Objective To investigate the clinical applications of plasma shock wave lithotripsy （PSWL） in the treatment of calculi via choledochoscope. Methods Between 2004 and 2009, 56 huge residual calculi (54 cases) were underwent PSWL via choledochoscope treatment in our hospital. Calculi size: diameter ≤10 mm in 9 calculi, 10 mm lt;diameter ≤15 mm in 24 calculi, 15 mm lt;diameter ≤20 mm in 17 calculi, and diameter gt; 20 mm in 6 calculi. Twenty four cases of these 54 patients had bile duct stricture. Procedure: Firstly found the calculus, and then the lithotriptor wire was introduced to the place 0.5-1.0 mm far away from the calculus surface through choledochoscope channel, and powered on, fired, destructed. Results Forty-eight cases of 54 patients were cured by PSWL with 1 times, 2 cases with 2 times, 2 cases with 3 times, and 2 cases with 4 times. Shock 4-300 times were exported per PSWL, with an average of 65 times. Crushing each stone needed shock for 4-680 times, with an average of 77 times. The calculi were ruptured in different degrees by PSWL, of which 20 cases were completely ruptured. All calculi were completely extracted. Except one case with bile duct stricture was found a small amount of bile duct bleeding during operation, all other patients had no operation complications. Conclusion PSWL technique plays an important role in lithotripsy. It is easy to deal with intrahepatic impacted calculi by PSWL, especially the pigment stones with rough surface.
Objective To explore the effects of bile from anomalous parcreaticobiliary ductal union (APBDU) patients on the growth of hunan cells of bile ducts, and the relationship between APBDU with bile duct carcinoma. Methods Bile sample from APBDU patients and normal persons were used for cells of bile ducts. The proliferative effect of bile was measured by mathabenzthiazuron (MTT) assay; Cell cycle and apoptosis were analyzed by flow cytometry (FCM); Expression level of c-erbB-2 was detected by Western blot assay. Results Bile from APBDU patients significantly promoted the proliferation of human cells of bile ducts compared with normal bile （P＜0.05）. The effect was abolished by addition of COX-2 inhibitor or iNOS inhibitor. The percentage of S period cells in group pretreated with APBDU bile was significantly increased compared with pretreated with normal bile (P＜0.001). The expression level of c-erbB-2 was increased in cell pretreated with APBDU bile. Conclusion Bile from APBDU patients can promote the proliferation of normal cells of bile ducts and may have potential carcinogenesis.
【Abstract】ObjectiveTo analyze the factors influencing the prognosis of patients with bile duct carcinoma after resection. MethodsThe clinical data of 120 patients with bile duct carcinoma receiving resection in our hospital from 1980 to 2004 were collected retrospectively and clinicopathologic factors that might influence survival were analysed. A multiple factor analysis was performed through Cox proportional hazard model. ResultsThe overall 1year, 3year and 5year survival rates were 71.7%, 32.5% and 19.2% respectively. The single factor analysis showed that the major significant factors influencing survival of these patients were histological type of the lesions, lymph node metastasis, pancreatic infiltration, duodenal infiltration, resected surgical margin, perineural infiltration, peripheral vascular infiltration and depth of tumor infiltration (P＜0.05). Lymph node metastasis, pancreatic infiltration and perineural infiltration were found to be the the statistically significant factors influencing survival by multiple factor analysis through the Cox model. ConclusionThe most important prognostic factors for bile duct carcinoma after resection were lymph node metastasis, pancreatic infiltration and perineural infiltration.
Objective To explore the effects of bile from patients with cholecystolithiasis on the growth of human gallbladder carcinoma cells GBC-SD and the potential correlation between cholecystolithiasis and gallbladder carcinoma. Methods Cholecystolithiasis bile (CB) and normal bile (NB) specimens were used for this study. The proliferative effects of bile were measured by methabenzthiazuron (MTT) assay and cell cycle and apoptosis were analyzed by flow cytometry. Results CB can significantly promote the proliferation of GBC-SD cells, GBC-SD proliferative index increased significantly after treated with 1% CB for 48 h （P＜0.05）.The Sphase fraction of CB 〔（49.26±8.07）%〕 increased remarkably (P＜0.05) compared with that of NB 〔（25.54±6.57）%〕, and the CB percentage of G0/G1 phase 〔（40.59±9.12）%〕 decreased remarkably (P＜0.05) compared with NB 〔(60.64±13.42）〕%. Conclusion CB can promote the proliferation of human gallbladder carcinoma GBC-SD cells.
Objective To investigate the prevention and treatment strategy of bile duct injury (BDI) in laparoscopic cholecystectomy (LC). MethodsLatest progress was reviewed based on recent documents and the experience on BDI in LC in our department. ResultsWith the popularity of LC, BDI in LC is increasing. The reasons include illegibility and variability of local anatomy in gallbladder trigone,injury caused by galvanothermy, as well as operator’s overconfidence. In order to prevent BDI, we should apply more blunt dissection, not to use electrocogulation if possible and to study local anatomy and its variance clearly. The common bile duct and common hepatic duct should be clearly identified. Intraoperative cholangiography, laparoscopic ultrasonography and hepatobiliary scintigraphy are selections as necessary.The treatment of BDI depends on the type of BDI and its site and local condition.The treatment includes end to end anastomosis, repairing the defect, choledochoduodenostomy, RouxenY choledochojejunostomy and so on. T tube should be maintained in place for more than half a year after operation.Conclusion The key to improve the prognosis of BDI is prevention and treatment in proper time and in correct way.
