Abstract:

Objective: To summarize the experience in choledochoscopic treatment of postoperative intrahepatic duct stones and strictures, so as to improve the therapeutic efficacy of this condition. Methods: The clinical records of 697 patients with postoperative intrahepatic duct stones and strictures undergoing choledochoscopic treatment via T-tube sinus tract from January 2000 to December 2012 were reviewed and, the technical essentials were analyzed and therapeutic efficacy was evaluated. Results: The stones were completely removed in 672 patients and rate of complete stone removal was 96.4%. One thousand three hundred and six intrahepatic duct strictures were detected by choledochoscopy, 1 297 of which were dilated, and the stricture-resolution rate was rate was 99.3%. The epithelial cells of the bile duct recovered in the patients after biliary stricture dilation and stone removal. Nine patients developed severe complications that were all resolved by appropriate treatments. Conclusion: The standardized choledochoscopic treatment can effectively resolve the postoperative biliary strictures and remove the intrahepatic stones; detection and management of the intrahepatic strictures is the major advantage of choledochoscopic technique, but they should be treated specifically according to the stricture types. Resection of atrophic hepatic segment and intraoperative stone removal are still the important treatment methods for intrahepatic duct stones.

Abstract:Objective: To investigate the clinical characteristics of bronchobiliary fistula (BBF) in Chinese patients. Methods: Chinese Literature concerning BBF published from 1989 to 2013 was searched, and the clinical data of the patients were extracted and analyzed aggregately. Results: Fifty-one papers were finally selected with a total of 213 BBF patients. In these BBF patients, the male to female sex ratio was about 1.22:1, average age was (50.4±11.1) years old, and 70.1% of cases had previous history of surgery. The common clinical symptoms of BBF included biliptysis (96.5%), cough (94.5%), fever (83.8%), abdominal pain (79.3%), chest tightness/pain (76.2%), jaundice (59.2%), and dyspnea (13.5%).The primary causes comprised of bile duct stones (41.8%),hepatic hydatid (31.0%), biliary ascariasis (5.6%),primary or metastatic liver tumors (5.2%), trauma (4.7%), liver abscess (4.2%), congenital diseases (2.3%), multiple etiological factors (1.9%) or other single etiological factor (1.9%), and gallbladder stones with gallbladder wall perforation (1.4%). Of the patients, 90.6% received surgical treatment, and the overall cure rate was 89.5%, improvement rate was 3.3% and mortality rate was 6.2%. Conclusion: BBF is a relatively rare condition with multiple primary causes; rapid diagnosis can be made by bilioptysis and ERCP; patients receiving timely surgical treatment may obtain a satisfactory result.

Abstract:Objective: To compare the safety and efficacy between laparoscopic and open surgery in treatment of choledochal cyst by using Meta-analysis. Methods: The retrospective or case-control studies comparing laparoscopic versus open surgery for choledochal cyst in children were searched from the national and international databases. Meta-analysis was performed after literature screening according to the inclusion criteria. Results: Ten studies were finally included, involving a total of 1 394 patients, of whom, 589 cases underwent laparoscopic surgery (laparoscopic group) and 805 cases underwent open surgery (open surgery group). In laparoscopic group compared with open surgery group, the operative time was prolonged (WMD=54.51, 95% CI=24.37–84.64, P<0.05), while the intraoperative blood loss was reduced (WMD=–16.27, 95% CI= –21.16––11.39, P<0.05), time to first postoperative flatus and food intake was shortened (WMD=–1.2, 95% CI= –1.22––1.18; WMD=–1.31, 95% CI=–1.62––1.00, both P<0.05), and length of postoperative hospital stay and incidence of postoperative complications were decreased (WMD=–3.04, 95% CI=–4.08––2.36; OR=0.37, 95% CI=0.15–0.90, both P<0.05). Conclusion: Laparoscopic surgery has shown superiority in treatment of choledochal cyst compared with open surgery. With the improvement of laparoscopic techniques and deftness of surgeon’s practice, laparoscopic surgery may become the first choice procedure for choledochal cyst.

