Intrahepatic cholestasis is a manifestation of liver damage commonly seen in clinical practice,with a complex etiology and involvement of a wide range of diseases. Its pathogenesis is related to hepatocellular damage and bile capillary cell damage,bile acid transport disorder,and abnormal bile flow. The treatment of intrahepatic cholestasis mainly includes drug therapy,and major drugs include ursodeoxycholic acid,obeticholic acid,S- adenosyl methionine,and traditional Chinese medicine preparations. The pathogenesis and treatment of intrahepatic cholestasis are reviewed in this article.

Progressive familial intrahepatic cholestasis( PFIC) refers to a heterogeneous group of autosomal- recessive disorders. The estimated incidence varies between 1 /50,000 and 1 /100,000 births. Three types of PFIC have been identified and related to mutations in hepatocellular transport system genes involved in bile formation. PFIC- 1,PFIC- 2,and PFIC- 3 are due to mutations in ATP8B1,ABCB11,and ABCB4 genes involved in bile secretion,respectively. Serum gamma- glutamyl transpeptidase is normal in patients with PFIC- 1 and PFIC- 2,while it is raised in patients with PFIC3. The main clinical manifestation of PFIC is severe intrahepatic cholestasis. PFIC usually appears in infancy or childhood and rapidly progresses to end- stage liver disease before adulthood. Diagnosis of this disease is based on clinical manifestations,liver function tests,liver ultrasonography,liver histology,and genetic testing. Ursodeoxycholic acid therapy is the initial treatment in all PFIC patients to prevent liver damage. In some PFIC1 and PFIC2 patients,biliary diversion may also relieve pruritus and slow disease progression. However,most PFIC patients are ultimately candidates for liver transplantation.

Primary biliary cirrhosis( PBC) is a chronic autoimmune cholestatic liver disease. The paper introduces the progress in etiology,pathogenesis,clinical characteristics,and treatment of PBC,which has great significance for early diagnosis,disease surveillance,guiding standardized treatment,and improving the quality of life and prognosis in patients with PBC.

The incidence of iatrogenic bile duct injuries has been increased along with the application of laparoscopic surgery,although surgical lesions have been reduced and postoperative recovery has been accelerated. Once bile duct injury occurs,the short- term and long-term adverse effects are very severe. Therefore,the prevention and timely diagnosis and treatment of bile duct injuries are critical. In order to better understanding iatrogenic bile duct injuries and guiding the clinical practices for young surgeons,this paper provides the updated information on common causes,mechanisms,diagnosis,and treatment of iatrogenic bile duct injuries through review of domestic and international literature.

Hepatolithiasis is one of the most prevalent benign biliary tract diseases in Southwest China,and surgery is the optimal treatment for this disease. However,hepatolithiasis has insidious onset and complicated course,as well as high rate of residual stones and recurrence and high incidence of cholangiocarcinoma after operation,and some patients undergo surgery several times due to inappropriate initial therapeutic strategy,resulting in more severe condition and more difficult treatment. Therefore,initial surgical treatment is the key to the short-term and long- term outcomes of hepatolithiasis. For previously untreated patients,comprehensive diagnosis and adequate disease assessment,standardized and individualized therapeutic strategy,and appropriate operation time are warranted,the procedures based on hepatic segments and hepatic lobes are preferred,and the choledochoscope and B- mode ultrasound should be properly used during the operation,so as to resect the lesions,prevent recurrence,and reduce the reoperation rate.

Objective To explore the clinical efficacy of several medications for acute biliary colic. Methods Two hundred and forty patients with acute biliary colic admitted to Beijing Anzhen Hospital from January 2012 to January 2014 were selected for retrospective analysis and randomly divided into four groups,namely raceanisodamine hydrochloride group( group A),phloroglucinol group( group B),tramadol hydrochloride( group C),and dezocine group( group D),with 60 cases in each group. The Visual Analogue Scale( VAS) score,clinical efficacy,and adverse reactions were compared between the four groups using analysis of variance for continuous data and chi- square test for categorical data. Results VAS scores were decreased significantly after the treatment in each group( P < 0. 01) and the score in group D was the lowest( P < 0. 01). In terms of time to pain relief,the time in group A was the longest,and that in group D was the shortest,with significant difference( P < 0. 05). As for clinical efficacy,the overall response rate in group D was the highest,while that in group A was the lowest,with significant difference( P < 0. 05). The incidence of adverse reactions in groups C and D was the lowest,while that in group A was the highest,with significant difference( P < 0. 01). Conclusion The clinical efficacy of dezocine and tramadol hydrochloride is better than that of raceanisodamine hydrochloride and phloroglucinol,and the former two are worthy of further clinical application.

