-582.
PREMKUMARM,SABLET.Obesity,dyslipidemia and cho-lesterol gallstone disease during one year of Antarctic residence[J].,2012,12(12):398.
Abstract INTRODUCTION: Age, gender, ethnicity, geographic location, diet, obesity, diabetes mellitus and dyslipidemia are known risk factors for development of gallstone disease (GD). We describe the development of four cases of symptomatic GD including a case of acute cholecystitis in Indian Antarctic expedition members during 1 year of polar residence and their response to 6 months of ursodeoxycholic acid (UDCA) therapy. METHODS: Twenty subjects were evaluated at baseline and at serial intervals using clinical history, dietary assessment, anthropometry, blood investigations and ultrasonography for development of gallstone disease. Ursodeoxycholic acid and lipid lowering agents were prescribed as indicated and response to therapy measured over a period of 1 year in Antarctica. RESULTS: Four cases of cholesterol GD and two cases of biliary sludge were detected after 4 months. Dyslipidemia including hypertriglyceridemia in four of 20 cases (20%), hypercholesterolemia in nine of 20 cases (45%) and low high density lipoprotein (HDL) cholesterol in six of 20 cases (30%) was seen to develop after 3 months of polar residence. Impaired glucose tolerance was found in three of 20 cases (15%), two of whom developed gallstones. Ursodeoxycholic acid therapy completely dissolved gallstones in three cases and led to partial resolution in one case at 6 months. A trial of lipid lowering agents and 1 month of UDCA led to resolution of biliary sludge in both cases. CONCLUSION: Obesity, dyslipidemia, impaired glucose tolerance and high fat and caloric intake were found to increase the risk of developing cholesterol GD during the Antarctic expedition. Ursodeoxycholic acid therapy was found to be efficacious in dissolution of gallstones and prevention of formation of larger stones in cases with gall bladder sludge. The effect of geographical factors such as exposure to colder environments on the development of GD needs further research.
APREAG,CANFORAA,FERRONETTIA,et al.Morpho-functionnal gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease[J].,2012,12(1):1-5.
Cholecystectomy, gold standard treatment for gallstone-related diseases, is practiced in a high percentage of patients with this condition. Such procedure, considered by many harmless, was, in our study, associated with a significant risk of developing biliary gastritis after 6 months during the postoperative period.
WEIS.The clinical application of the hard gallbladder end oscope combined with soft choledochoscope in the surgery of laparoscopic microscopic trauma for the removal of calculi and preservation of gallbladder[J].,2013,23(2):106-108.
The clinical application of the hard gallbladder end oscope combined with soft choledochoscope in the surgery of laparoscopic microscopic trauma for the removal of calculi and preservation of gallbladder