Abstract:Objective: To investigate the impact of the preoperative peripheral blood neutrophil-to-lymphocyt ratio (NLR) on postoperative prognosis of patients with intrahepatic cholangiocarcinoma (ICC). Methods: Clinicopathologic data of 96 ICC patients undergoing partial hepatectomy were collected. Based on the preoperative peripheral blood NLR, the patients were divided into low NLR group (NLR<2.5) and high NLR (NLR≥2.5) group. The overall survival rate and relapse-free survival time between the two groups were compared, and risk factors that would influence the prognosis of these patients were determined by univariate and multivariate analyses. Results: The 1,3 and 5-year overall survival rate for the entire group was 48%, 35% and 30%, which for high NLR group was 37%, 26% and 22%, and for low NLR group was 63%, 49% and 42% respectively, and the difference between the two groups had statistical significance (P=0.016). The median relapse-free survival time for the entire group was 10.2 months, which for high NLR group and low NLR group was 8.9 and 14.6 respectively, and the difference between the two groups had statistical significance (P=0.045). Univariate analysis showed that the overall survival of the patients was associated with the preoperative NLR along with the factors that included the preoperative CA19-9 and CEA level, lymph node metastases, tumor number and maximal size, adjacent organ invasion, distant metastasis, TNM stage and type of surgery (all P<0.05); multivariate analysis revealed that the preoperative NLR, lymphatic metastasis, and tumor number and maximal size were the independent risk factors for the overall survival of the patients (all P<0.05). Univariate analysis suggested that the relapse-free survival of the patients was related to the preoperative NLR together with the factors that included the preoperative CA19-9 and CEA level, lymph node metastases, tumor number and maximal size, distant metastasis, TNM stage and type of surgery (all P<0.05); multivariate analysis demonstrated that the lymphatic metastasis, tumor number and distant metastasis were the independent risk factors for the relapse-free survival of the patients (both P<0.05). Conclusion: Preoperative peripheral blood NLR can be used as a prognostic predictor of ICC patients, and those with high NLR face a poor prognosis.

Abstract:Objective: To investigate the diagnostic value of abnormal liver function parameters on the concomitant asymptomatic choledocholithiasis in cholecystolithiasis patients. Methods: The clinical data of 507 cholecystolithiasis patients undergoing surgical treatment were collected. The relations of the preoperative liver function parameters with the concomitant common bile duct stones were analyzed, and the receiver operating characteristic (ROC) curves for the significant parameters were generated to assess their sensitivities and specificities for diagnosis of the concomitant asymptomatic choledocholithiasis. Results: Except for total bilirubin (TBIL), the increases of the parameters that included the direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), and γ-glutamyltransferase (GGT) in the patients were significantly related to the concomitant asymptomatic choledocholithiasis (P<0.05). The ROC curve analysis showed that area under the ROC curve of DBIL, ALT, AST, AKP and GGT was 0.548, 0.546, 0.584, 0.734 and 0.850, and their corresponding sensitivity was 46.4%, 33.3%, 48.8%, 72.6% and 75%, and specificity was 72.5%, 75.8%, 60.5%, 63.5% and 79.5%, respectively. Conclusion: Among the liver function parameters, the increased GGT level has the greatest value for the detection of cholecystolithiasis with concomitant asymptomatic choledocholithiasis.

Abstract:Objective: To analyze the factors affecting stone recurrence in patients with gallbladder stones and concomitant common bile duct stones after endoscopic treatment. Methods: The clinical and follow-up data of 99 patients with gallbladder stones and concomitant common bile duct stones undergoing endoscopic treatment(51 cases undergoing laparoscopic cholecystectomy plus common bile duct exploration and 48 cases undergoing laparoscopic cholecystectomy plus endoscopic sphincterotomy) from January 2010 to December 2012 were retrospectively analyzed. The related factors affecting stone recurrence were determined by univariate and multivariate analysis. Results: Stone recurrence occurred in 19 patients after operation, and the recurrence rate was 19.19%. Univariate analysis showed that postoperative stone recurrence was significantly associated with the factors that included age, jaundice, bile duct dilation, common bile duct diameter, stone maximum diameter and number, inflammation of the pancreas and procedure type(all P<0.05). Logistic regression analysis identified that age (OR=2.692, P=0.011), common bile duct diameter (OR=2.249, P=0.022), stone number(OR=2.647, P=0.017), maximum diameter of the stone (OR=2.348, P=0.009), combined inflammation (OR=2.801, P=0.013) and procedure type (OR=2.421, P=0.018) were the independent risk factors for stone recurrence. Conclusion: Postoperative stone recurrence in patients with gallbladder stones and concomitant common bile duct stones undergoing endoscopic treatment is affected by many factors, so the relevant measures should be tailored to specific conditions to reduce stone recurrence.