Objective To analyze the clinical efficacy of glucocorticoid therapy in addition to conventional treatment for patients with drug-induced cholestatic liver disease. Methods A total of 115 patients with drug- induced cholestatic liver disease who were admitted to Affiliated Hospital of Inner Mongolia University for the Nationalities from January 2010 to December 2014 were collected and divided into glucocorticoid treatment group and non- glucocorticoid treatment group. The glucocorticoid treatment group was given methylprednisolone sodium succinate 120 mg once daily by intravenous injection in addition to conventional treatment. The indicator for glucocorticoid response was defined as 10% decrease of total bilirubin( TBil) on the third day or 30% decrease on the seventh day. Then the patients were orally given prednisone tablets 10 mg three times daily based on the level of TBil,and the administration of prednisone tablets was adjusted to twice daily a week later. The course of treatment was less than three weeks. Comparison of continuous data in normal distribution between the two groups was made by t test,and comparison of continuous data not in normal distribution between the two groups was made by rank sum test. Results The levels of gamma- glutamyl transpeptidase( GGT),alanine aminotransferase( ALT),and TBil in the glucocorticoid treatment group decreased significantly on days 3,7,and 14 of treatment compared with those before treatment( tGGT= 3. 64,13. 08,16. 22; tALT= 2. 39,4. 73,8. 36; tTBil= 3. 46,7. 41,13. 17; all P < 0. 05). Compared with the non- glucocorticoid treatment group,the glucocorticoid treatment group had significantly lower AST and ALT levels before treatment and on days 3 and 7 of treatment( all P > 0. 05). The GGT,AST,and TBil levels in the glucocorticoid treatment group were significantly lower than those in the non- glucocorticoid treatment group on day 14 of treatment( t = 7. 074,2. 929,2. 018; all P < 0. 05). The average decreasing speed of bilirubin in the glucocorticoid treatment group was12. 21% ± 2. 91% per day,significantly faster than 6. 27% ± 0. 92% per day in the non- glucocorticoid treatment group( t = 15. 11,P <0. 001). Conclusion Glucocorticoid therapy in addition to conventional treatment for patients with drug- induced cholestatic liver disease is superior to conventional treatment alone in lowering TBil,GGT,and ALT levels.

Objective To investigate the prevalence of cholelithiasis in the employees of Kailuan Corporation and to provide a reference for effective preventive measures. Methods A total of 101 510 in- service or retired employees of Kailuan Corporation were recruited. All of them completed checkups organized by Kailuan Corporation from June 2006 to October 2007. The cholelithiasis examination data of 1133 employees were lost and the data of 100 377 employees were finally included in the statistical analysis. Questionnaire survey,blood biochemical examination,and ultrasound examination of the gallbladder were carried out. According to the ultrasound examination results,the subjects were divided into cholelithiasis group and non- cholelithiasis group. Comparison of the means between the two groups was made by t- test and comparison of the incidence rates between the two groups was made by chi- square test. The risk factors for cholelithiasis were assessed using multiple logistic regression analysis. Results There were 80 129 males and 20 248 females in the 100 377 subjects. Their ages ranged from 18 to 98 years( mean,51. 89 ± 12. 66 years). There were 98 109 subjects without cholelithiasis and 2268 subjects( 2. 3%) with cholelithiasis. The females had a significantly higher incidence of cholelithiasis compared with the males( 2. 5% vs 2. 2%,χ2= 4. 60,P =0. 033). The incidence rate of cholelithiasis increased with age in both men and women. According to the result of logistic regression analysis,sex,age,body mass index,occupation,fasting plasma glucose,high- sensitivity C- reactive protein( hs- CRP),and cholecystitis were all risk factors for cholelithiasis and the odds ratios( 95% confidence interval) of them were 0. 765( 0. 687- 0. 853),1. 439( 1. 388-1. 493),1. 403( 1. 282- 1. 535),0. 821( 0. 706- 0. 955),1. 234( 1. 075- 1. 416),1. 080( 1. 022- 1. 142),and 12. 519( 10. 678-14. 678),respectively. Conclusion People with advanced age,female sex,obesity,hyperglycemia,high hs- CRP,cholecystitis,or unhealthy lifestyle have high risk of cholelithiasis.

Objective To systematically evaluate the association between smoking and the risk of primary biliary cirrhosis( PBC) from the perspective of evidence- based medicine. Methods A literature search was performed in Pub Med,EMBASE,CBM,CNKI,Wanfang Data,and VIP database to collect the case- control studies on the association between smoking and the risk of PBC published in the last two decades. Chinese search words were “吸烟”,“香烟”,“原发性胆汁性肝硬化”,“危险因素”,“队列研究”,and “病例对照研究”,and English search words were “smoking”,“cigarette”,“tobacco”,“risk factors”,“primary biliary cirrhosis”,“cohort studies”,and“case- control studies”. And then a meta- analysis was performed using Review Manager 5. 2. The pooled odds ratio( OR) and 95% confidence interval( CI) were calculated,and the publication bias was analyzed by funnel plots. Results A total of 7 case- control studies involving 5459 subjects( 2652 patients with PBC vs 2807 controls) were included in the meta- analysis. The analysis results showed that smokers had a significantly higher risk of PBC compared with non- smokers( OR = 1. 49,95% CI: 1. 11- 2. 00,P = 0. 009). The geographical subgroup analysis results showed that there was a significant difference in the risk of PBC between non- smokers and smokers in North America( OR = 1. 57,95% CI: 1. 20- 2. 04,P = 0. 0008). However,there was no significant difference in the risk of PBC between non- smokers and smokers in Europe( OR = 1. 41,95% CI: 0. 73- 2. 73,P = 0. 31). Conclusion Smoking can increase the risk of PBC. However,it needs to be confirmed in high- quality prospective studies with larger samples because of the heterogeneity of current included studies.

