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Role of laparoscopic subtotal cholecystectomy in the treatment of complicated cholecystitis

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Hepatobiliary & Pancreatic Diseases International 2006年第4期5卷 584-589页

作者： Wu Ji, Ling-Tang Li and Jie-Shou Li research institute of {2. {3., nanjing {2. hospital of nanjing PLA command Area, nanjing 210002, China research institute of {2. {3. Nanjing General Hospital of Nanjing PLA Command Area Nanjing 210002 China.

BACKGROUND: Laparoscopic cholecystectomy (LC) has become the 'gold standard' in treating benign gallbladder diseases. Increasing laparoscopic experience and techniques have made laparoscopic subtotal cholecystectomy (LSC) a feasible option in more complex procedures. In recent years, few studies with a few cases of LSC have reported good results in patients with various types of cholecystitis. This study was designed to evaluate the feasibility, indications, characteristics and benefits of LSC in patients with complicated cholecystitis. METHODS: Altogether, 3.85 patients were scheduled to receive LC during the past 4 years at our institute. Among them, 168 patients with various complicated forms of cholecystitis were treated by LSC. Meanwhile, the other 3.17 patients who received standard LC were enrolled as the control group. Perioperative data from the two groups were collected and retrospectively analyzed. RESULTS: In the LSC group, 13. patients suffered from acute calculic cholecystitis, 18 from chronic calculic cholecystitis with cirrhotic portal hypertention, and 15 from chronic calculic atrophy cholecystitis with severe fibrosis. These patients constituted 4.8% of the total patients who underwent LC (168/3.85) in the same period at our institute. In 12. patients, the cystic duct and artery were clipped before division. In another 46 patients, the gallbladder was initially incised at Hartmann's pouch. Five patients (3.0%) were converted to open subtotal cholecystectomy. The median operation time for LSC was 65.5±15.2.minutes, estimated operative blood loss was 71.5±15.5 ml, and the time to resume diet was 2..4±6.3.hours. Thirteen patients (7.7%) had local complications. The mean postoperative {2. stay was 4.2.2.6 days. In the LC group, 2.87 had chronic calculic cholecystitis, 3.2.ad acute calculic cholecystitis, 47 had chronic calculic atrophy cholecystitis, and 71 had polypus. Seventeen patients (0.5%) were converted to open cholecystectomy. The median o

关键词： laparoscopic cholecystectomy cholecystitis cirrhotic portal hypertension complication bile duct injury

Application of laparoscopic cholecystectomy in patients with cirrhotic portal hypertension

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Hepatobiliary & Pancreatic Diseases International 2004年第2期3卷 270-274页

作者： Wu Ji, Ling-Tang Li, Xun-Ru Chen and Jie-Shou Li nanjing, Chinaresearch {2. of {3. surgery, nanjing Ge- neral hospital of nanjing PLA command, nanjing 210002, China and Department of Hepatobiliary surgery, Kunming {3. hospital of Chengdu PLA command, Kunming 65003.2} China research institute of {2. {3. of PLA Nanjing General Hospital of Nanjing PLA Command Nanjing 210002 China.

BACKGROUND: Laparoscopic cholecystectomy (LC) has been widely adopted in treating benign gallbladder disea- ses. Cirrhosis and cirrhotic portal hypertension (CPH) are contraindicated for LC in its early period. In recent years, several studies have reported liberal use of LC in patients with cirrhosis. But its benefits and successful use in patients with CPH are less documented. This study was designed to evaluate the feasibility, safety and technical characteristics of LC in CPH patients. METHODS: In 3. patients with symptomatic gallbladder disease and CPH, 19 belonged to Child A class, 15 Child B class and 4 Child C class. Perioperative data of these pa- tients were collected and analyzed. RESULTS: LC was successfully performed in 3. patients, and 2.patients (5.3.) were converted to open cholecystec- tomy (OC) for difficulty in management of bleeding under laparoscopy and dense adhesion of Calot' s triangle. The sur- gical time was 62.6±15.2.minutes. The estimated amount of intraoperative hemorrhage was 75.5±15.5 ml. No blood transfusion was necessary. The time to resume diet was 18.3.±6.5 hours. Seven postoperative complications in 5 patients (13.2.) included port-site infection (1 patient), respiratory infection (2., upper digestive tract bleeding (1), slight hepatic encephalopathy (1) and increased ascites (2.. All patients were cured and discharged from the hospital within 5.6±2.4 days after LC. CONCLUSIONS: Despite LC is difficult for CPH patients, it is feasible and relatively safe. To make LC successful in patients with CPH, it is necessary for surgeons to acquaint with the technical characteristics of LC and emphasize me- ticulous perioperative management.

