BACKGROUND Intrahepatic duct(IHD)stones are among the most important risk factors for cholangiocarcinoma(CCC).Approximately 10%of patients with IHD stones develop CCC;however,there are limited studies regarding the ef...BACKGROUND Intrahepatic duct(IHD)stones are among the most important risk factors for cholangiocarcinoma(CCC).Approximately 10%of patients with IHD stones develop CCC;however,there are limited studies regarding the effect of IHD stone removal on CCC development.AIM To investigate the association between IHD stone removal and CCC development.METHODS We retrospectively analyzed 397 patients with IHD stones at a tertiary referral center between January 2011 and December 2020.RESULTS CCC occurred in 36 of the 397 enrolled patients.In univariate analysis,chronic hepatitis B infection(11.1%vs 3.0%,P=0.03),carbohydrate antigen 19-9(CA19-9,176.00 vs 11.96 II/mL,P=0.010),stone located in left or both lobes(86.1%vs 70.1%,P=0.042),focal atrophy(52.8%vs 26.9%,P=0.001),duct stricture(47.2%vs 24.9%,P=0.004),and removal status of IHD stone(33.3%vs 63.2%,P<0.001)were significantly different between IHD stone patients with and without CCC.In the multivariate analysis,CA19-9>upper normal limit,carcinoembryonic antigen>upper normal limit,stones located in the left or both lobes,focal atrophy,and complete removal of IHD stones without recurrence were independent factors influencing CCC development.However,the type of removal method was not associated with CCC risk.CONCLUSION Complete removal of IHD stones without recurrence could reduce CCC risk.展开更多
Abnormalities and variations of the biliary ducts are not rare.Most aberrant bile ducts eventually drain into the descending part of duodenum through the papilla of vater.However,drainage of the left hepatic bile duct...Abnormalities and variations of the biliary ducts are not rare.Most aberrant bile ducts eventually drain into the descending part of duodenum through the papilla of vater.However,drainage of the left hepatic bile duct into the stomach is extremely rare.A 29-year old man was admitted to the hospital with the diagnosis of biliary reflux gastritis.Comprehensive imaging modalities were performed including electronic endoscopy,endoscopic ultrasonography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangio-pancreatography.Finally,congenital ectopic left intrahepatic bile duct draining into the stomach was found,which caused biliary reflux gastritis.The patient did not receive any surgery.Good recovery was achieved by medical treatment.展开更多
To explore the relationship between the expression of E-cadherin and the apoptosis in intrahepatic bile duct epithelial cells in biliary atresia (BA).Methods The E-cadherin expression was demonstrated by immunohistoch...To explore the relationship between the expression of E-cadherin and the apoptosis in intrahepatic bile duct epithelial cells in biliary atresia (BA).Methods The E-cadherin expression was demonstrated by immunohistochemical staining for the liver specimens from 38 children with BA and 16 normal children.The apoptotic intrahepatic bile duct epithelial cells in these specimens were visualized by TdT-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay,and the apoptotic index (AI) was calculated from the percentage of apoptotic cells in total cells.Results The intensity of E-cadherin expression in bile duct epithelial cells in BA group was lower than that in the normal control group (0.33±0.12 vs 0.62±0.20,P<0.01).On the other hand,the AI in BA group was significant higher than that in control group (51.74±19.93 vs 12.34±19.32,P<0.01).An inverse correlation was detected between the intensity of E-cadherin and the AI in the liver from children with BA.Conclusion The abnormal decrease of E-cadherin may lead to an increase of the apoptosis of intrahepatic bile epithelial cells in BA,resulting in developmental disorder of intrahepatic bile duct and ductal plate malformation in the liver.12 refs,4 figs,1 tab.展开更多
A 70-year-old man was referred to our hospital due to abnormal liver function. A tumor of 92 mm × 61 mm was detected on ultrasound screening of the left liver lobe. Although the tumor was suspected to be intrahep...A 70-year-old man was referred to our hospital due to abnormal liver function. A tumor of 92 mm × 61 mm was detected on ultrasound screening of the left liver lobe. Although the tumor was suspected to be intrahepatic bile duct carcinoma, he had chronic heart disease and was unable to undergo surgery. Therefore, he was followed without further testing. No increase in tumor serum markers or tumor size was observed for the subsequent 7 years. We continued to suspect intrahepatic bile duct carcinoma, and we decided to perform a tumor biopsy. Tumor biopsy findings indicated intrahepatic bile duct adenoma(BDA), which is a rare benign epithelial liver tumor typically ranging from 1 mm to20 mm. We herein report a case of very large BDA followed for 7 years.展开更多