Objective To assess the efficacy of adjuvant therapy with fenofibrate for primary biliary cirrhosis( PBC). Methods CNKI,Wanfang Data,China Biology Medicine,Pub Med,Embase,and Cochrane library were searched for the pertinent literature of randomized controlled trials( RCTs) of adjuvant therapy with fenofibrate for PBC published up to December 31,2014. Data extraction and quality assessment were carried out,and the data were statistically analyzed by Stata10. 1 software. Respectively,for heterogeneity test. The fixed effect model is chosen for homogeneity,and the random effect model is chosen for heterogeneity. Results Six RCTs met the inclusion criteria. Treatment with fenofibrate was associated with significantly reduced levels of gamma- glutamyl transpeptidase,alanine aminotransferase,and alkaline phosphatase in PBC patients( SMD =- 1. 595,- 0. 447,and- 2. 125,respectively,all P < 0. 05). There were no significant changes in the levels of aspartate aminotransferase and total bilirubin after adjuvant therapy with fenofibrate( both P > 0. 05). Also,fenofibrate led to no significant improvement in immunoglobulin M( P > 0. 05). Conclusion Fenofibrate,which improves the indicators of liver function but leads to no changes in immunological indicators,appears to be an effective adjuvant therapy in PBC patients. There is a critical need for more large-scale,multi- center,high- quality RCTs to determine its effect on liver disease- related morbidity and mortality.

Objective To evaluate the clinical effect of holmium laser lithotripsy combined with fiber choledochoscope in the treatment of intra- and extra- hepatolithiasis. Methods Sixty- four patients who were diagnosed with intra- and extra- hepatolithiasis in our hospital from January 2012 to July 2014 were assigned to receive fiber choledochoscope treatment( 33 cases) or holmium laser lithotripsy combined with fiber choledochoscope( 31 cases). The one- time stone removal rate and incidence of complications were compared between the two groups. Comparison of categorical data was made by chi- square test,while comparison of continuous data was made by t test. Results The fiber choledochoscope group had a significantly lower one- time stone removal rate and a significantly higher incidence of complications compared with the combination therapy group( 72. 73%( 24 /33) vs 93. 55%( 29 /31),χ2= 4. 868,P = 0. 027; 21. 21%( 7 /33) vs3. 23%( 1 /31),χ2= 4. 728,P = 0. 030). Conclusion Holmium laser combined with fiber choledochoscope can effectively increase the one- time stone removal rate and reduce the incidence of complications in patients with intra- and extra- hepatolithiasis. This therapy holds promise for clinical application.

Objective To evaluate the safety and efficacy of therapeutic endoscopic retrograde cholangiopancreatography( ERCP) in very elderly patients( 85 years or older) with common bile duct stones. Methods A retrospective study was conducted on 150 patients with common bile duct stones who underwent ERCP in the Second Affiliated Hospital of Nanjing Medical University between January 2013 and December 2014. The subjects were divided into two groups: very elderly group of 50 patients aged 85 or above and non- elderly group of 100 patients aged 60 or below. Postoperative vital signs were closely monitored. Symptoms such as fever and abdominal pain were recorded.Blood test was performed and the level of serum amylase was determined at 3 and 24 h after ERCP. The treatment success rate,success rate of stone removal in one setting,and incidence rate of complications in the two groups were compared by chi- square test. Results The treatment success rate in very elderly group( 98. 0%) was similar to that in non- elderly group( 99. 0%)( χ2= 0. 253,P > 0. 05). The success rate of stone removal in one setting in very elderly group( 70. 0%) was significantly lower compared with that in non- elderly group( 91. 0%)( χ2= 10. 938,P < 0. 05). The incidence rate of complications in very elderly group( 8. 0%) was similar to that in non- elderly group( 12. 0%)( χ2= 0. 560,P > 0. 05). Conclusion Therapeutic ERCP is an effective and safe method for the treatment of common bile duct stones in very elderly patients and can be recommended as the first choice of treatment.

Objective To investigate the efficacy of endoscopic retrograde cholangiopancreatography( ERCP) in the treatment of acute obstructive suppurative cholangitis( AOSC),and to examine the results of bile bacterial culture and drug susceptibility test. Methods A retrospective analysis was performed on 150 AOSC patients who were admitted to the Fifth Affiliated Hospital of Zunyi Medical University from November 2009 to November 2014. All patients underwent ERCP. The bile of patients was collected during treatment. Antibiotics were chosen according to the results of bile bacterial culture and drug susceptibility test. The efficacy of ERCP was assessed. Comparison of continuous data between groups was made by independent- samples t test,while comparison of categorical data by chi- square test. Results The rate of successful intubation was 92%( 138 /150),and the rate of effective drainage was 94. 2%( 130 /138). After treatment,the 130 patients treated with effective drainage had significantly reduced total bilirubin and direct bilirubin( 60. 3 ± 43. 4 μmol/L vs 110. 2 ± 53. 1 μmol/L,t = 8. 56,P < 0. 05; 35. 5 ± 23. 6 μmol/L vs 65. 5 ± 33. 2 μmol/L,t = 8. 65,P < 0. 05) and a significantly reduced percentage of neutrophils( 65. 2% vs83. 4%,χ2= 11. 85,P < 0. 05). The results of bile bacterial culture showed that Gram- negative bacteria were found in 85. 7%( 78 /91) of positive specimens. The β- lactam antibiotics with enzyme inhibitor could be used as the preferred drug,and carbapenems as second- line drugs. Conclusion ECRP is a simple and effective therapy for AOSC. Antibiotics,chosen based on the results of bile bacterial culture,can quickly relieve symptoms of poisoning and prevent drug resistance.

