Objective To explore the indications for liver transplantation among patients with hepatolithiasis. Methods Data from 1431 consecutive patients with hepatolithiasis who underwent surgical treatment from January 2000 to December 2006 were retrospectively collected for analysis. Surgical procedures included T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones, hepatectomy, cholangiojejunostomy, and liver transplantation. Results Nine hundred and sixty-one patients who had a stone located in the left or right intrahepatic duct underwent hepatectomy or T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones. The rate of residual stones was 7.5% (72/961). Four hundred and seventy patients who had a stone located in the bilateral intrahepatic ducts underwent surgical procedures other than liver transplantation; the rate of residual stones was 21.7% (102/470). Only 15 patients with hepatolithiasis underwent liver transplantation; they all survived. According to the degree of biliary cirrhosis, recipients were divided into 2 groups: a group with biliary decompensated cirrhosis (n=7), or group with biliary compensated cirrhosis or noncirrhosis group (n=8). There were significant differences in operative times, transfusion volumes and blood losses between 2 groups (P＜0.05). In the first group, 6 of 7 patients experienced surgical complications, and in the second, 8 recipients recovered smoothly with no complications. Health status, disability and psychological wellness of all recipients (n=15) were significantly improved in 1 year after transplantation as compared with pretransplantation (P＜0.05). Conclusion Liver transplantation is a possible method to address hepatolithiasis and secondary decompensated biliary cirrhosis or difficult to remove, diffusely distributed intrahepatic duct stones unavailable by hepatectomy, cholangiojejunostomy, and choledochoscopy.
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.
ObjectiveTo study the clinical value of digital technology assisted minimally invasive surgery in diagnosis and treatment of hepatolithiasis. MethodsThe image data of 64-slice spiral CT scanning were obtained from five patients of complicated hepatolithiasis and introduced into medical image three-dimensional visualization system (MI-3DVS) for three-dimensional reconstruction. On the basis of the data of three-dimensional reconstruction, minimally invasive surgical planning of preoperation was made to obtain reasonable hepatectomy and cholangiojejunostomy, and then preoperative emulational surgery was carried out to minimize the extent of tissue damage and provide guidance to actual operation. ResultsLiver, biliary system, stone, blood vessel, and epigastric visceral organ were successfully reconstructed by MI-3DVS, which showed clearly size, number, shape, and space distribution of stone, and location, degree, length, and space distribution of biliary stricture, and anatomical relationship of ducts and vessels. The results of three-dimensional reconstruction were successfully confirmed by actual operation, which was in accordance with emulational surgery. There was no operative complication. No retained stone in internal and external bile duct was found by Ttube or other supporting tube cholangiography on one month after operation. ConclusionThree-dimensional digitizing reconstruction and individual emulational surgery have important significance in diagnosis and treatment of complicated hepatolithiasis by minimally invasive technique.
ObjectiveTo observe the effects of oral Xiaoyan Lidan tablets(XYLDT) on the bile composition(total bile acids, cholesterol, phospholipids) in patients with intrahepatic duct stones after common bile duct exploration(CBDE) with T tube drainage, to explore its possible preventive effects on stone recurrence. MethodsForty consecutive patients with intrahepatic bile duct stones who underwent CBDE with T tube drainage were randomly divided into experi mental group and control group. XYLDT were administrated at day 4 after surgery in experimental group(n=20), while none of medication were given in control group(n=20). 2 mL of bile was collected through T tube in both groups at day 1, 2, 3, 7, 14, and 21 postoperatively. Total bile acids(TBA), cholesterol(CHO), and phospholipids(PLIP) in bile were measured, and TBA/CHO ratio and PLIP/CHO ratio were calculated respectively. The results were statistical analyzed. ResultsThe demographic data in both groups including age, gender, height, weight, preoperative concomitant diseases, operative time, postoperative complications, hospital stays, serum total bilirubin, direct bilirubin, alanine aminotransferase(ALT), aspartate aminotransferase(AST), and amylase were not significantly different(P > 0.05). The measurements of TBA, CHO, PLIP, and the ratio of TBA/CHO and PLIP/CHO in bile were not significant on day 1, 2, and 3 after surgery in both groups(P > 0.05). In experimental group, the TBA, CHO, and PLIP on day 7, 14, and 21 after surgery were significantly increased compared with the control group(P < 0.05). The ratio of TBA/CHO on day 7, 14, and 21 was 2.17±0.29, 2.29±0.44, and 2.59±0.58, the ratio of PLIP/CHO was 2.03±0.68, 2.84±0.64, and 2.86±0.77, respectively, which were also significantly increased compared with the control group(P < 0.05). ConclusionsOral XYLDT can increase the secretion of TBA, CHO, and PLIP, elevate the TBA/CHO and PLIP/CHO ratio, and change the bile composition which may increase the dissolution of cholesterol in the bile. Presumably, oral XYLDT may have preventive effects in the recurrence of intrahepatic bile duct stones.
