Objective To discuss the effective surgical treatment of intrahepatic lithiasis combined with high hepatic duct strictures. MethodsTwo hundreds and sixteen cases of intrahepatic lithiasis and high hepatic duct strictures treated in this hospital from January 1993 to October 2002 were analysed retrospectively.ResultsOne hundred and eightythree cases underwent different selective operation by selected time; 33 cases complicated with acute obstructive suppurative cholangitis underwent emergency were performed single biliary drainage, in which 30 cases were reoperated. The operative procedure were: hepatic lobectomy,high cholangiotomy and plastic repair,exposure of hepatic duct of the 2nd and the 3rd order,and plastic repair with own patch and choledochojejunostomy.Two hundreds and six cases were cured,the curative rate was 95.4%; 8 cases improved (3.7%), and 2 cases died (0.9%).Conclusion The best effective surgical treatment of intrahpatic lithiasis is hepatic lobectomy. Exposure of hepatic duct of the 2nd and the 3rd order is a satisfactory to release the hepatic duct strictures and to clear the intrahepatic lithiasis. For patients with normal extrahepatic bile duct and Oddi’s function, plastic repair of bile duct with own patch is possible to keep the normal form and function. Cholangioscopy may play an important role in the treatment of intrahepatic tract lithiasis during operation.
Objective To investigate the phenotypic change and proliferation of fibroblasts in human inflammatory strictured bile duct wall. Methods We observed the density and ultrastructure of fibroblasts, and the histologic structure in human normal bile duct wall and inflammatory strictured bile duct wall by light and electron microscope.Results The results showed that fibroblasts were the main source of extracellular matrix production in bile duct wall. The phenotype of fibroblasts in inflammatory strictured bile duct wall changed obviously, quiescent fibroblasts were activated and transformed to myofibroblasts, with massive proliferation. Conclusion These data suggest that massive proliferation of activated fibroblasts and myofibroblasts is the main source of extracellular matrix overproduction which results in inflammatory bile duct stricture.
Eighty two cases of acute gallstone pancreatitis on early operation are reported and the significance of the clinical picture and pathology are analysed. The data showed that gallstone was found in 85.5%, among the cases of them mulliple gallstone was 71.1%, dilated cystic duct was 26.4%, common bile duct stone 36.8%, distal bile ductal stricture was found in 9.3%, and anomalous conjunction of biliary and pancreatic duct was 20.1%. Sixteen cases with serious pancreatitis were determined on operation, but death rate was 3.7% only. The authors claim that early operation may be of value in patients of acute gallstone pancreatitis with or without jaundice espesially in bile duct obstruction.
目的 减少肝内胆管结石术后的残留。方法 回顾性分析近5年我科收治的50例肝内胆管结石病例行病灶肝切除并结合术中、术后胆道镜应用的近期疗效及术后残石率。结果 术后近期并发症发生率为8%，无胆漏、肝衰及手术死亡发生，术后B超、逆行T管造影及术后胆道镜检查证实的即期残石率仅4%（2例）。结论 减少肝内胆管结石术后结石残留的关键是术中术后胆道镜的使用，肝内及肝门胆管狭窄的彻底处理； 依据狭窄胆管所引流区域行“根治性”的肝组织切除是取尽结石，清除病灶的合理方法。
ObjectiveTo evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) for biliary strictures post-orthotopic liver transplantation (OLT). MethodsA systematic review was performed by searching electronic bibliographic databases, including the Cochrane Library, Medline, EMbase, CNKI, and WanFang from 1994 to 2014. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were used to describe the diagnostic value. Summary receiver operating characteristic (SROC) curve with area under the SROC curve (AUC) were used to summarize overall diagnostic performance. ResultsSix studies involving 261 subjects were eligible for the analysis. The summary estimates of pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and AUC of MRCP for the diagnosis of biliary strictures after OLT were 89% (95% CI:0.83-0.94), 94% (95% CI:0.88-0.98), 8.04 (95% CI:2.83-22.85), 0.11 (95% CI:0.04-0.37), and 0.961, respectively. ConclusionMRCP is a sensitive and specific technique to diagnose biliary strictures after OLT.
