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Objective To evaluate intraoperative placement of bile duct decompression drainage tube in CBD primary suture after laparoscopic choledocholithotomy.Methods 152 patients undergoing laparoscopic choledocholithotomy were divided into group A (placement of bile duct decompression drainage tube during operation,82 cases) and group B (no decompression drainage tube placement,70 casas).Results There was no significant difference in operative time and intraoperative bleeding between the two groups (P ＞ 0.05).In group B patients the abdominal drainage tube indwelling time,abdominal drainage volume,peritoneal drainage fluid bilirubin value,postoperative hospitalization time were significantly longer than group A,the difference was statistically significant (P ＜ 0.05).No recurrence of choledocholithiasis and biliary stricture were found in either groups.Conclusions Placement of bile duct decompression drainage tube in laparoscopic choledocholithotomy and CBD primary suture after laparoscopic choledochotomy can significantly reduce the incidence of biliary leakage and shorten the postoperative hospital stay.
ABSTRACT
Objective To explore the prevalence of autoimmune liver disease-related antibodies in patients with PBC, and study the clinic significance of autoimmune liver disease related antibody profiles in patients with PBC. Methods The anti-AMA in 247 specimens from patients with liver disease, including 173 PBC, 37 AIH and 37 LDC were detected by IIF. Anti-AMA-M2, anti-GP210, anti-SP100, anti-SLA, anti-LCI and anti-LKM-1 antibodies were measured by ELISA. Results The positive rates of anti-AMA, anti-AMA-M2, anti-GP210, anti-SPl00, anti-LC1, anti-SLA and anti-LKM-1 antibodies were92. 5% (160/ 173), 86.7% (150/173), 35. 8% (62/173), 24. 3% (42/173), 0.6% (1/173), 0% (0/173) and 0.6%(l/173) in PBC group, 18.9% (7/37), 5.4% (2/37),8.1% (3/37),13. 5% (5/37),0% (0/ 37 ) ,5.4% (2/37 ) and 2. 7% (1/37 ) in AIH group and 5.4% (2/37), 2.7% (1/37 ) , 5.4% (2/37 ) , 10. 8% (4/37) , 0% (0/37) , 0% (0/37) and 0% (0/37) respectively in LDC group. Anti-AMA, anti-AMA-M2 and anti-GP210 was detected more frequently in patients with PBC group than AIH group (x~2 =101.3,100.8 and 11.0,P<0.01) while anti-SLA was detected more frequently in patients with AIH group than PBC group (x~2 = 9. 4, P < 0.01). The levels of ALT, TBIL, DBIL, GGT and ALP were higher in patients known to have positive anti-GP210 ( U = 1212.0,1199.0,1218.0,1074.0,1030. 0,P < 0. 01) and the levels of IgM were higher in patients known to have positive AMA ( U = 94.0, P <0.05). Conclusions Anti-LCI, anti-SLA and anti-LKM-1 antibodies in PBC and AIH are detected at a very low frequency in the corhort. Anti-GP210 antibody is found to be associated with the severity of liver damage while AMA is found to be associated with immunologic function in patients with PBC. There is little significance for screening anti-LCI, anti-SLA, anti-LKM-1 antibodies in patients with autoimmune liver diseases. It is of importance to detect anti-AMA and anti-GP210 antibodies for diagnosis of PBC.
ABSTRACT
Objective To explore the prevalence of the anti-saccharomyces cerevisiae antibody (ASCA) in patients with primary biliary cirrhosis and evaluate it's clinical significance. Methods The subtypes of ASCA including IgA and IgG in blood samples from 162 patients with PBC, 44 patients with AIH,4-1 patients with other non-autoimmune liver diseases controls (LDC), 144 patients with inflammatory bowel disease (IBD) and 35 healthy controls were measured by ELISA. Chi-square test and Mann Whitney U test were used for statistical analysis. Results The positive rate of ASCA-IgA in PBC was 24.1%, which was higher than that in ulcerative colitis (UC) group ( 11.6%,χ2=5.5, P＜0.05 ) and healthy controls (0, χ2=10.5,P＜0.01 ). Compared with the AIH group (20.5%) or LDC group ( 14.6% ) or Crohn's disease (CD) (34.5%),there was no statistically significant difference (P＞0.05). The prevalence of ASCA-IgG in PBC was 11.1%,lower than the CD group (27.6%, χ2=8.9, P＜0.01 ), but higher than that in the healthy controls (0, χ2=10.5,P＜0.01 ). There was no statistically significant difference (P＞0.05) between PBC and the AIH group (15.9%)or LDC group (7.3%) or UC group (8.1% ). The positive rate of both ASCA-IgA and ASCA-IgG in PBC was only 6.2%, statistically lower than that of the CD group ( 17.2%, χ2=6.3, P＜0.05). The prevalence of ASCA-IgA or ASCA-IgG in PBC was 29.0%, which was statistically lower than that of the CD group (44.8%, χ2=4.8,P＜0.05), but higher than that of the UC group (χ2=5.9, P＜0.05) or healthy controls (χ2=13.3, P＜0.01).ASCA was detected more frequently in PBC patients with positive anti-GP210 antibody than in anti-GP210 antibody negative PBC patients (38.6% vs 23.8%,χ2=3.9, P＜0.05). The positive rate of ASCA between AMA positive and negative patients with PBC or anti-SP100 antibodies positive and negative patients with PBC was not significantly different. PBC patients with positive ASCA-IgA had higher level of TBIL, DBIL, TBA, LD,IgA, IgM, ESR and lower level of ALB, A/G, CHE than patients with negative ASCA-IgA. There was no statistically significant difference in liver injury indicators and immune function parameters between patients with positive ASCA-IgG and negative ASCA-IgG. Conclusion ASCA is not an IBD-specific antibody. There is a high prevalence of ASCA in patients with PBC, especially the subtype of ASCA-IgA. ASCA-IgA is found to be associated with the severity of liver damage and immune activity whereas ASCA-IgG is not associated with them.