ObjectiveTo evaluate feasibility of laparoscopic radical resection and re-resection for suspicious and incidental gallbladder cancer.MethodsWe searched PubMed and other databases, reviewed relevant literatures and summarized from aspects like whether efficacy comparable to laparotomy and enough lymph node dissection could be achieved through laparoscopy, timing of reoperation for incidental gallbladder cancer.ResultsLaparoscopic radical resection and re-resection were theoretically and technically feasible, but its efficacy and timing of re-resection were controversial, and its long-term efficacy needed further discussions in multi-center and large-scale cohort studies.ConclusionsLaparoscopy shows prospects of resection and re-resection for suspicious and incidental gallbladder cancer. Tentative explorations could be done in properly selected patients by well-experience medical centers and to achieve efficacy comparable to laparotomy is the fundamental principle.
The morbidity and mortality of gallbladder cancer were rising. At present, there was no effective chemotherapy regimen, so it was of great practical significance to explore new therapy target. Ferroptosis is a non-apoptotic form of cell death characterized by iron-dependent lipid peroxidation and metabolic constraints. In recent years, it had become a research hotspot. Many studies had been carried out on the relevant biological mechanisms such as liver cancer, breast cancer, pancreatic cancer, and other cancer. At present, there are still few studies on ferroptosis in gallbladder cancer, and its relevant mechanisms need further in-depth analysis, which opens up a new research direction for exploring the treatment of gallbladder cancer.
ObjectiveTo explore the feasibility and curative effect of gastric pacing on postsurgical gastroparesis. MethodsThe indexes of gastric dynamic of applying gastric pacing to the experimental animal model of acute postsurgical gastroparesis was compared with that of injecting erythromycin (1 mg/kg).ResultsThe pressure of gastric antrum and the pressure gradient between gastric antrum and duodenum were respectively higher than basic pressure in the two experimental groups (P＜0.01); Except duodenal pressure, the indexs of gastric dynamic of pacing group were higher than that of erythromycin group (P＜0.05). The gastric emptying rate of pacing group 〔(66.37±7.21)%〕 was higher than erythromycin group 〔(49.92±9.27)%， (P＜0.01)〕. ConclusionHigherfrequency gastric pacing can improve the indexes of gastric dynamic and be applied to treat postsurgical gastroparesis, its effect may be better than erythromycin.
ObjectiveTo explore clinical manifestation, diagnosis and treatment of IgG4 sclerosing cholangitis developed postoperative gastroduodenal hemorrhage, so as to improve awareness and treatment of this disease. MethodThe clinical data of a case of IgG4 sclerosing cholangitis misdiagnosed as the hilar cholangiocarcinoma which developed postoperative gastrointestinal hemorrhage in this hospital were analyzed retrospectively. ResultsThis patient was misdiagnosed as the hilar cholangiocarcinoma and accepted the radical resection, while the postoperative pathology proved to be the IgG4 sclerosing cholangitis. One month later, the patient developed the acute gastrointestinal hemorrhage and it was resolved by using the endovascular embolization. ConclusionsPreoperative distinguishing IgG4 sclerosing cholangitis from hilar cholangiocarcinoma can avoid an unnecessary surgery. Endovascular intervention is both a useful measure of diagnosis and treatment for gastroduodenal pseudoaneurysm. Attention should be paid to arterial protection during process of arterial osteogenesis in hepatobiliary operation.
At present, the application of extended radical surgery in hilar cholangiocarcinoma (hCCA) remained controversial. The author reviewed the relevant literatures published in recent years and combined with his own experience, preliminarily discussed the application value of extended radical surgery in hCCA, and believed that: for some strictly selected cases of hCCA, under the premise of ensuring patient safety, extended radical surgery was an important treatment method for hCCA patients to obtain R0 removal, and the survival status of patients was better than that of palliative surgery, but the indications need to be strictly mastered. For patients with hCCA, whether to adopt extended radical surgery and the specific scope of surgical resection should be based on the scope of lesions and the involved organs, tissues and blood vessels to implement an individualized surgical program on the premise of comprehensive evaluation and full preparation before surgery. Do not blindly carry out extended radical surgery.