关键词： cirrhosis portal hypertension laparoscopic cholecystectomy

S-adenosylmethionine in treatment of cholestasis after total parenteral nutrition: laboratory investigation and clinical application

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Hepatobiliary & Pancreatic Diseases International 2002年第1期1卷 96-100页

作者： Ning Li Hong-Hai Zhang Shao-Hua Wang Wei-Ming Zhu Jian-An Ren Jie-Shou Li From the institute of general {2. {3. general hospital of {3. PLA command, {3., 210002 China institute of general {2. Nanjing General Hospital Nanjing PLA Command Nanjing 210002 China

Objective: To observe the effects of S-adenosylmethio-nine (SAMe) in the treatment of cholestasis after totalparenteral nutrition (TPN).Methods: Thirty SD rats were randomly divided intocontrol group, hypercalorie group, hypercalorie+SAMegroup, sepsis group and sepsis+SAMe group to com-pare their states of cholestasis. Sixteen patients re-ceived SAMe because of cholestasis after prolongedTPN, and the therapeutic efficacy was ***: Bile flow was obviously decreased and theserum levels of total bile acid and gamma-glutamyltranspeptidase(γ-GT) were markedly increased in thehypercalorie and sepsis groups. Meanwhile, hepatocytefatty degeneration, dilatation of cholangioles, and bilesludge could be seen microscopically. SAMe adminis-tration in the hypercalorie+SAMe and sepsis+SAMegroups could increase the bile flow, decrease theserum levels of total bile acid and γ-GT, reduce thepathological damage to the liver, and clear the bilesludge in the cholangioles. Cholestasis and abnormalliver function were the main manifestations of the 16patients before SAMe administration. After SAMe treat-ment for 3.weeks, serum levels of total bilirubin, al-kaline phosphatase(AKP), γ-GT, alanine aminotrans-ferase(ALT), and aspartate aminotransferase(AST)were obviously decreased, and normalized in the ***: SAMe could prevent and treat cholestasiswithout discontinuation of TPN.

关键词： total parenteral nutrition cholestasis complication S-adenosylmethionine rat clinical application

Outpatient single-incision laparoscopic cholecystectomy in 2. patients with gallbladder disease

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Hepatobiliary & Pancreatic Diseases International 2010年第6期9卷 629-633页

作者： Wu Ji,Kai Ding,Rong Yang,Xing-Dong Liu,Ning Li and Jie-Shou Li research institute of {2. {3.,Jinling hospital, nanjing University School of Medicine,nanjing 210002,China research institute of {2. {3. Jinling Hospital Nanjing University School of Medicine

BACKGROUND:Transumbilical single-incision laparoscopic cholecystectomy(SILC)is a new *** has been described by some authors as scarless *** our knowledge,however, there has been no study on outpatient *** present study was designed to determine the safety,feasibility and benefits of transumbilical outpatient SILC. METHODS:Twenty-two patients underwent transumbilical outpatient SILC at our department from December 2.08 to October *** all patients,the preoperative work-up and operation were completed in the outpatient *** perform the operation,a 2.to 2.5-cm semi-circular incision was made around the umbilicus and three 5-mm trocars were inserted separately by direct puncture.A 5-mm flexible laparoscope, an UltraCision harmonic scalpel and curved instruments were used to perform the laparoscopic cholecystectomy(LC) procedure. RESULTS:All patients except one were operated on successfully. The conversion rate to standard LC was 5%.In the 2. successfully completed patients,the median duration of operation was 56.5 minutes and estimated operative blood loss was 16.2.*** time to resume liquid food was 10.8 hours and semi-liquid food was 16.2.hours after the *** patients went home on the same day,and 12.on the second day after the *** mean postoperative hospital observation time was 18.5 *** retention was observed in 1 *** follow-up was conducted for all patients at 2.weeks after *** patients were satisfied with the good cosmetic effect of the *** total satisfaction rate was 95%.CONCLUSIONS:Outpatient SILC is a safe and feasible technique for operating with fewer scars and reducing perioperative discomfort at the same time.A direct puncture method to insert trocars is technically *** a flexible laparoscope and curved instruments make the procedure easier and more time-saving.