Objective To observe the effect of gefitinib on expression of epidermal growth factor receptor (EGFR) in bile duct epithelial cells, and the feasibility of inhibiting hyperplasia of bile duct epithelial cells with gefitinib. Methods Sixty-one patients with hepatolithiasis having to be in hospital for surgery from the First People’s Hospital of Shuangliu county were selected, with 25-65 years old, average 46.92 years. The patients were randomly divided into therapy group and control group. There were 30 cases in therapy group, in which fine duct was placed on lesion bile duct during operation, and through whom gefitinib solution was perfused after operation. There were 31 cases in control group with only T tube drainage after operation. The bile duct sample was obtained respectively during the operation and 6 weeks and 12 weeks after operation. The histology and expression change of EGFR were observed by HE staining, immunohistochemistry and RT-PCR method respectively. Results There were no significant differences in pathohistology changes of bile duct and the EGFR protein and mRNA expression between therapy group and control group during operation. The hyperplasia of epithelium mucosae and submucosal gland in the therapy group were obviously decreased as compared with those in control group, the EGFR mRNA and protein expression in therapy group were weaker than those of control group （Plt;0.05） 6 weeks and 12 weeks after gefitinib treatment. Conclusion EGFR is overexpressed in the chronic proliferative cholangitis, and continuously local application of gefitinib after operation can specifically interrupt the activation and expression of EFGR and then effectively inhibit the hyperplasia of bile duct epithelial cells.
After analysising 15 patients with portal hypertension (PHT) in secondary biliary cirrhosis due to hepatolithiasis, the authors consider that the surgical procedure depends on indivedual’s specificity: majority of patients with PHT but no hemorrhage may be treated by removing the hepatobiliary stone, resolving the bile duct stricture and then reconstructing it as the first step. Whether or not to dispose of PHT depended on the postoperative condition. If the patient had previous hemorrhage and is accompanied by severe obstructive jaundice, splenectomy with shunt and simple biliary external drainage is the choice and removal of stone with biliary tract reconstruction will be performed in the second stage. Meanwhile, it is very important to monitor perioperative condition of the patient and treat the complications.
【Abstract】ObjectiveTo evaluate the advances in minimally invasive surgery treatment for hepatolithiasis. MethodsLiteratures about the advances in minimally invasive surgery treatment for hepatolithiasis were collected and reviewed. ResultsHepatectomy and bile duct exploration using laparoscopy can get better effect. Fibrocholedochoscopy play an important role in the course of operation and after operation for hepatolithiasis. ConclusionThe individualization treatment program should be used for hepatolithiasis. Association application of multipathway minimally invasive operation, such as laparoscopy, fibrocholedochoscopy and so on, can increase the cure rate of hepatolithiasis.
Objective To investigate the recurrence of hepatolithiasis and reoperation and their relation to the location of intrahepatic stone. MethodsTwo hundred and twentysix patients of hepatolithiasis operated upon in the period of 1990-1995 were retrospectively analysed.ResultsAmong those patients, there were 101 patients (44.7%) had previous operation for the gallstones diseases including cholecystectomy for gallbladder stones (n=21, 20.8%), choledocholithotomy (n=72, 71.3%),liver segmentectomy (n=6， 5.9%), and choledochojejunostomy (n=2, 2.0%). The operative mortality was 5.0% for the reoperation group and none for the first time operation for hepatolithiasis.Conclusion Although the liver resection is an ideal surgical method to eradicate the diseased lesion and to minimize the malignant changes especially in primary hepatolithiasis (type I, or IE)， choledochojejunostomy is only recommended for the secondary type (type IE or IE) where possible. In the management of hepatolithiasis, the complete information of biliary tract is needed for the choice of surgical methods.
Objective To evaluate the value of the application of laparoscopic hepatectomy in hepatolithiasis. Methods The clinical data of 35 patients with hepatolithiasis performed with laparoscopic hepatectomy were analyed retrospectively. Operations included laparoscopic left lateral sectionectomy， left hemihepatectomy， cholecystectomy， choledocholithotomy， choledochoscopy， and T-tube drainage. Results All operations of 35 patients were performed complete laparoscopically. The mean operative time was 205 minutes （150-370minutes）. The mean blood loss was 330mL（50-1 000mL）. Patients felt less pain without administration of painkillers after operation. Ambulation resumed on thefirst day and liquid diet resumed on the second day after operation. The average hospital stay was 12.7 days （4-15d）. There was no death. The excellent and good rate of operation was 71.4% and 25.7%， respectively. Conclusion Laparoscopic hepatetomy is an effect and minimally invasive alternative method for hepatolithiasis in slective patients.
ObjectiveTo evaluate the feasibility and effect of treatment of bile duct exploration though hepatic sections instead of spliting common bile duct, cured for hepatolithiasis with bile duct stones. MethodsClinical data of 122 cases of our hospital were retrospectively reviewed, these patients with left intrahepatic bile duct stone and common bile duct calculi. As control group, during the period from June 2007 to June 2010, in which 64 patients underwent left hepatic lobectomy, common bile duct exploration and T tube drainage. In observation group, 58 patients from June 2011 to December 2013, underwent left hepatic resection combined biliary duct exploration by the liver section stump bile duct. The operative time, intraoperative bleeding volume, postoperative hospitalization time, and incidence of complications between the 2 groups were compared. ResultsCompared with the control group, the postoperative hospitalization time was shortened obviously in observation group patients(P < 0.05), there were no significant difference in operative time and bleeding during operation of 2 groups(P > 0.05), The incidence of postoperative complications in the observation group was significantly lower than the control group(P < 0.05). In 122 patients, 105 cases were followed-up(86.1%), the follow-up time was 2 years. Two groups of patients had no stone residual and recurrence. ConclusionsBile duct exploration by intraoperative liver section is an effective method to treat left hepatolithiasis, it can simplified procedures, shortening the postoperative hospitalization time, and effectively avoid complications caused by common bile duct incision and T tubedrainage.