Objective To improve the curative resection rate of hilar cholangiocarcinoma (H-CC).Methods Lileratures about surgical treatment of H-CC were collected and reviewed. Results The crucial points are as follow: ①Early diagnosis; ②Recognition of the invasion to liver; ③Rational resection of the tumor with associated vessels; ④Reduction of postoperative complications. Conclusion Improved longterm resection effects on H-CC is possible.
目的 探讨胰十二指肠切除术后严重并发症的防治方法。方法 分析2002～2005年7例胰十二指肠切除术后严重并发症的资料。结果 手术严重并发症发生率为25.9%（7/27），经积极治疗后无一例死亡。结论 术中仔细操作和操作技术改进是降低胰十二指肠切除术并发症发生率的关键，并发症经积极治疗后有望痊愈。
ObjectiveTo investigate the change of renal endothelin (ET) excretion and its relation to renal dysfunctions in obstructive jaundice.MethodsSixty male Wistar rats were randomized into two groups, the common bile ducts were ligated to establish the model of obstructive jaundice in experimental group, and only sham operation was done in control group. Ten rats were taken from each group at 5, 10 and 15 days respectively after operation, renal functions were evaluated by paminohippuric acid clearance (CPAH), inulin clearance (CIN) and fractional sodium excretion (FENa+); furthermore, plasma endotoxin (EX) level was determined, and ET1 contents in renal arterial plasma, renal venous plasma and renal tissue were detected. ResultsOnly FENa+ was significantly increased at the 5th day in experimental group; since the 10th day, all the three renal functional parameters gradually decreased, and FENa+ was significantly lower than that in control group at 15th day (P＜0.01 vs control). ②The plasma EX sustained at significantly higher levels after operation in experimental group (P＜0.01 vs control). ③The renal arterial plasma ET1 was significantly decreased, while the contents in renal venous plasma and renal tissue were significantly increased after operation in experimental group (P＜0.01 vs control). ④There were positive correlation between plasma EX and renal ET1 content, negative correlation between renal ET1 content and CPAH/CIN, and positive correlation between renal ET1 content and FENa+ (P＜0.01).ConclusionThe increased excretion of renal ET stimulated by endotoxemia may play an important role in the renal dysfunctions in obstructive jaundice.
目的探讨肝内胆管结石合并肝胆管癌的临床诊断和治疗经验。 方法回顾性分析我院手术治疗28例肝内胆管结石合并肝胆管癌的病例资料。结果本组28例占同期肝内胆管结石病例的6.7%。术前各类影像学检查发现癌灶17例，5例获细胞学检查确诊。术中7例经快速组织活检证实。另4例系术后确诊。肿瘤多为腺癌，位于肝门胆管18例，肝内胆管9例，肝内、肝门部广泛浸润1例。根治性肿瘤切除8例，获随访6例，平均生存23个月； 姑息性肿瘤切除8例，获随访6例，平均生存11个月； 仅行外引流者7例，其中3例于术后2周内死亡，3例术后9个月内死亡，1例生存4个月后失访。结论长期肝内胆管结石刺激及继发感染是肝胆管癌发生的重要因素。联合应用影像学检查结合病理活检获得早期诊断和选择合理的根治性肝切除术是提高疗效的有效措施。
Objective To investigate the regulatory effect of somatostatin analogue (SMS201995,SMS) on proliferation and apoptosis in human cholangiocarcinoma cell line in vitro. MethodsProliferation curve, flow cytometry, agarose gel electrophoresis, Annexin VFITC and flow cytometric immunofluorescent technique were performed to identify the inhibitory effect on cell proliferation and the induction of apoptosis of human cholangiocarcinoma cells (SKChA1). ResultsSMS significantly reduced the SKChA1 cell growth by serum in long experiments and transiently accumulated it in G0/G1 phase. Dotplot analysis of cells duallabeled with Annexin VFITC and PI confirmed the induction of apoptosis by SMS in SKChA1 cells.AnnexinVFITC labeling was markedly enhanced following treatment with SMS for 24 h. DNA of treated SKChA1 cells appeared a ladder pattern characteristic of apoptosis. Besides, timedependent increase in bax and decrease in bcl2 occured during SMS treatment. Conclusion SMS could inhibit the proliferation activity and induce apoptosis of cholangiocarcinoma cell line SKChA1. The mechanisms of apoptosis might be correlated with the expression of apoptosisregulatory gene bax and bcl2.