关键词： single-incision surgery outpatient surgery laparoscopic cholecystectomy natural orifice transluminal endoscopic surgery

Lipopolysaccharide decreasing albumin expression in rat hepatocytes

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Hepatobiliary & Pancreatic Diseases International 2005年第3期4卷 410-415页

作者： research institute of {2. {3., Jinling hospital, nanjing 210002, China (Wang XY, Li WQ, Li N and Li JS) and Department of Orthopaedics, Zhongda hospital, nanjing 2.0009, China (Lu J) research institute of {2. {3. Jinling Hospital Nanjing 210002 China. wxinying@***

The relations of the severity of hypoalbu-minemia to morbidity and mortality of patients with critical illness illustrate the need for better understanding of molecular mechanism of hypoalbuminemia. This study was undertaken to investigate the response of albumin synthesis to lipopolysaccharide(LPS)in rat hepatocytes in vitro in early acute phase of sepsis. METHODS:Hepatocytes were cultured at an initial cell density of 1.5×106 cells/well in 3.ml culture medium. There were two groups of samples which received either normal saline or 1 μg/L LPS randomly. Albumin mRNA in hepatocytes was assessed by reverse transcription-poly-merase chain reaction(RT-PCR) and albumin level in the supernatant was measured by ELISA at 0,2.8,12.2. hours after exposure. Meanwhile, the albumin precursor was evaluated at the same time points by flow cytometry. RESULTS:The quantitative changes of mRNA, albumin precursor and its protein were analogous. All of them tended to decline at 12.hours post-treatment and did not decrease significantly until 2. hours after LPS exposure. Meanwhile, albumin mRNA decreased about 3.% and the levels of albumin precursor and albumin reduced approximately 50%. CONCLUSIONS: LPS can inhibit albumin synthesis in rat hepatocytes by prevention of albumin transcription. Moreover, the response of hepatic albumin synthesis to LPS changes with the stage of sepsis process. The results show that albumin metabolism in sepsis is a complicated process and further studies are required to understand the molecular mechanism of LPS-induced hypoalbuminemia in sepsis.

关键词： lipopolysaccharide hepatocyte albumin hypoalbuminemia signal transduction sepsis

New development of biliary surgery in China

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World Journal of Gastroenterology 2000年第2期6卷 187-192页

作者： Zhi Qiang Huang The research institute of {2. {3.,The {2. hospital of PLA,Beijing 100853.China 解放军总医院北京

CHARACTERISTICS OF BILIARY CALCULOUSDISEASES IN CHINA:THE CHANGING SCOPEDiseases of the biliary tract in China is complicatedwith the prevalence of primary infection of the bileduct *** the middle of the 2.th century,biliary infection,biliary parasitic infestation,andbiliary stones made up the three chief componentsof biliary diseases in *** to the

关键词： biliary surgery cholelithiasis intrahepatic stones carcinoma gallbladder carcinoma bile duct

Mechanism of reduction of albumin expression induced by lipopolysaccharide in rat hepatocytes

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中华医学杂志(英文版) 2005年第20期 25-32页

作者： WANG Xin-ying, LI Wei-qin, LU Jun, LI Ning and LI Jie-shou research institute of {2. {3., Jinling hospital, nanjing 210002, China Department of Orthopaedics, Zhongda hospital, nanjing 2.0009, China

Background The severity of hypoalbuminemia has been sho wn to be related to morbidity and mortality in some critical illnesses, illustra ting the need for better understanding of molecular mechanism of hypoalbuminemia . Lipopolysaccharide (LPS) is a key mediator inducing hypoalbuminemia in sepsis and septic shock. The present study was designed to identify if the reduction of albumin expression is directly induced by LPS and modulated by activated extr acellular signal-regulated protein kinase (ERK) and p3. mitogen-activated prot ein kinase (MAPK) in rat hepatocytes. Methods Primary rat hepatocytes were divided into five groups. In two of them, hepatocytes were treated with normal saline or 1 μg/ml LPS, th en albumin mRNA expression was observed at 0, 2. 8, 12.and 2. hours after treatm ent. In another group, hepatocytes were pretreated with 100, 40 or 2. μmol/L o f cycloheximide (CHX, an inhibitor of protein synthesis) for 3. minutes followed by 1 μg/ml LPS for 2. hours. Then the RNA was extracted from the cells for RT -PCR to detect the expression of albumin. The other two groups were administer ed 1 μmol/L, 10 μmol/L and 50 μmol/L of SB2.3.80 (p3. MAPK inhibitor) or PD98 059 (ERK inhibitor) 3. minutes prior to 1 μg/ml LPS treatment. After 2. hours of LPS treatment, the supernatant was collected and assayed for albumin concentr ations. Data were analyzed by one-way analysis of variance, followed by the Ne wman-Keul test; a P2.-hours treatment with normal saline. The reductio n did not occur until 2. hours after LPS treatment, and albumin mRNA decreased b y 3.% approximately compared to the control group at 2. hours (0.587 vs 0.83.0} P=0.007). CHX could inhibit the decline of albumin mRNA induced by LPS an d the effect was correlated with the dose of CHX. The ERK inhibitor PD98059 cau sed a significant increase in LPS-induced albumin production

关键词： lipopolysaccharide · hepatocytes · albumin · hypoalbuminemia · signal transduction

TNF-α Regulates the Effect of Glutamine on Protein Synthesis in Rats

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TNF-α Regulates the Effect of Glutamine on Protein Synthesi...