ObjectiveTo evaluate the effects of high intensity focused ultrasound (HIFU) on hepatic cancer cells spreading in blood.Methods AFP mRNA in peripheral blood of 19 patients with hepatocellular carcinoma was detected before and after HIFU therapy by RTPCR.Results①Before HIFU therapy, 11 of 19 cases were AFP mRNA positive (57.9%), while the control group were all negative. AFP mRNA was correlated with some clinical parameters such as serum AFP level, tumor size, portal vein embolism and extrahepatic metastasis (P＜0.05). ②In 8 cases with preoperative AFP mRNA negative, only 2 cases became AFP mRNA positive immediately after therapy, and one of the 2 cases became negative again after 72 hours. One week after HIFU therapy, the AFP mRNA positive rate (31.6%) was much lower than the preoperative positive rate (57.9%), but there was no statistical significance (Pgt;0.05). ③After one week of HIFU therapy, the AFP mRNA positive rate of the group with tumor size less than 8 cm was much lower than that of tumor size larger than 8 cm (P＜0.05). ConclusionHIFU may reduce the spreading of hepatocellular carcinoma cells in blood. It is effective for patients with tumor size less than 8 cm.
Objective The method of metabonomics based on nuclear magnetic resonance (NMR) imaging was used to explore the difference in metabolites of serum and bile, and to analyze the metabolic variation related to the pathogenesis of gallbladder stones between normal people/liver transplantation donors and patients with gallbladder stones. Methods Prospectively collected the serum samples (17 cases) and bile samples (19 cases) in 19 patients with gallbladder stones who underwent surgery in West China Hospital form March 2016 to December 2016, as well as the serum samples of 10 healthy persons and the bile samples of 15 liver transplantation donors at the same time period. The differences of metabolites in the blood and bile in these 3 groups were compared by using 1H-NMR metabonomics technology and chemometric methods. Results The concentrations of valine, alanine, lysine, glutamine, glutamate, pyruvate, creatinine, choline, alpha-glucose, beta-glucose, tyrosine, histidine, and hypoxanthine in serum of patients with gallbladder stones decreased significantly, comparing with those of healthy people without gallbladder stones (P<0.05), while 1, 2-propanediol, acetoacetate, and lactate increased significantly in the serum of patients with gallbladder stones (P<0.05). The concentrations of taurine conjugated bile acids, glycine conjugated bile acids, choline, and phosphatidylcholine decreased significantly in the bile of patients with gallbladder stones when compared with those of liver transplantation donors (P<0.05), while cholesterol increased significantly in the bile of patients with gallbladder stones (P<0.05). Conclusions There are significant differences of the serum and bile metabolites between patients with gallbladder stones and healthy men without gallbladder stones/liver transplantation donors. 1H-NMR metabonomics is helpful to investigate the pathogenesis of gallbladder stones.
Objective To investigate the application of gluteus maximus transplantation for fecal incontinence after surgery of high anal atresia. Methods Between December 2002 and November 2010, 25 patients with fecal incontinence were treated with gluteus maximus transplantation, which was caused by surgery of high anal atresia. There were 11 malesand 14 females with an average age of 10.2 years (range, 3-22 years). Preoperative radiography, anorectal manometer, and electromyogram showed abnormality or deficiency of anal sphincter function. Wexner score, Fecal Incontinence Quality of Life (FIQL) questionnaire, and Self-rated Health Measurement Scale Version 1.0 (SRHMS) score were used to evaluate l ife qual ity of the patients. The anorectal manometer, intra-rectal ultrasound examination, and defecation radiography were performed. Results Healing of incision by first intention was achieved in 23 cases and rectal-wound fistula occurred in 2 cases. The follow-up time was 1 to 9 years (mean, 6.3 years). Defecation frequency was decreased from more than 10 times to 4-6 times every day. Wexner score and SRHMS were significantly improved at 1 or 2 years after surgery when compared with preoperative socres (P lt; 0.05). FIQL was also significantly improved after 2 years (P lt; 0.05). At 2 years after surgery, the anal maximum systol ic pressure, contraction duration, and maximum systol ic volume were improved, showing significant differences when compared with those at preoperation and 1 year after surgery (P lt; 0.05). Conclusion Gluteus maximus transplantation can improve defecation controls in the patients with fecal incontinence after surgery of high anal atresia.
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.
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.