Objective To analyze the clinical characteristics of patients treated with multiple therapeutic endoscopic retrograde cholangiopancreatography( ERCP) procedures and to evaluate the causes,safety,and efficacy of repeated ERCP. Methods Analyses of therapeutic results,complications,and postoperative outcomes were performed on the clinical data of the patients who were admitted to Beijing Army General Hospital and received ERCP at least twice from July 2010 to December 2014. Results Seventy- seven patients underwent 187 times of ERCP procedures in total,among which 2 times were performed in 60 patients,3 times in 6 patients,4 times in 8 patients,5 times in 2 patients,and 7 times in 1 patient. Postoperative events included hemorrhea after endoscopic sphincterotomy in 2 cases,post- ERCP pancreatitis in 2 cases,duodenal perforation in 1 case,and death within 3 weeks after ERCP in 2 cases due to chronic obstructive pulmonary disease. Conclusion Recurrent common bile duct stones,inflammatory stenosis of the bile duct,chronic pancreatitis,and prolonged survival of malignant tumor patients are the main reasons for repeated ERCP. The patients aged over 80 years are more likely to undergo multiple ERCP procedures. Repeated ERCP shows good overall safety and efficacy.

Objective To compare the efficacy of precise and traditional liver resection in the treatment of intrahepatic bile duct stones.Methods One hundred and twenty- seven patients with intrahepatic bile duct stones who were treated with surgery in our hospital from December 2008 to December 2014 were selected and divided into precise liver resection group( n = 72) and traditional liver resection group( n =55) based on the type of surgery. The operation time,intraoperative blood loss,amount of postoperative drainage,postoperative time to recovery,postoperative complications( incision infection,biliary fistula,lung infection,and pleural effusion),hospitalization cost,postoperative residual calculi,and postoperative calculus recurrence were compared between the two groups. Between- group comparison of continuous data was made by t test,and between- group comparison of categorical data was made by χ2test. Survival data were analyzed using survival function. Results There were significant differences in operation time,intraoperative blood loss,amount of postoperative drainage,postoperative time to recovery,and hospitalization cost between the precise liver resection group and the traditional liver resection group( t =3. 720,58. 681,19. 169,5. 990,and 6. 944; all P < 0. 05). There were no significant differences in postoperative complications including incision infection,biliary fistula,lung infection,and pleural effusion between the two groups( all P > 0. 05). There were also no significant differences in the incidence rates of postoperative residual calculi and calculus recurrence between the two groups( all P > 0. 05). The survival analysis of postoperative calculus recurrence time showed that there was no significant difference in calculus recurrence time between the two groups( P > 0. 05). Conclusion Compared with traditional liver resection,precise liver resection has the advantages of shorter operation time,less intraoperative bleeding,less postoperative drainage,and faster recovery; however,precise liver resection raises hospitalization cost. Moreover,precise liver resection does not increase the risks of postoperative complications including incision infection,biliary fistula,lung infection,and pleural effusion; however,it does not reduce the incidence rates of postoperative residual calculi and calculus recurrence.

Objective To explore the clinical application of preoperative biliary drainage in the treatment of patients with malignant obstructive jaundice( MOJ) with acute cholangitis( AC). Methods A retrospective study was performed on the clinical data of 74 patients with MOJ and AC who were treated with preoperative biliary drainage in our hospital from January 2010 to December 2014. In those patients,29 patients treated with percutaneous transhepatic biliary drainage( PTCD) were assigned to PTCD group,and 35 patients treated with endoscopic retrograde biliary drainage( ERBD) were assigned to ERBD group. The levels of total bilirubin( TBil),direct bilirubin( DBil),and alanine aminotransferase( ALT) before and after treatment,total hospitalization cost,average duration of hospitalization,and postoperative complications were compared between the two groups. The advantages and disadvantages were compared between the two preoperative biliary drainage approaches. Between- group comparison of continuous data was made by t test,and between- group comparison of categorical data was made by χ2test. Results In both groups,the levels of TBil,DBil,and ALT were significantly reduced after treatment( all P < 0. 05).The ERBD group had significantly larger decreases in the levels of the three biochemical indices than the PTCD group( all P < 0. 05). The ERBD group had significantly shorter average duration of hospitalization and significantly lower total hospitalization cost than the PTCD group( t = 3. 172,P < 0. 05; t = 2. 562,P < 0. 05). The incidence of acute pancreatitis in the ERBD group was significantly higher than that in the PTCD group( 14. 28% vs 3. 45%,P < 0. 05); however,the incidence rates of biliary tract bleeding,biliary tract infection,and resection or puncture site infection were significantly lower in the ERBD group than in the PTCD group( all P < 0. 05). Conclusion Preoperative biliary drainage can substantially control AC symptoms and improve liver function. Compared with PTCD,ERBD achieves shorter duration of hospitalization,lower total hospitalization cost,and lower incidence rates of complications after treatment,which can be taken as the first choice for the treatment of MOJ with AC.

