目的 總結開展腹腔鏡下經膽囊管膽總管探查取石的手術技巧及應用體會。方法 回顧性分析筆者所在醫院肝膽外科2010年7月至2012年12月期間行腹腔鏡經膽囊管膽總管探查取石術的36例患者的臨床資料。結果 30例病例經膽道探條擴張膽囊管后直接完成網籃取石，3例經膽囊管匯入膽總管處微切開完成取石，3例經膽道鏡聯合激光碎石完成手術。全組病例的手術時間為（110.88±25.99） min，術后住院時間為（6.59±1.18） d，均無嚴重操作相關并發癥發生。結論 腹腔鏡下經膽囊管膽總管探查取石術是安全可行的，若能綜合各種技術，可提高手術的成功率。
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.