Intestinal permeability in patients after surgical trauma and effect of enteral nutrition versus parenteral nutrition

中华医学会整形外科学分会第十一次全国会议、中国人民解放军整形外科学专业委员会学术交流会、中国中西医结合学会医学美容专业委员会全国会议

作者： Jihong Zhou1,Yousheng Li2.Fangnan Liu2.Yacheng Cao3.Zijian Hong1,Jieshou Li2.(l.Dpatment of burns and Plastic {3.,nanjing general hospital of nanjing command,{2.,China {3.,nanjing general hospital of nanjing command,{2.,China 3. institute of Soil Science,Chinese Academy of Sciences, nanjing 2.0008,China)

*** of the main roles of glutamine is to improve nitrogen balance by stimulating protein synthesis in *** has been widely used,such as in critical illness and ***,a systemic review showed that addition of glutamine to nutritional regimens for septic patients is not as effective as for trauma patients, especially in the early stage of *** present studies were performed to disclose the possible mechanism. *** aim of this study was to determine whether the regulation of glutamine on protein synthesis could be inhibited by TNF-αin rat. Materials and *** male SD rats,weighing 160-180g,were assigned randomly into four groups:A,B, C,D(n=10).All rats received isonitrogenous and isocaloric total parenteral nutrition(TPN) solutions for 3.days,group A were supplemented only by TPN;group B were infused intravenously with TNF-a in the third 2. hours;group C were given by glutamine TPN for 3.days,group D supplemented by glutamine and TNF-α.At the last 0.5 hour,all animals were mainlined with[L-15N]leucine. Plasma levels of TNF-α,glutamine concentration in plasma and tissues were measured after 72.hours,and the fractional synthesis rate(FSR) were assessed with stable isotope. *** TNF-αlevel of group A is higher than that of group C(7.903.2.119 versus 2.442.1.92.,P2.07.3.9±2.6.76 versus 11673.767±108.774,P3.6.766±5.045 in group A to 3.8.750±5.045 in group B,403.5164±4.43. in group C,40.816±19.916 in group D,but in tissues,it elevates evidently from group A,to C,B D(compared with any two groups,P<0.01). However,the FSR was improved significantly from B to A, D,C. *** results indicated that TNF-αcould increase the levels of glutamine in plasma and tissues and attenuate promoting protein synthesis of glutamine in tissues.

关键词： TNF Regulates the Effect of Glutamine on Protein Synthesis in Rats

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World Journal of Gastroenterology 2003年第8期9卷 1878-1880页

作者： Xiao-Hua Jiang Ning Li Jie-Shou Li, research institute of {2. {3., Medical School of nanjing University, nanjing 210002, Jiangsu Province, China research institute of {2. {3. Medical School of Nanjing University Nanjing 210002 Jiangsu Province China. dr_jxh@***

AIM: To study the intestinal permeability (IP) following stress of abdominal operation and the different effects on IP of enteral nutrition (EN) and parenteral nutrition (PN).METHODS: Forty patients undergoing abdominal surgery were randomized into EN group and PN group. Each group received nutritional support of the same nitrogen and calorie from postoperative day (POD) 3.to POD 11. On the day before operation (POD-1), POD 7 and POD 12. 10 g of lactulose and 5 g of mannitol were given orally, and urine was collected for 6 hours. Urine excretion ratios of lactulose and mannitol (L/M) were ***: L/M ratios of EN group on POD-1, POD 7 and POD 12.were 0.02.±0.017, 0.059±0.02., 0.02.±0.017,respectively, and those of PN group were 0.02.±0.013.0.080±0.03.1} 0.047±0.02., respectively. Patients of both groups had elevated L/M ratios on POD 7 vs. POD-1. However the ratio returned toward control level in EN group by POD *** contrast, PN group still had elevated L/M ratios on POD ***: L/M ratio increases for a period of time after surgical trauma and the loss of gut mucosal integrity can be reversed by substitution of enteral nutrition.

关键词：手术后肠内营养肠内营养肠渗透性