Objective To observe the effects of different suture techniques on complications after choledochojejunostomy. Methods A retrospective analysis was performed on the clinical data of 162 patients who underwent choledochojejunostomy from January 2005 to December2014 in our hospital. The patients were divided into group A undergoing simple interrupted suture( n = 68),group B undergoing simple continuous suture( n = 45),and group C undergoing parachute type continuous suture( n = 49). The intraoperative conditions and postoperative complications were compared between the three groups. Comparison of continuous data between the three groups was made by ANOVA and pairwise comparison between any two groups was made by LSD t- tests; comparison of categorical data between the groups was made by chi- square test. Results The anastomosis time and the rate of T- tube insertion showed significant differences between the three groups( P < 0. 05). Groups B and C had significantly shorter anastomosis time than group A( P < 0. 001),but there was no significant difference in the anastomosis time between groups B and C( P > 0. 05). Among the three groups,group A had the highest rate of T- tube insertion;group B had the second highest rate; group C had the lowest rate. Significant differences were found between any two groups in the rate of T- tube insertion by pairwise comparison( P < 0. 05). However,there were no significant differences between the three groups in the incidence rates of postoperative bile leakage and choleperitonitis( P > 0. 05). There was significant difference in biliary stricture between the three groups in the follow- up examination 6 months after surgery( P < 0. 001) and the differences analyzed by pairwise comparison were also significant( P < 0. 05). Among the three groups,the degree of biliary stricture in the group A was the highest and that in the group C was the lowest. Conclusion Parachute- type continuous suture is a fine suture technique for choledochojejunostomy,which can reduce the anastomosis time,the rate of T- tube insertion,and the degree of biliary stricture.

Objective To systematically review the efficacy and safety of fast- track surgery( FTS) in perioperative nursing for biliary calculi surgery. Methods Online databases of Pub Med,Cochrane Library,CBM,CNKI,VIP,and Wanfang Data were comprehensively searched for relevant randomized controlled trials( RCTs). Potential bias was evaluated by Cochrane tools and data were analyzed by RevMan 5. 3. Results A total of 11 RCTs with 1455 patients were included( 738 cases in FTS group and 717 cases in control group). The results of meta- analysis showed that FTS significantly reduced the length of postoperative hospital stay( MD =- 4. 10,95% CI:- 5. 68 to- 2. 52,P < 0. 000 01) and hospital costs( MD =- 0. 47,95% CI:- 0. 60 to- 0. 34,P < 0. 000 01); meanwhile,FTS shortened the time to gastrointestinal recovery( SMD =- 2. 05,95% CI:- 2. 84 to- 1. 27,P < 0. 000 01),as well as the time to first defecation( SMD =- 1. 27,95% CI:- 2. 08 to- 0. 46,P < 0. 000 01). As for safety,FTS significantly reduced the total complications of choledocholithiasis( RR = 0. 53,95% CI: 0. 43- 0. 65,P < 0. 000 01) and hepatolithiasis( RR = 0. 52,95% CI: 0. 35- 0. 77,P = 0. 001). Conclusion FTS is effective and safe in perioperative nursing for biliary calculi surgery. It can significantly reduce the length of postoperative hospital stay,enhance gastrointestinal recovery,shorten the time to first defecation,and reduce total complications.

Objective To systematically evaluate the advantages and disadvantages of choledochoscopic gallbladder- preserving cholelithotomy( CGPC) and laparoscopic cholecystectomy( LC) in the treatment of gallstones. Methods The databases of CBM,CNKI,VIP,Wanfang Data,Pub Med,EMBASE,the Cochrane Library,and Web of Science were searched for randomized controlled trials( RCTs) related to CGPC and LC in the treatment of gallstones published up to June 2015. Data extraction and quality evaluation were performed for the literature included,and Review Manager 5. 3 was used for the meta- analysis. Results Five RCTs involving 685 patients were included. The results of the meta- analysis showed that CGPC group and LC group had significant differences in operation time( OR = 8. 85,95% CI:0. 49- 17. 21,P = 0. 04) and incidence of postoperative diarrhea( OR = 0. 24,95% CI: 0. 11- 0. 53,P = 0. 000 4). However,no significant differences were seen between the two groups in intraoperative bleeding volume( OR =- 12. 37,95% CI:- 29. 73- 4. 99,P = 0. 16),time to postoperative intestinal function recovery( OR =- 7. 19,95% CI:- 24. 28- 9. 90,P = 0. 41),hospitalization days( OR =- 0. 17,95% CI:- 1. 98- 1. 63,P = 0. 85),and hospital costs( OR =- 1. 14,95% CI:- 2. 57- 0. 28,P = 0. 12). Conclusion The operation time and incidence of postoperative diarrhea in CGPC are superior to those in LC,while no significant differences are observed in intraoperative bleeding volume,time to postoperative intestinal function recovery,hospitalization days,and hospital costs. Due to a limited number of articles included and publication bias,RCTs with a large sample size and high quality are needed to provide more effective data.