The rendezvous procedure combines an endoscopic technique with percutaneous transhepatic biliary drainage(PTBD).When a selective common bile duct cannulation fails,PTBD allows successful drainage and retrograde access...The rendezvous procedure combines an endoscopic technique with percutaneous transhepatic biliary drainage(PTBD).When a selective common bile duct cannulation fails,PTBD allows successful drainage and retrograde access for subsequent rendezvous techniques.Traditionally,rendezvous procedures such as the PTBDassisted over-the-wire cannulation method,or the parallel cannulation technique,may be available when a bile duct cannot be selectively cannulated.When selective intrahepatic bile duct(IHD) cannulation fails,this modified rendezvous technique may be a feasible alternative.We report the case of a modified rendezvous technique,in which the guidewire was retrogradely passed into the IHD through the C2 catheter after end-to-end contact between the tips of the sphincterotome and the C2 catheter at the ampulla's orifice,in a 39-year-old man who had been diagnosed with gallbladder carcinoma with a metastatic right IHD obstruction.Clinically this procedure may be a feasible and timesaving technique.展开更多
patients with left/right intrahepatic bile-duct calculi received ultrasonic lithotresis via abdomen by using the percutaneous cholecystoscopeand ultrasonic lithotresis apparatus. The results indicated that all the sur...patients with left/right intrahepatic bile-duct calculi received ultrasonic lithotresis via abdomen by using the percutaneous cholecystoscopeand ultrasonic lithotresis apparatus. The results indicated that all the surgical manipulations were successful with a residual rate of 6. 7 %, compared with a residual rate of 78. 2 % in 23 cases of left/right intrahepatic bile-duct lithiasis treated simultaneously by lithotomy apparatus. The differences between them were statistically significant (μ= 4. 29, P<0. 01). Among 12 cases undergoing follow-up observation , no side effect due to ultrasonic lithotresis and no residual calculus after 2- 4 check-ups with B-mode ultrasound diagnostic set were found and all of their symptoms disappeared except for 1 case.展开更多
Objective:To investigate the effects of endoscopic small sphincterotomy and balloon dilatation (ESBD) on immune function, stress, serum amylase and urinary trypsinogen-2 levels in patients with common bile duct stones...Objective:To investigate the effects of endoscopic small sphincterotomy and balloon dilatation (ESBD) on immune function, stress, serum amylase and urinary trypsinogen-2 levels in patients with common bile duct stones.Methods: The clinical data of 150 patients with common bile duct stones admitted to Wuxi people's Hospital affiliated to Nanjing Medical University from January 2015 to December 2017 were retrospectively analyzed. According to the different surgical methods, the study group and the control group were divided into 75 cases. The study group was treated with ESBD, and the control group was treated with endoscopic sphincterotomy (EST). The changes of inflammation [high mobility group protein B1 (HMGB1), glycoprotein antigen 19-9 (CA19-9) and procalcitonin (PCT)] and stress response [C peptide (C-P), natural killer cell (NK) and cortisol (Cor)], blood amylase (AMS) and trypsinogen-2 (Try-2) were compared between the two groups.Results: The levels of C-P, NK and Cor, the HMGB1, CA19-9 and PCT, and the AMS and Try-2 in two groups before the operation were not significant difference (P>0.05). The levels of NK, CA19-9 was significantly decreased and C-P, Cor, HMGB1, PCT, AMS and Try-2 were significantly increased in both groups after operation (P<0.05). The levels of CP and Cor levels in the study group were (1.16±0.13) nmol/L and (150.23±15.12) nmol/L, respectively, which were lower than the control group (P<0.05). The levels of NK was (25.27±2.39)%, which were higher than the control group (P<0.05). The HMGB1, CA19-9 and PCT levels in the study group were (12.02±1.10) μg/L, (20.31±2.26) U/mL and (5.33±0.53) μg/L, respectively, which were lower than the control group (P<0.05). The AMS and Try-2 levels in the study group were (250.02±25.20) U/L and (36.11±3.51) ng/mL, respectively, which were lower than the control group (P<0.05).Conclusion: ESBD can effectively alleviate inflammatory reaction and stress response, and has little effect on blood amylase and urinary trypsin-2 in patients with common bile duct stones, which is worthy of clinical promotion.展开更多