An retrospective analysis of 112 cases with localized left hepatolithiasis (LLH) treated in our center in recent two decades was made. The results showed: ①Coexisting involvements of both left external hepatic duct (LEHD) and left medial hepatic duct (LMHD) were the most common pathological pattern (83.08%), came next the only LEHD involvement (12.31%). There was no localized LMHD caculi in this group. ②The rate of concomitant LHD stricture was 59.82% and that of LMHD or LEHD were 84.85% and 84.00% respectively, in which severe degrees dominate. ③Lateral segmentectomy was the most common clinical practice for LLH (58.93%), and left lebectomy was much less frequently used (12.50%), although the latter led to a significantly smaller rate of residual (7.14% vs 21.21%) and had a satification follow-up rate of 85.71% being superior to lateral segmentectomy (46.97%), or cholangiojejunostomy (40.00%), bile duct exploration and drainage (0). ④The most common prognostic factors were residual or recurrent stones of LMHD (62.50%) and residual LHD stricture (37.50%). ⑤There was no significant difference between left lobectomy and lateral segmentectomy in length of operation, intraoperative bleeding, and postoperative complications. The results indicate that too much dependence on lateral segmentectomy in the management of LLH is one of the most important factors affecting the longterm results, for which left lobectomy is an applicable and safe therapy of choice.
Immunohistochemical study on 39 specimens of hepatobilibary duct stricture due to stones were performed. Collagen types Ⅲ and Ⅳ were studied by quantitative analysis. The results showed that significant increase of type Ⅲ collagen was found in the stenotic bile duct wall, the portal area and liver sinusoid with fibrosis. Abnormal increasing of type Ⅳ collagen was found in the liver sinusoid of the stenotic bile duct.
【Abstract】ObjectiveTo improve curative effects in the treatment of hilar bile duct stricture. MethodsIntrahepatic cholelithiasis was associated with the development of hilar bile duct stricture.Plastics of hilar bile duct stricture (PHBDS) using pedicled cholecystic graft and Roux-en-Y cholangiojejunostomy (RYCJ) were performed. The patients with hepatolithiasis treated with PHBDS or RYCJ between Jan. 1994 and Jan. 2004 were retrospectively analyzed.ResultsFollow-up was carried out from 16 months to 87 months with an average of 47 months. The postoperative morbidity of cholangitis was 5.66% and 21.88% (P=0.010) and recurring rate of hepatolithiasis was 3.77% and 16.67%(P=0.021).ConclusionPHBDS can preserve the physiological compatible, convenient and effective in treatment of hilar bile duct stricture. The late result after operation of PHBDS is better than that of RYCJ.
Objective To determine whether local delivery of c-myc shRNA could inhibit hyperplasia and lithogenic potentiality in a rat model of chronic proliferative cholangitis (CPC) via specific blockade of the c-myc expression. Methods The CPC animal model (CPC group) was established via retrograde insertion of a 5-0 nylon thread into the common bile duct through Vater’s papilla. Three kinds of c-myc shRNAs were then respectively injected in c-myc shRNA group, which were included shRNA-1, shRNA-2, and shRNA-3, respectively. Negative control group and sham operation group were established for comparison. Subsequently, histopathological changes of bile duct wall were observed by HE, Massion, and PAS/AB staining; c-myc protein was detected by immunohistochemistry method; 5-bromodeoxyuridine (BrdU) protein was tested by immumofluorescence method; c-myc, Mucin 3, and Procollagen Ⅰ mRNAs were detected by real time PCR; Ki-67 protein was determined by Western blot; Activity of β-glucuronidase was measured by modified Fisherman method. Results ①Compared with the CPC and negative control groups, biliary tract mucosa epithelium (HE staining), submucosal acid mucinous gland (mid-blue staining, PAS/AB staining), and degree of over-hyperplasia of collagen fiber in bile duct wall (blue staining, Massion staining) were weaker in the c-myc shRNA group. ②The expressions of c-myc mRNA, Mucin 3 mRNA, Procollagen Ⅰ mRNA, Ki-67 protein, and β-G activity in the c-myc shRNA group were lower than those of the CPC and negative control groups (Plt;0.05), but higher than those of the sham operation group (Plt;0.05). Conclusion c-myc shRNA treatment could effectively inhibit the hyperplastic behavior and lithogenic potential of CPC, which might help to prevent the biliary restenosis and stone recurrence.