Twenty-one patients(male 18 cases,femal 3 cases)died of primary liver cancer after operation are reviewed.The liver tumors were located in the right lobe(13 cases),left lobe(3 cases),middle position of liver(4 cases)and hepatic hilum(1 cases).The average diameter of the tumors were 9.0cm.All the patients had suffered from liver cirrhosis and were operated on (most of them partial hepatectomy).The times of death were about 7 days,7-14 days later after operation.The data suggest that causes of death were different from the different stage after operation.The relations between partial hepatectomy and hepatic failure,and the liver cirrhosis and liver regeneration are discussed.
３０ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｐｒｉｍａｒｙ ｃａｒｃｉｎｏｍａ ｏｆ ｇａｌｌｂｌａｄｄｅｒ ｗｅｒｅ ｔｒｅａｔｅｄ ｓｕｒｇｉｃａｌｌｙ ｆｒｏｍ １９８７ ｔｏ １９９４． Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈｅ ｍｉｓｄｉａｇｎｏｓｉｓ ｒａｔｅｓ ｏｆ ｇａｌｌｂｌａｄｄｅｒ ｃａｎｃｅｒ ａｎｄ ｏｆ ｃａｎｃｅｒ ｗｉｔｈ ｇａｌｌｂｌａｄｄｅｒ ｓｔｏｎｅｓ ｗｅｒｅ ｈｉｇｈ． Ｍｏｓｔ ｏｆ ｐｒｉｍａｒｙ ｃａｒｃｉｎｏｍａ ｉｎ ｔｈｉｓ ｓｅｒｒｉｅｓ ｗｅｒｅ ａｄｅｎｏｃａｒｃｉｎｏｍａｓ． Ａｌｓｏ ｐｒｉｍａｒｙ ｇａｌｌｂｌａｄｄｅｒ ｃａｒｃｉｎｏｍａ ｃｌｏｓｅｌｙ ｒｅｌａｔｅｄ ｗｉｔｈ ｇａｌｌｂｌａｄｄｅｒ ｓｔｏｎｅｓ．
Four hundred and eighty two paients suffering from intrahepatic bile duct stone undergoing lobectomy and segmental resection (from 1975 to 1994,9) has reported. 63% of the patient in this group underwent 1-5 operations, including different types of biliary-intestinal anastomosis (21.6%). 482 cases underwent different types of hepatectomy, including left lateral-lobetomy 321 cases (66.6%),left hemihepatectomy 80 cases(16.6%), right hemihepatectomy 19 cases (3.9%), and multiple segmental resections 39 cases (8.1%, including Ⅴ+Ⅷ 11 cases, Ⅵ+Ⅶ 28 cases). Other type hepatectomy combined with guadrate lobectomy 20 cases (4.1%). Postoperative complication rate was 10.2%, including diliary fistula. hemobilia and subdiaphragmatic and resectional surface infectioin, 85% of the patients were followed up with an excellent result of 88%. The authors emphsize that hepatic lobectomy nad segmental resection is the core of treatment and selection of operative methods depends on clinical-patholigic types of the disease.
Objective To investigate the expression of multigenes mediated by adenovirus in liver cancer cells and the effects on growth of cells transducted with multigenes. MethodsBy construction of recombinant adenovirus containing human p53, B7-1, GM-CSF, and IL-2 genes (Ad-multigenes), the expression level of target genes in three human hepatocellular carcinoma cell lines and a human hepatocellular cell line L02 was detected using ELISA, immunohistochemistry and FACS assay and the change of growth of these cells and the tumor cell apoptosis were observed. Results The human hepatic cells and liver cancer cells were all sensitive to adenovirus infection. At a MOI of 50 PFU/cell, among the cells examined nearly 90% were positive expression and except IL-2, other three genes were expressed with high efficiency. The growth of Ad-multigenes-transduced liver cancer cell lines was inhibited and apoptosis was induced, but the growth of Ad-multigenes-transduced normal hepatic cell line L02 did not change. Conclusion These results indicate that the adenovirus is an efficient vector for gene transfer into human liver cancer cells. These liver cancer cell lines transduced with multigenes constructed on one recombinant adenoviral vector can highly express target genes and their growth was inhibited, and apoptosis appeared.