BACKGROUND: In orthotopic liver transplantation, ische-mic-reperfusion is one of the most important factors thatcause the incidence of biliary complicance. The aim of thisstudy was to investigate the effects of ischem...BACKGROUND: In orthotopic liver transplantation, ische-mic-reperfusion is one of the most important factors thatcause the incidence of biliary complicance. The aim of thisstudy was to investigate the effects of ischemia reperfusionon epithelial cells apoptosis and proliferation of intrahepaticbile duct (IBD) (>20 μm).METHODS: 30-minute warm ischemia was applied to ratlivers respectively, and experiment was performed on days2,7, 14, 28 after reperfusion. Apoptosis was determined insitu by morphology and TUNEL, and cholangiocyte proli-feration was evaluated in situ by morphometry of liver sec-tions stained for cytokeratin-19 ( CK-19) and by prolifera-ting cellular nuclear antigen staining in liver sections.RESULTS: Two days after ischemia reperfusion, apoptosisof cells was observed in large intrahepatic bile ducts (>20μm) (5.6%±1.2%) , but the number of large intrahepaticbile ducts reduced (0.32 ±0.06). Seven days after ischemiareperfusion, the apoptosis index of cholangiocytes de-creased to 1.2%±0.3%, and the number of intrahepatic bileducts began to proliferate and returned to nearly normal onday 28.CONCLUSION: Ischemia reperfusion causes a decrease inthe number of intrahepatic bile ducts (>20 μm) as a resultof a higher rate of apoptosis and absence of initial prolifera-tion.展开更多
BACKGROUND: Despite its rare incidence, few cases of left-side gallbladder have been already published. METHODS: We reported herein the case of a 29-year-old man with a left liver tumor in whom left lateral bisegmen- ...BACKGROUND: Despite its rare incidence, few cases of left-side gallbladder have been already published. METHODS: We reported herein the case of a 29-year-old man with a left liver tumor in whom left lateral bisegmen- tectomy was mandatory. It represents the first description of a sinistroposition of both gallbladder and common bile duct. RESULTS: Surgical exploration revealed a left-side gall- bladder , located under the left lobe of the liver. During he- patic parenchyma dissection at the left side of the round liga- ment and the Rex recessus, the common bile duct was in- jured. Complete separation of hepatic pedicle structures showed that the upper biliary convergence passed on the left side of the Rex recessus before reaching the hepatoduo- denal ligament. CONCLUSION: Only careful dissection of the hepatoduo- denal ligament up to Rex recessus level prior to liver paren- chyma resection could avoid biliary tract injury during left lobectomy.展开更多
目的探讨加速术后康复(enhanced recovery after surgery,ERAS)理念应用于微创肝切除术治疗肝内胆管结石肝萎缩病人围手术期的临床价值。方法回顾性队列研究分析青岛市市立医院肝胆外科2016年12月至2023年3月通过腹腔镜下肝切除术治疗...目的探讨加速术后康复(enhanced recovery after surgery,ERAS)理念应用于微创肝切除术治疗肝内胆管结石肝萎缩病人围手术期的临床价值。方法回顾性队列研究分析青岛市市立医院肝胆外科2016年12月至2023年3月通过腹腔镜下肝切除术治疗的63例肝内胆管结石肝萎缩病人的临床资料,根据围手术期处理方法不同将其分为ERAS组(32例)和对照组(常规组,31例)。比较分析ERAS理念对病人术中情况(手术时间及术中出血量)、住院费用、术后肝功能、康复时间及并发症等指标的影响。呈偏态分布的计量资料以M(Q1,Q3)表示,采用秩和检验。结果ERAS组与对照组比较,病人术后康复时间明显缩短[6.0(5.0,7.0)d比8.0(5.0,9.0)d,P<0.01],住院费用更少[46531(38676,51311)元比55553(47638,65529)元,P<0.01],并发症发生率更低[31.3%(10/32)比93.5%(29/31),P<0.01],术后留置T管率更低[28.1%(9/32)比58.1%(18/31),P<0.01];两组病人在手术时间、出血量以及术后1 d、3 d的血谷丙转氨酶、谷草转氨酶、C反应蛋白及预后营养指数方面差异均无统计学意义(均P>0.05)。结论ERAS理念应用于肝切除治疗肝胆管结石肝萎缩的围手术期管理是安全有效的,有助于病人的快速安全康复,值得在肝内胆管结石肝切除术中推广。展开更多
基金Supported by a grant from the National R&D Program for Cancer Control,Ministry of Health and Welfare,Republic of Korea,No.HA20C0009.
文摘BACKGROUND Intrahepatic duct(IHD)stones are among the most important risk factors for cholangiocarcinoma(CCC).Approximately 10%of patients with IHD stones develop CCC;however,there are limited studies regarding the effect of IHD stone removal on CCC development.AIM To investigate the association between IHD stone removal and CCC development.METHODS We retrospectively analyzed 397 patients with IHD stones at a tertiary referral center between January 2011 and December 2020.RESULTS CCC occurred in 36 of the 397 enrolled patients.In univariate analysis,chronic hepatitis B infection(11.1%vs 3.0%,P=0.03),carbohydrate antigen 19-9(CA19-9,176.00 vs 11.96 II/mL,P=0.010),stone located in left or both lobes(86.1%vs 70.1%,P=0.042),focal atrophy(52.8%vs 26.9%,P=0.001),duct stricture(47.2%vs 24.9%,P=0.004),and removal status of IHD stone(33.3%vs 63.2%,P<0.001)were significantly different between IHD stone patients with and without CCC.In the multivariate analysis,CA19-9>upper normal limit,carcinoembryonic antigen>upper normal limit,stones located in the left or both lobes,focal atrophy,and complete removal of IHD stones without recurrence were independent factors influencing CCC development.However,the type of removal method was not associated with CCC risk.CONCLUSION Complete removal of IHD stones without recurrence could reduce CCC risk.