Abstract:Objective: To determine the factors affecting gallbladder function recovery after minimally invasive cholecystolithotomy with gallbladder preservation. Methods: Using completely randomized case-control design, 59 cases were selected among the patients who underwent minimally invasive gallbladder-preserving cholelithotomy after the completion of 1-year follow-up. Of the patients, 37 cases had excellent gallbladder function recovery and 22 cases had poor gallbladder function recovery. The factors affecting the postoperative gallbladder function recovery were statistically analyzed. Results: Univariate analysis showed that age, thickness of the gallbladder wall, submucosal calculi, inflammatory pathology, stone recurrence, diabetes mellitus, operative time and postoperative drug administration were associated with gallbladder function recovery of the patients (all P<0.05). Logistic regression analysis revealed that stone recurrence (OR=13.121, P=0.046), diabetes mellitus (OR=12.263, P=0.043), inflammatory pathology (OR=6.891, P=0.037) and operative time (OR=6.718, P=0.030) were risk factors for gallbladder function recovery. Conclusion: Stone recurrence, diabetes mellitus, long-term (chronic) inflammation of the gallbladder and long operative time are the main factors hampering gallbladder function recovery after minimally invasive gallbladder-preserving surgery.

Abstract:Objective: To investigate the method of surgical treatment and clinical efficacy of hepatolithiasis with bile duct stricture. Methods: The clinical data of 62 patients with hepatolithiasis concomitant with bile duct stricture treated between January 2008 and November 2012 were retrospectively analyzed. These patients were divided into observational group and control group according to the surgical methods used. All patients in observational group underwent caudate lobe resection during surgery, while those in control group received surgical treatments without caudate lobe resection. The clinical efficacy, incidence of postoperative residual stones and complications, recurrence and alterations of liver function before and after surgery between the two groups were compared. Results: No death occurred in either group of patients. In observational group compared with control group, the excellent rate of clinical efficacy was improved (93.2% vs. 77.8%), the incidence of postoperative residual stones and complications as well as recurrence rate was significantly decreased (9.1% vs. 27.8%; 9.1% vs. 22.2%; 2.2% vs. 16.7%), and all the differences had statistical significance (all P<0.05). The preoperative liver function enzymes of the two groups showed no statistical difference (all P>0.05), and all were improved at time of hospital discharge, but all the enzyme parameters were improved significantly better in observational group than those in control group (all P<0.05). Conclusion: In surgical treatment of hepatolithiasis with bile duct stricture, caudate lobe resection can improve the surgical efficacy, reduce the rate of residual stones, and improve the liver function of these patients.

Abstract:Objective: To evaluate the clinical efficacy of modified loop-type biliary-enteric (Warren) anastomosis in children with congenital bile duct dilatation (CBDD). Methods: The clinical data of 51 CBDD children treated form January 2005 to December 2012 were retrospectively analyzed. Of the children, 23 cases underwent modified loop-type bilioenteric anastomosis (observational group), while 28 cases received Roux-en-Y anastomosis (control group). The intra- and postoperative conditions between the two groups of children were compared. Results: In observational group compared with control group, the operative time and intraoperative blood loss was reduced, and the time to bowel sounds recovery and first flatus was shortened (all P<0.05). The differences in liver function parameters on postoperative day 7 between the two group showed no statistical significance (all P>0.05). One case in observational group and 4 cases in control group developed mild bile reflux, and 2 cases in control group developed acute cholangitis respectively after operation, but the incidences of the two postoperative complications showed no statistical difference between the two groups (both P>0.05). Conclusion: The modified loop-type bilioenteric anastomosis is a simple procedure for CBDD, with rapid postoperative recovery and demonstrable short-term efficacy. However, its long-term efficacy requires further observation.

