Objective To investigate the role of KiSS-1 gene in the metastatic process of carcinoma of gallbladder and the clinicopathologic significance of KiSS-1 gene expression in carcinoma of gallbladder. Methods Pathological specimens from 59 gallbladder carcinoma tissues (13 hepatic invasion and 13 lymphatic invasion tissues were included), matched with 7 para-tumor and 6 normal gallbladder tissues, were examined for the expression of KiSS-1 gene by tissue microarray technique and immunohistochemistry (EnVision). Results The positive rate of KiSS-1 expression was down-regulated (P＜0.05) in tumor tissues, as compared with normal and para-tumor tissues. In carcinoma of gallbladder, the expression of KiSS-1 had no relationship with the gender, age, tumor size, histological grade or differentiation, and metastasis of lymph node, while was associated with the depth of infiltration, invasion of liver and the clinical stages (Nevin). In Ⅰ+Ⅱ, Ⅲ+Ⅳ and Ⅴ stage, the positive rates of KiSS-1 were 92.3%, 57.1% and 27.8% respectively, with an undeniably clear lowering tendency (P=0.002). Conclusion Down-regulating expression of KiSS-1 is closely associated with the processes of genesis, invasion and metastasis in carcinoma of gallbladder, and may participate in regulating these processes.
Objective To study the relationship between the expression of apoptosisrelated gene bclx,bax and estrogen receptor (ER) in primary gallbladder carcinoma (PGC) and its clinical significance. MethodsImmunohistochemistry of labeled dextran polymer (LDP) with EnvisionTM system was used to detect ER and gene bclx and bax. ResultsThe positive rate of bclx,bax and ER were 72.3%,66.0% and 59.6% in 47 cases with primary gallbladder carcinoma and 40.0%,93.3% and 93.3% in 6 cases with gallbladder adenomahyperplastic. The expression of bax and ER in PGC was significantly lower than that in gallbladder adenomahyperplastic (P＜0.05),the expression of bclx was significantly higher in PGC than that in the latter (P＜0.05).The expression of bclx and ER in well differentiated PGC was significantly higher than that in moderately, poorly differentiated PGC (P＜0.05); bax expression in well differentiated PGC was lower. ER and bax expression in male PGC was significantly lower than that in female PGC （P＜0.01）, the expression of bclx in male PGC was higher (P＜0.05).ER was more highly expressed in smaller PGC than in larger one (P＜0.05). ER and bax, bclx were not different between various clinical stages and ages (P＞0.05,respectively). Conclusion The expression ER, apoptosisrelated gene bclx and bax have correlation with differentiation and sex in PGC, their levels shows significance in the prognosis of PGC.
目的 评价腹腔镜胆囊切除术（LC）中意外胆囊癌的诊断、处理及预后。方法 对我院2000年1月至2010年1月期间5 832例行LC中16例意外胆囊癌患者的临床资料进行回顾性分析。结果 16例意外胆囊癌中7例行LC，9例行开腹胆囊癌根治术。术后病理TNM分期：Ⅰ期10例，Ⅱ期4例，Ⅲ期2例。16例患者术后随访6～60个月，平均23.3个月。随访期内死亡15例。9例接受胆囊癌根治手术的患者术后1、3、5年生存分别为8/9、4/9及1/9，而7例仅行LC的患者术后1年生存为4/7，无生存超过2.5年者。结论 LC术中应高度警惕意外胆囊癌的发生，意外胆囊癌多为早期，应及时中转开腹行胆囊癌根治术，仅行单纯的LC治疗效果欠佳。
Objective To study the feasibility of radical resection of gallbladder cancer with extensive invasion. Methods A patient of the gallbladder cancer with invasion of liver, gastric antrum, duodenum, caput pancreatis and colon transversum, was received radical resection (including pancreatoduodenectomy, hepatectomy and colectomy). Results Seven months later, the value of CEA and Hb were normal and cancer recurrence was not observed. Conclusion The radical resection of gallbladder cancer with extensive invasion, can improve survival quality and extent survival time.