Objective To analyze the influencing factors for conversion of laparoscopic cholecystectomy to open surgery,and to provide a clinical reference for developing surgical procedures. Methods A total of 278 patients receiving laparoscopic cholecystectomy in our hospital from January 2009 to December 2013 were analyzed. Among them,31 patients were converted to open surgery during laparoscopic cholecystectomy,while the remaining 274 patients were not. The influencing factors for conversion to open surgery were investigated. The t test was applied in the comparison of continuous data,whereas the χ2test was used for categorical data. The univariate logistic regression analysis was performed to investigate significant influencing factors,and the independent influencing factors were determined by multivariate logistic regression analysis. Results The univariate analysis showed that sex( P = 0. 022),arteriosclerosis( P < 0. 001),diabetes( P < 0. 001),heart failure( P = 0. 002),previous upper abdominal surgery( P < 0. 001),age( P < 0. 001),body mass index( BMI)( P = 0. 003),gallbladder wall thickness( P < 0. 001),the count of white blood cells( P < 0. 001),and serum total bilirubin level( P = 0. 046) were significantly different between groups. The multivariate logistic regression analysis further showed that previous upper abdominal surgery( P <0. 001),sex( P = 0. 001),BMI( P = 0. 002),and the count of white blood cells( P = 0. 019) were independent influencing factors,among which previous upper abdominal surgery was the most significant one( OR = 4. 646,95% CI: 2. 012- 10. 729). Conclusion Previous upper abdominal surgery,sex,BMI,and the count of white blood cells were independent influencing factors for conversion of laparoscopic cholecystectomy to open surgery. Careful evaluation of these factors before surgery would help to increase the operation efficacy,possessing an important clinical value.

Objective To investigate the identification and treatment of variation of extrahepatic bile duct in laparoscopic cholecystectomy( LC),and to reduce the occurrence of bile duct injury. Methods This study included 60 patients who received LC in the People's Hospital of Caidian District in Wuhan and had structural variation of extrahepatic bile duct found during the operation from January 2012 to January2014. The clinical data were retrospectively analyzed,and the intraoperative and postoperative conditions were summarized. Results During operation,cystic duct variation was found in 32 cases,abnormal position of the point where the cystic duct joins the extrahepatic bile duct in 20 cases,the cystic duct and the common hepatic duct having the common wall before joining the common bile duct in 2 cases,aberrant bile duct in the gallbladder bed in 2 cases,and accessory hepatic duct in 4 cases. Fifty- one patients( 85%) successfully underwent LC; 9 patients( 15%) were converted to open surgery. All patients finished surgery successfully. There were 2 cases of postoperative complications; one patient developed residual stones in the bile duct,and bile leakage occurred in the other patient at one week after LC,who recovered after reoperation. All patients were cured and discharged,without severe complications such as intraperitoneal hemorrhage,infection,and intestinal injury. Conclusion Identifying the structural variation of extrahepatic bile duct,dissecting the Calot's triangle meticulously,and determining the type of variation of extrahepatic bile duct play important roles in LC and significantly reduce the incidence of bile duct injury.

Objective To evaluate the clinical efficacy of transumbilical single- port laparoscopic cholecystectomy in patients with acute cholecystitis and the effect of this surgical procedure on the postoperative recovery of gastrointestinal function. Methods This study enrolled74 patients who were diagnosed with acute cholecystitis at Yanan University Affiliated Hospital,Shaanxi Province,China,from January 2013 to February 2014. The patients received either transumbilical laparoscopic surgery( treatment group) or conventional laparoscopic treatment( control group). Differences in operative time,intraoperative blood loss,rate of postoperative complications,time to first bowel sound,time to first flatus,time to ambulation,and hospital costs were compared between the two groups. Categorical data were compared using the χ2test and continuous data were compared using the t test. Results No significant difference was noted between the treatment group and the control group in terms of operative time( P > 0. 05). However,the treatment group had significantly lower blood loss( 10. 5 ± 1. 5 L),rate of postoperative complications( 10. 8%),and hospital costs( 8218 ± 389 yuan) and significantly less time to first bowel sound( 2. 5 ± 0. 3 h),time to first flatus( 1. 6 ± 4. 1 h),and time to ambulation( 9. 7 ± 5. 8 h) than the control group( all P < 0. 05). Conclusion Transumbilical single- port laparoscopic cholecystectomy is a safe and feasible procedure for the treatment of acute cholecystitis as it offers minimal trauma and fast recovery of gastrointestinal function after surgery,which warrants its greater use in clinical practice.

Objective To investigate the risk factors for the complications of transumbilical single- port laparoscopic cholecystectomy( TUSPLC) and to explore the prophylactic methods. Methods The clinical data of 120 patients undergoing TUSPLC in our hospital from January 2012 to December 2014 were retrospectively analyzed. The association of different factors with the complications was analyzed,including sex,age,body mass index( BMI),height,underlying diseases( hypertension,diabetes,and hyperthyroidism),surgeon level,operation time,and intraoperative blood loss. The risk factors were determined by univariate and multivariate logistic regression analyses. Results The incidence of the complications of TUSPLC was 8. 3%( 10 /120),including surgical site infection( 4 cases),umbilical hernia( 2cases),hemorrhage( 2 cases),and intra- abdominal organ injury( 2 cases). The univariate logistic regression analysis indicated that BMI,height,underlying diseases,surgeon level,operation time,and intra- operative blood loss were risk factors for the complications of TUSPLC( all P < 0. 05). The multivariate logistic regression analysis showed that underlying diseases and operation time were independent risk factors for the complications of TUSPLC( P < 0. 01). Conclusion The underlying diseases and operation time are independent risk factors for the complications of TUSPLC,so appropriate intervention strategies for these factors could be developed to reduce the incidence of the complications of TUSPLC.