Abstract:Objective: To observe the apoptosis of polymorphonuclear neutrophils (PMN) in the bronchoalveolar lavage fluid (BALF) and occludin protein alteration in the alveolar epithelial cells in rats with bile duct obstruction (BDO), and analyze the relations of the two parameters with obstructive jaundice related lung injury. Methods: Seventy-two SD rats were used, 8 of them were randomly selected as normal control group, and the remaining 64 rats were equally randomized into sham group and model group. Rats in sham group underwent a sham operation and those in model group were subjected to double ligation of the common bile duct to establish a BDO model. Rats in sham group and model group were sacrificed in four batches with equal number of animals (n=8) to harvest specimens at 3, 7, 10 and 14 d after surgery, and rats in normal control group were killed to obtain specimens at random during the experimental period. The morphological analysis of the lung tissue of the rats was performed, PMN apoptosis and MMP-9 activity in the BALF, and occludin protein expression in lung tissue were determined, and the lung permeability index (LPI) was also calculated. Results: Compared with normal control group, all the parameters in sham group showed no obvious changes at each time point, and quantitative differences had no statistical significance (all P>0.05). In model group, evident lung injuries were observed, and compared with sham group, the PMN apoptosis was decreased and MMP-9 activity in the BALF was gradually increased, and the differences at each time point from 3-14 d reached statistical significance (all P<0.05); the occludin protein expression in lung tissue was decreased and LPI was gradually increased, and the differences at each time point from 7-14 d reached statistical significance (all P<0.05). Correlation analysis showed that in BDO rats, the PMN apoptotic rate was negatively correlated with MMP-9 activity (r=–0.935), the MMP-9 activity was negatively correlated with occludin protein level in lung tissue (r=–0.796), and the occludin protein level in lung tissue was negatively correlated with LPI (r=–0.800) (all P<0.05). Conclusion: In BDO rats, alveolar PMN apoptosis is decreased and MMP-9 activity is increased which may cause attenuation of occludin protein in alveolar epithelial cells, alveolar epithelial barrier damage and increased permeability. This pathological process may contribute greatly to the initiation and development of obstructive jaundice related acute lung injury.

Abstract:Objective: To investigate the influence of sustained-release fluorouracil implants on the healing process of the bilioenteric anastomosis in rabbits, so as to provide data related to the safety and feasibility of its clinical application. Methods: Forty healthy New Zealand rabbits were equally randomized into experimental group and control group. Rabbits in both groups underwent bilioenteric anastomosis, and those in experimental group received sustained-release fluorouracil implantation near the anastomotic stoma, while those in control group received the empty granules instead. In both groups, the tissues around the anastomotic site were harvested on postoperative day (POD) 3, 7, 14, 21 d respectively, and the general conditions of the abdominal cavity and anastomotic stoma were observed, van der Ham adhesion scoring for the anastomotic stoma was performed, the anastomotic bursting pressure (ABP) was measured, and the histopathological changes and collagenous connective tissues at the anastomotic stoma were examined. Results: In experimental group, 18 rabbits survived, one died of postoperative bile leakage and one died of abdominal infection; 19 rabbits survived in control group and one died of bile leakage, and there was no statistical difference in mortality between the two groups (P>0.05). The general healing statuses of the two groups were similar, and there was no significant difference in van der Ham score or ABP at each time point between the two groups (all P>0.05). The histopathological examinations (HE staining and Mallory’s trichrome staining) demonstrated that the two groups showed a similar pattern regarding the inflammatory reactions, neovascularization, and collagen fiber hyperplasia around the anastomotic stoma after operation. Conclusion: Sustained-release fluorouracil implant exerts no obvious influence on the healing process of the bilioenteric anastomosis in rabbits, so it can be used as a safe adjuvant chemotherapeutic method for prevention and treatment of postoperative local recurrence and metastasis of biliopancreatic malignant tumors.

Abstract:

Objective: To investigate the effects of different biliary drainage methods on gastric mucosa in rats with obstructive jaundice (OJ) and the mechanisms. Methods: Eighty SD rats were randomized into sham operation group, OJ model group (model group), OJ model plus internal biliary drainage group (internal drainage group), and OJ model plus external biliary drainage group (external drainage group), and the total experiment time was two weeks. At the end of the experiment, rats in each group were sacrificed and the histological changes in gastric mucosa were observed; the serum endotoxin and endothelin 1 (ET-1) levels, and ET-1 level and endothelin receptor type A (ET-A) mRNA expression in gastric mucosal tissues were determined. Results: All rats, except those in sham operation group, showed gastric mucosal injury of varied severity, but the injury in internal drainage group was remarkably milder than that in either model group or external drainage group. Compared with sham operation group, the serum endotoxin and ET-1 levels, and ET-1 and ET-A mRNA expression levels in gastric mucosal tissues in both internal drainage group and external drainage group were markedly increased, and all differences reached statistical significance (all P<0.05), while they were slightly increased in internal drainage group, but with no statistical differences (all P>0.05). Conclusion: Internal biliary drainage exerts protective effect on gastric mucosa in OJ rats, and the mechanism is probably due to its reducing ET-1 level and ET-A expression.