目的 探讨瓷样胆囊腹腔镜手术治疗的技术和适应证。方法 对1995年1月至2009年1月期间我院收治的10例接受腹腔镜手术治疗的瓷样胆囊患者的临床资料进行回顾性分析。结果 10例瓷样胆囊均接受腹腔镜手术治疗，其中胆囊逆行切除6例, 胆囊大部切除2例，中转开腹2例（术中发生胆管损伤和发现胆囊癌各1例）。有1例术中冰冻检查证实为胆囊癌的患者经腹腔镜完整地切除胆囊。腹腔引流10例，仅1例发生漏胆，二次开腹手术探查见右肝管电灼伤，经放置T管引流，2周后痊愈。所有患者均痊愈出院, 无死亡病例。随访1.5~14年（平均11年），除1例胆囊癌患者于术后1.5年死亡，其余患者均恢复良好。结论 严格的适应证加上个体化的操作方法可以安全地完成腹腔镜瓷样胆囊切除术。
SerumIgG,IgA,IgM,C3andC4weredeterminedbyneophelmetricimmunoassay,serumandbiliaryIL2,sIL2Rlevelsweremeasuredbyatwoantibodysandwichenzymelinkedimmunosorbentassayinpatientswithsimplegallbladdercarcinoma,withbothgallbladdercarcinomaandgallstone,withsimplegallstoneandhealthyindividuals.Theresultsshowedthat:①Comparedwithcontrols,thegallbladdercarcinomapatientshadobviouslyloweredserumandbiliarylevelsofIL2andCD+4cell;andtheypresentedamarkedincreasedserum,biliarylevelsofsIL2RandCD+8cell.②TherewascorrelationbetweenthelevelsofsIL2RandCD+8,IL2andCD+4inthepatientswithgallbladdercarcinomaandtheirclinicstage.③Comparedwiththepatientswithgallbladdercarcinoma,gallstonepatientspresentedamarkeddecreasedserumandbiliarylevelofsIl2RandCD+8cell,andamarkedincreasedserumandbiliarylevelofIL2andCD+4cell.Theresultssuggestthat:①Thepatientswithgallbladdercarcinomahaveimmunedepression;②Inthepatientswithgallbladdercarcinomaandgallstone,gallstoneasainjuryfactorbrokethebalancebetweenCD+4andCD+8,thebalancebetweenIL2anditsreceptor;③TcellsubpopulationandsIL2R,IL2levelsmaybeusedasmarkerstopredictthechangesinpatientswithgallbladdercarcinoma.
目的 综合评价胰胆管合流异常（PBM）与胆囊癌发生的关系，为胆囊癌的预防提供更多、更准确的信息。 方法 计算机检索中国生物医学文献数据库（CBM）、中国期刊网（CNKI）、PubMed、EMBASE、万方等数据库，检索时间从1977年4月－2011年5月，并结合文献追溯的方法，收集国内外公开发表的关于PBM与胆囊癌关系的病例对照研究或队列研究，采用RevMan 5.0.25软件进行Meta分析。 结果 总计纳入文献8篇，其中3篇仅对比分析了PBM在胆囊癌患者与正常对照组中发生率的差异，2篇仅对比分析了胆囊癌在PBM患者与正常对照组中发生率的差异，而另外3篇文献则对这两种发生率的差异都进行了对比。Meta分析结果显示：胆囊癌患者中PBM的发生率明显高于正常对照组，差异有统计学意义[OR=7.41，95%CI（5.03，10.87），P＜0.000 01]；且PBM患者中胆囊癌的发生率明显高于正常对照组，差异有统计学意义[OR=17.67，95%CI（10.43，29.94），P＜0.000 01]。 结论 PBM是胆囊癌发生的高危因素，与胆囊癌的发生密切相关。
ObjectiveTo summarize the research progress of long non-coding RNA (lncRNA) in the regulation of malignant biological behavior of gallbladder cancer so as to provide references for its related research.MethodThe relevant literatures about studies of lncRNA in gallbladder cancer in recent years were reviewed.ResultsThe recent studies had shown that 19 lncRNAs associated with gallbladder cancer had played the important roles in regulating tumor cell proliferation, migration, invasion, apoptosis, “sponge” miRNAs, chemoresistance, and tumor metastasis. Among them, most lncRNAs tended to have carcinogenic properties, only a few had anticarcinogenic effect. Although the research suggested the mechanism and role of lncRNA to promote or inhibit the occurrence and development of gallbladder cancer, the current research on its mechanism was still limited. In addition, some lncRNAs were found to be specifically expressed in the serum of patients with gallbladder cancer, so which were expected to become biomarkers for tumor diagnosis and prognosis.ConclusionslncRNAs associated with gallbladder cancer have carcinogenic or anticarcinogenic effect, or chemoresistance. They play potential roles in diagnosis, prognosis, and (or) treatment of tumors, but molecular mechanisms of their effects are still limited.
目的探讨原发性胆囊癌治疗的措施。方法对我院1998年4月至2003年2月外科治疗的122例原发性胆囊癌患者的临床资料，结合部分患者随访结果进行分析总结。结果19例Ⅰ、Ⅱ及Ⅲ期胆囊癌患者手术治疗效果满意； 103例Ⅳ、Ⅴ期胆囊癌患者中34例行根治或扩大根治术，根治切除率为33.0%，余69例行姑息性手术治疗，行胆囊癌根治术后患者的平均生存时间明显长于姑息性手术者（17.6个月 vs 7.3个月）。结论对胆囊癌应采取积极的、个体化的治疗措施。扩大根治术可使部分Ⅳ、Ⅴ期胆囊癌患者受益。应注意淋巴结清扫的范围和做到无残留癌的根治性切除。对综合治疗的研究还需进一步深入。