ObjectiveTo study the clinical manifestations, pathologic characteristics, imaging features, diagnosis and treatment of adenomas of extrahepatic bile duct.MethodsTwo cases of adenomas of extrahepatic bile duct in our hospital and 14 cases reported in the literatures were analyzed retrospectively.ResultsThe patients’(male 5, female 11) mean age was 58.4 years (range 21-85). The main manifestations included jaundice (n=11), abdominal pain (n=8),fever (n=6),dyspepsia (n=4),body weight loss (n=3) and claycolored stool (n=1). The locations of tumors were in the left hepatic duct (n=1), right hepatic duct (n=3), hepatic common bile duct(n=3）,the junction of cystic duct and common bile duct (n=1），distal common bile duct (n=8). The pathologic types were tubular adenomas (n=5), papillary (villous) adenomas (n=10),and mucous adenoma (n=1). All the patients underwent surgical therapy. The tumors were identified by postoperative histopathologic examination.ConclusionIt is difficult to correctly diagnose adenomas of extrahepatic bile duct before operation, because the clinical manifestations are usually atypical. The definite diagnosis should depend on histopathologic examination. It is the key to completely resect the tumors. Postoperative followup should be done on regular basis.
【Abstract】Objective To investigate the imaging features of malignant invasion of major intrahepatic ductal structures (the portal and hepatic venous vasculature, the bilie duct) by primary hepatocellular carcinoma (HCC) using multidetector-row spiral CT (MDCT). Methods We retrospectively analyzed 68 documented HCC patients with tumorous invasion of the major intrahepatic ductal structures who had undergone contrast-enhanced dual-phase MDCT scanning of the upper abdomen.The morphological changes of the portal and hepatic venous vasculature, the bile duct, and the liver parenchyma at both the hepatic arterial phase and portal venous phase images were carefully observed and recorded. Results Among the 68 patients, 47 patients had malignant invasion of the intrahepatic portal venous vessels with secondary tumor thrombus formation; 12 patients had tumor involvement of the hepatic veins and intraheptic segment of the inferior vena cava; Tumor invasion of the bile duct was seen in 9 patents. The direct CT signs of tumor invasion of intrahepatic venous vessels included: ①dilatation or enlargement of the involved vein with intraluminal softtissue “filling defect”； ②enhancement of the tumor thrombus at hepatic arterial phase, the so-called “venous arterialization” phenomenon. The indirect CT signs included: ①arterial-venous shunt, ②early and heterogeneous enhancement of the hepatic parenchyma adjacent to HCC focus, ③cavernous transformation of the portal vein. The CT signs suggesting tumor invasion of the bile duct included: ①dilation of the bile ducts near or proximal to HCC lesion, ②soft-tissue nodule or mass inside the bile ducts. Conclusion Invasion of major intrahepatic ductal structures by HCC will present corresponding CT imaging features. Contrast-enhanced MDCT dualphase scanning combined with appropriate image postprocessing techniques can better evaluate the malignant invasion of major intrahepatic ductal structures.
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 effects of activities of Na+K+ATPase in plasma membranes of hepatocytes on the formation of calcium bilirubinate gallstone. MethodsThe research were studied in Xiao’s rabbit models.One hundred and three rabbits were randomly divided into the control group (Con,n=28),simple biliary obstruction group (BO,n=36),biliary obstruction and infection group (BOI,n=39).The activities of Na+K+ATPase,contents of intracellular calcium and bile acids in bile were measured in 3rd,7th,14th and 20th day. ResultsThe activities of Na+K+ATPase,contents of bile acids in bile decreased gradually and the contents of intracelluar calcium of hepatocytes increased continously in all phases of experimental groups compared with control group (P＜0.01).There was more significant changes in BOI group than in BO group (P＜0.05). Conclusion The progressive decrease of activities of Na+K+ATPase has a close relationship with the overloaded intracellular calcium and the continous decrease of bile acids contents in bile in formation of calcium bilirubinate gallstone.Infection can promote above mentioned changes and more stone formation.
Objective To investigate the effect of cholecystectomy on the induction of large intestine cancer and its mechanism. Methods After cholecystectomy, the large intestine neoplasm in mice was induced with dimethylhydrazine(DMH).The histogenesis and growth pattern of large intestine cancer were observed.The Sphase fraction (SPF) of epithelium cells in large intestine mucosa was determined using flow cytometry. Before and after operation, the feces of mice were collected to determine the cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA) and lithocholic acid (LCA) concentration by highperformance liquid chromatography. Results The average number of large intestine neoplasms per mouse,percentage of large intestine adenomas in examined mice and SPF of experimental group were significantly higher than those of control group (P＜0.05). The fecal LCA concentration in postcholecystectomy was significantly higher than that in precholecystectomy and in sham operation group (P=0.00). Conclusion The large intestine neoplasm of mice induced by DMH is increased and the proliferation of epithelium cell in large intestine mucosa is increased after cholecystectomy. This suggests that cholecystectomy has promoting effect on induction of large intestine neoplasm in mice. The gut may deal with the increased secondary bile acid(LCA) concentration postcholecystectomy.