Abstract:Objective: To investigate the expression of transmembrane protease, serine 4 (TMPRSS4) and its clinical significance in gastric cancer. Methods: The mRNA and protein expressions of TMPRSS4 in 33 specimens of gastric cancer along with their adjacent tissues were measured by real-time RT-PCR and Western blot analysis, respectively. The TMPRSS4 expressions in 108 paraffin specimens of gastric cancer along with their adjacent tissues were determined by immunohistochemical staining, and the relations of TMPRSS4 expression with the clinicopathological profiles and prognosis of gastric cancer patients were analyzed. Results: Both the TMPRSS4 mRNA and protein levels in gastric cancer tissue were significantly higher than those in adjacent tissues (both P<0.05). TMPRSS4 expression rate in gastric cancer tissue was significantly higher than that in adjacent tissue (55.56% vs. 18.52%) (P<0.05), and high TMPRSS4 expression was significantly related to the tumor size (≥5 cm), depth of invasion, TNM stage and lymph node metastases (≥3) (all P<0.05). Kaplan-Meier survival analysis showed that the 5-year overall survival in TMPRSS4 expression patients was poorer than that in low TMPRSS4 expression patients (P=0.035). Cox analysis revealed that the high TMPRSS4 expression was an independent prognostic factor for gastric cancer patients (P=0.045). Conclusion: The TMPRSS4 level is closely associated with the progression of gastric cancer and could be used as a potential prognostic marker for gastric cancer.

Abstract:Objective: To assess the significance of the plasma D-dimer (D-D) level in predicting portal vein thrombosis (PVT) after laparoscopic splenectomy and esophagogastric devascularization (LSED) in patients with portal hypertension secondary to posthepatitic cirrhosis. Methods: Forty-seven patients with portal hypertension caused by posthepatitic cirrhosis scheduled for LSED were enrolled. The plasma D-dimer levels and coagulation function parameters of the patients before and at 1, 7 and 14 d after surgery were determined, color Doppler ultrasonography was performed on postoperative day (POD) 7 and 14 for PVT, and receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic efficiency of D-dimer level for post-LSED PVT. Results: Twenty-one of 47 patients developed PVT after LSED. The D-dimer levels in both PVT group and non-PVT group continued to rise after surgery, but the D-dimer levels in PVT group on POD 7 and 14 were significantly higher than those in non-PVT group (P<0.05). The prothrombin time PT, thrombin time (TT), and activated partial thrombin time (APTT) showed no obvious change before and after surgery in both PVT group and non-PVT group, and also showed no statistical difference between the two groups (P>0.05). The postoperative platelet (PLT) counts in both groups were increased compared with their preoperative levels, but showed no statistical difference between the two groups (P>0.05). The area under the ROC curve (AUC) reflecting the predictive accuracy of the D-dimer level on POD 7 for post-LSED PVT was 0.7 801 (P<0.05). Conclusion: Plasma D-dimer level is increased after LSED in patients with portal hypertension caused by posthepatitic cirrhosis, and the risk of PVT is increased in patients whose post-LSED plasma D-dimer sustains a high level (>14 mg/L), for whom, thrombus monitoring and preventive anticoagulation should be enhanced.

Abstract:Objective: To observe the clinical efficacy of additive breviscapine in interventional selective arterial therapy for elderly patients with severe acute pancreatitis (SAP). Methods: Sixty elderly SAP patients (≥60 years of age) were randomly designated to observational group (32 cases) and control group (28 cases). Patients in control group underwent continuous regional pancreatic-arterial infusion of octreotide and antibiotics, while those in observational group received continuous regional pancreatic-arterial infusion of the above infusion drugs plus breviscapine. The clinical efficacies between the two groups were compared. Results: After 7-d treatment, the APACHE II scores in both groups were significantly decreased compared with those before treatment (both P<0.05), but were significantly lower in observational group than those in control group (P<0.05); the serum levels of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in both groups were significantly decreased compared with those before treatment (all P<0.05), but the decreasing degree of the two factors in observational group were both significantly greater than those in control group (both P<0.05). The overall incidence of complications in observational group was significantly lower than that in control group (34.38% vs. 60.71%, P<0.05), and though the surgery conversion rate and mortality in observational group were lower than those in control group (12.5% vs. 21.5%; 9.38% vs. 14.29%), both differences reached no statistical significance (both P>0.05). Conclusion: Additive breviscapine in interventional selective arterial therapy has satisfactory efficacy for elderly SAP patients.