Objective To explore the feasibility and efficacy of percutaneous transhepatic approach in the treatment of intrahepatic and extrahepatic bile duct stones. Methods Nineteen patients with bile duct stones who were treated in our hospital from January 2000 to October2014 were enrolled as subjects. In the treatment of bile duct stones,all patients received percutaneous transhepatic approach combined with the application of cholangioscopy and lithotripsy equipment. Results In the 19 patients,12 had the stones successfully removed in a single session,5 had the stones completely removed through the liver sinus in three sessions,and 2 had residual stones in intrahepatic tertiary bile ducts. The success rate of lithotomy reached 89. 47%( 17 /19). Conclusion The percutaneous transhepatic approach achieves minor surgical invasion and slight pain in the treatment of bile duct stones,which can be selectively used based on patients' condition.

Objective To investigate the factors influencing the liver histological features in chronic hepatitis B virus( HBV) infection patients with low alanine transaminase( ALT) levels by analyzing the relationship of serum hepatitis B surface antigen( HBs Ag) level with liver inflammation grade and fibrosis stage. Methods A total of 511 HBV infection patients admitted to our hospital from December 2010 to December 2013 were studied. The liver histological features,serum HBs Ag level,and HBV DNA copy number were examined. Comparison of categorical data between different groups was made by chi- square test,comparison of continuous data following the normal distribution was made by t test,and comparison of continuous data not following the normal distribution was made by Kruskal- Wallis H test. The relationship of serum HBs Ag level with liver inflammation grade and fibrosis stage was determined by Spearman's rank correlation analysis. Results All patients showed different degrees of hepatic histological abnormalities. The group aged more than or equal to 40 years had significantly lower HBe Ag positive rate,HBs Ag level,and HBV DNA copy number compared with the group aged less than 40 years( χ2= 86. 8,P <0. 000 1; t = 2. 99,P = 0. 003; t = 7. 25,P < 0. 000 1). The groups with different ages had significant differences in liver inflammation grade and fibrosis stage( χ2= 70. 03,P < 0. 000 1; χ2= 61. 92,P < 0. 000 1). The Spearman's rank correlation analysis indicated that in both HBe Ag- positive and- negative patients HBs Ag level was negatively correlated with liver inflammation grade( r =- 0. 245,P < 0. 000 1;r =- 1. 51,P = 0. 019) and fibrosis stage( r =- 0. 153,P = 0. 012; r =- 0. 181,P = 0. 005). Conclusion Age is one of the important factors influencing the liver histological progression in chronic HBV infection patients with low ALT levels. HBs Ag level is negatively correlated with liver inflammation grade and fibrosis stage in chronic HBV infection patients with low ALT levels,so it could be used as an important non- invasive indicator for the liver histological status in these patients.

Objective To investigate the HBs Ag seroprevalence in the young generation in Qidong of Jiangsu Province,China. Methods A total of 15 534 students for college entrance examination from 2006 to 2014 were randomly selected from three secondary schools in Qidong as student group. Some of them had hepatitis B vaccination at birth. A total of 1208 adults who had their routine checkups in our hospital from 2007 to 2013 were selected as adult group. It was confirmed that all of them did not have hepatitis B vaccination at birth. Serum HBs Ag levels of the two groups were measured using enzyme- linked immunosorbent assay and the seroprevalence was analyzed. Comparison of data between the two groups was made by chi- square test. Results In the 9 years from 2007 to 2013,the seroprevalence rates of HBs Ag in the student group were 4. 2%( 75 /1794),4. 3%( 77 /1797),4. 4%( 82 /1858),4. 3%( 82 /1903),3. 4%( 56 /1627),2. 6%( 46 /1768),1. 6%( 29 /1778),1. 6%( 27 /1642),and 1. 8%( 24 /1367),respectively. The mean HBs Ag seroprevalence of the student group was3. 2%( 498 /15534),significantly lower compared with 7. 1%( 86 /1208) of the adult group( χ2= 59. 986,P < 0. 001). In both of the student group and the adult group,the males had a significantly higher HBs Ag seroprevalence than the females( χ2= 10. 521,P = 0. 001;χ2= 8. 452,P = 0. 004) and the values were 3. 7%( 266 /7236) vs 2. 8%( 229 /8298) and 8. 8%( 66 /750) vs 4. 4%( 20 /458),respectively. Among male subjects,the HBs Ag seroprevalence of the adult group was 2. 4 times that of the student group; among female subjects,the HBs Ag seroprevalence of the adult group was 1. 6 times that of the student group. Conclusion In the recent 9 years from 2006 to 2014,the HBs Ag seroprevalence in students for college entrance examination declined continuously. The goal set by the World Health Organization Western Pacific Region in 2010 had been achieved ahead of the schedule that the HBs Ag seroprevalence should be controlled below 2% in children aged less than 5.

Objective To study the quality of life( Qo L) and its influential factors among outpatients with chronic hepatitis B or C. Methods Patients diagnosed with chronic hepatitis B or C between March 2012 and March 2014 were included in the hepatitis group,whereas volunteers presenting with neither significant physical nor mental diseases,who accompanied visiting patients or underwent physical examination,were involved in the control group. A survey using the Short Form- 36( SF- 36) Chinese version,the Chronic Liver Disease Questionnaire( CLDQ),and the Social Support Rating Scale( SSRS) were performed within the above groups. Results The SF- 36 scores of the hepatitis group were significantly lower than those of the control group in physical role,general health,vitality,social functioning,emotional role,and mental health( P < 0. 05). The CLDQ scores of the hepatitis group were significantly lower than those of the control group in systemic symptoms,role emotion,and anxiety( P < 0. 05). The hepatitis patients displayed significantly lower scores in all four scales of SSRS( P < 0. 05). Multivariable linear regression analysis showed that age,sex,occupation,marital status,income,subjective support,and social support utilization significantly influenced the Qo L among hepatitis patients. Conclusion The Qo L of outpatients with chronic hepatitis B or C is poor. The Qo L of patients showing the characteristics of old age,female sex,divorce,farmer,lower income,less subjective support,and poor social support utilization require more attention to their Qo L. Medical workers should provide proper individualized health guidance for those patients.