Abstract:Objective: To compare the impacts between laparoscopic and open surgery on immune function in treatment of colorectal cancer. Methods: Literature of randomized controlled trials (RCT), published between January 1995 and December 2012 in both Chinese and English, comparing the influences between laparoscopic and open surgery on immune function in treatment of colorectal cancer were collected, and the related parameters were evaluated using Meta-analysis. Results: Thirteen studies involving 959 patients were finally selected, with 465 cases in laparoscopic surgery group and 494 cases in open surgery group. Results of Meta-analysis showed that the activities of CD3+ and CD4+ T lymphocytes, and CD4+/CD8+ ratio in laparoscopic surgery group were significantly higher than those in open surgery group on postoperative day (POD) 1 to 7 (all P<0.05); the activity of natural killer cells in laparoscopic surgery group was significantly higher than that in open surgery group (time points for comparison were POD 1, 3 and 7) (P<0.05); the immune globulin levels (IgA, IgG and IgM) between the two groups on POD 3 showed no significant difference (all P>0.05); the interleukin 6 level in laparoscopic surgery group was significantly lower than that in open surgery group on POD 1 (time points for comparison were 4 h after operation, and POD 1, 3 and 7); the C-reactive protein levels in laparoscopic surgery group were significantly lower than those in open surgery group on POD 1 to 7 (time points for comparison were POD 1, 3, 7 and 14) (all P<0.05). Conclusion: Laparoscopic colorectal cancer surgery exerts a less negative influence on the immune system compared with open surgery, and has a better preservation of the immune function that is conducive to preventing pathogenic invasion and killing cancer cells.

Abstract:Objective: To evaluate the safety and feasibility of splenic hilar lymph node dissection during modified hand-assisted laparoscopic radical total gastrectomy. Methods: The clinical data of 8 gastric cancer patients undergoing modified hand-assisted laparoscopic radical total gastrectomy and splenic hilar lymph node dissection from June 2012 to July 2013 were retrospectively analyzed. Results: Procedures were successfully completed in all the 8 patients without open conversion, and none of them underwent splenectomy for intraoperative splenic vascular or parenchymal injury. A total of 27 lymph nodes were dissected from the 8 patients, and 3 (11.1%) of the lymph nodes were found positive for cancer. The average time for splenic hilar lymph node dissection was 23 min, average intraoperative blood loss was 176 mL, and average length of postoperative hospital stay was 9.5 d. One patient developed pulmonary infection after operation. The average cumulative follow-up for all patients was 3.6 months, during which time, no tumor recurrence or death occurred, and the general condition of all of the patients was satisfactory. Conclusion: Splenic hilar lymph node dissection during modified hand-assisted laparoscopic radical total gastrectomy is safe and feasible; however, its long-term effectiveness must be further assessed.

Abstract:Biliary cast syndrome (BCS) is defined as the necrotic debris filling the intra- or extra-hepatic biliary tracts and forming casts that take the shape of the biliary tree after liver transplantation, thus leading to a series of clinical manifestations. It is an unusual but very serious complication of liver transplantation. A better knowledge of the etiology, pathogenesis and clinical features of BCS may help prevent the occurrence of BCS and improve the survival of post-liver transplantation BCS patients, thus, the authors address the related issues along with the diagnosis and treatment of this condition.

Abstract:Incidental gallbladder cancer (IGBC) is defined as the gallbladder cancer (GBC) diagnosed during or after cholecystectomy for clinically considered as benign gallbladder disease. Patients with gallbladder carcinoma found during or after operation have increased with the wide use of laparoscopic cholecystectomy, and meanwhile, there is still much controversy about the treatment of IGBC. In this paper, the authors address the advances in IGBC treatment, so as to provide information for clinical practice.

Abstract:Natural orifice transluminal endoscopic surgery (NOTES) as a new type of minimally invasive surgery has a number of technical problems standing in its way. In this paper, the authors address the research progress on the essential issues that include operating platform, approaches and wound closure.