Objective To investigate the impacts of mannan- binding lectin( MBL) on the phenotype and function of CD11c- positive human peripheral blood myeloid dendritic cells( CD11c+m DC). Methods CD11c+m DC and CD4+T lymphocytes from healthy human volunteers were isolated by magnetic bead sorting and were stimulated by different concentrations of MBL( 5,10,20 μg/ml). Compared with the non- MBL stimulation group,the levels of interleukin- 12( IL- 12) in the supernatant of culture medium in different MBL stimulation groups were determined by enzyme- linked immunosorbent assay( ELISA). The expression of CD40,CD80,CD86,and HLA- DR on CD11c+m DC surface was measured by flow cytometry. CD11c+m DC- stimulated proliferation abilities of CD4+T lymphocytes were determined by MTT assay. The levels of interleukin- 4( IL- 4) and interferon- gamma( IFNγ) in the coculture medium were measured by ELISA. Comparison of the means between multiple groups was made by one- way ANOVA and pairwise comparison between any two groups was made by LSD t- test. Results Compared with the non- MBL stimulation group,the MBL stimulation groups( 5,10,20 μg/ml) had significantly higher expression of CD40,CD80,CD86,and HLA- DR on CD11c+m DC surface and significantly increased IL- 12 secretion( F = 44. 34,P < 0. 001; F = 27. 35,P < 0. 001; F = 15. 57,P < 0. 001; F = 48. 38,P < 0. 001; F = 38. 27,P < 0. 001). The IL- 12 secretion was MBL concentration- dependent. The proliferation ability of CD4+T lymphocytes was significantly higher in the MBL stimulation group than in the non- MBL stimulation group and the control group( F = 23. 43,P < 0. 001). The MBL group had a significantly higher IFNγ level but a significantly lower IL- 4 level compared with the non- MBL group and the control group( F = 28. 25,P < 0. 001; F =40. 03,P < 0. 001). Conclusion MBL can effectively stimulate the activation of CD11c+m DC and induce the differentiation from CD4+T lymphocytes to type 1 helper T cells. Therefore,MBL is possibly involved in the control and clearance of hepatitis B virus by regulating the phenotype and function of CD11c+m DC.

Although there are many surgical methods for intrahepatic bile duct stones,one single treatment cannot achieve the satisfactory therapeutic effect. The article introduces the progress in the etiology,pathological features,and therapeutic methods for intrahepatic bile duct stones. It is reckoned that combining various therapeutic methods according to the condition of disease is the key to reducing the rate of residual stones,preventing intrahepatic bile duct cancer,and achieving the optimal therapeutic effect.

Post- cholecystectomy syndrome( PCS) is a common digestive disease. The incidence of PCS is increasing with the popularization of laparoscopic technique. This article introduces the etiology,diagnosis,and treatment of PCS,and discusses the controversy over whether the gallbladder should be resected,so as to improve the treatment outcome of PCS.

In order to achieve the sustained suppression of hepatitis B virus replication,the long- term and even life- long antiviral therapy is needed for patients with chronic hepatitis B( CHB). So the adherence to antiviral therapy is one of the critical factors for achieving effective therapy. In this article,the current studies on the adherence to antiviral therapy in patients with CHB are reviewed. The rate of patients' adherence to antiviral therapy and its impact on treatment outcome are analyzed,and the influencing factors for adherence are summarized.The existing problems in current studies on adherence are also analyzed. It is proposed that the attention should be focused on how to improve medication adherence so as to improve the prognosis in the future.

HBV is a major health problem faced by human beings. The study of the mechanism of HBV infection has been a key point in this field. To carry out the related research on HBV,establishment of simple and available in vivo and in vitro infection models is the trend. Due to the close relationship between tree shrews and human/primates,the tree shrew model of HBV infection has attracted more and more attention. This review summarizes recent research,both at home and abroad,about in vivo and in vitro HBV infection in tree shrews,especially the research progress in in vitro culture of primary hepatocytes of tree shrews,and looks to the future research directions as well.

Intravoxel incoherent motion diffusion- weighted imaging( IVIM- DWI) can not only obtain various parameters,but also provide diffusion and perfusion information without contrast agents. IVIM- DWI could make up for the deficiency of traditional DWI and contrast enhancement methods. This paper introduces the basic principle of IVIM- DWI and its research progress and clinical significance in the diagnosis,prognosis,and treatment options for liver diseases,including hepatic steatosis,liver fibrosis,primary liver cancer,and focal liver lesions. This paper also summarizes the challenges confronting the clinical application of IVIM technology,including the determination of b- values,selection of mathematical models,and limitation from working platform conditions. The analyses demonstrate that the IVIM technology has been more and more widely used in clinical practice and scientific research. With continuous improvement in equipment conditions and further solution of technical problems,the IVIM technology will make a greater contribution to the assessment of liver diseases in an accurate,fast,and noninvasive manner.