文摘Abnormalities and variations of the biliary ducts are not rare.Most aberrant bile ducts eventually drain into the descending part of duodenum through the papilla of vater.However,drainage of the left hepatic bile duct into the stomach is extremely rare.A 29-year old man was admitted to the hospital with the diagnosis of biliary reflux gastritis.Comprehensive imaging modalities were performed including electronic endoscopy,endoscopic ultrasonography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangio-pancreatography.Finally,congenital ectopic left intrahepatic bile duct draining into the stomach was found,which caused biliary reflux gastritis.The patient did not receive any surgery.Good recovery was achieved by medical treatment.
文摘To explore the relationship between the expression of E-cadherin and the apoptosis in intrahepatic bile duct epithelial cells in biliary atresia (BA).Methods The E-cadherin expression was demonstrated by immunohistochemical staining for the liver specimens from 38 children with BA and 16 normal children.The apoptotic intrahepatic bile duct epithelial cells in these specimens were visualized by TdT-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay,and the apoptotic index (AI) was calculated from the percentage of apoptotic cells in total cells.Results The intensity of E-cadherin expression in bile duct epithelial cells in BA group was lower than that in the normal control group (0.33±0.12 vs 0.62±0.20,P<0.01).On the other hand,the AI in BA group was significant higher than that in control group (51.74±19.93 vs 12.34±19.32,P<0.01).An inverse correlation was detected between the intensity of E-cadherin and the AI in the liver from children with BA.Conclusion The abnormal decrease of E-cadherin may lead to an increase of the apoptosis of intrahepatic bile epithelial cells in BA,resulting in developmental disorder of intrahepatic bile duct and ductal plate malformation in the liver.12 refs,4 figs,1 tab.
文摘A 70-year-old man was referred to our hospital due to abnormal liver function. A tumor of 92 mm × 61 mm was detected on ultrasound screening of the left liver lobe. Although the tumor was suspected to be intrahepatic bile duct carcinoma, he had chronic heart disease and was unable to undergo surgery. Therefore, he was followed without further testing. No increase in tumor serum markers or tumor size was observed for the subsequent 7 years. We continued to suspect intrahepatic bile duct carcinoma, and we decided to perform a tumor biopsy. Tumor biopsy findings indicated intrahepatic bile duct adenoma(BDA), which is a rare benign epithelial liver tumor typically ranging from 1 mm to20 mm. We herein report a case of very large BDA followed for 7 years.
文摘The rendezvous procedure combines an endoscopic technique with percutaneous transhepatic biliary drainage(PTBD).When a selective common bile duct cannulation fails,PTBD allows successful drainage and retrograde access for subsequent rendezvous techniques.Traditionally,rendezvous procedures such as the PTBDassisted over-the-wire cannulation method,or the parallel cannulation technique,may be available when a bile duct cannot be selectively cannulated.When selective intrahepatic bile duct(IHD) cannulation fails,this modified rendezvous technique may be a feasible alternative.We report the case of a modified rendezvous technique,in which the guidewire was retrogradely passed into the IHD through the C2 catheter after end-to-end contact between the tips of the sphincterotome and the C2 catheter at the ampulla's orifice,in a 39-year-old man who had been diagnosed with gallbladder carcinoma with a metastatic right IHD obstruction.Clinically this procedure may be a feasible and timesaving technique.
文摘patients with left/right intrahepatic bile-duct calculi received ultrasonic lithotresis via abdomen by using the percutaneous cholecystoscopeand ultrasonic lithotresis apparatus. The results indicated that all the surgical manipulations were successful with a residual rate of 6. 7 %, compared with a residual rate of 78. 2 % in 23 cases of left/right intrahepatic bile-duct lithiasis treated simultaneously by lithotomy apparatus. The differences between them were statistically significant (μ= 4. 29, P<0. 01). Among 12 cases undergoing follow-up observation , no side effect due to ultrasonic lithotresis and no residual calculus after 2- 4 check-ups with B-mode ultrasound diagnostic set were found and all of their symptoms disappeared except for 1 case.
基金National Natural Science Foundation Youth Project.Project No:81502038.
文摘Objective:To investigate the effects of endoscopic small sphincterotomy and balloon dilatation (ESBD) on immune function, stress, serum amylase and urinary trypsinogen-2 levels in patients with common bile duct stones.Methods: The clinical data of 150 patients with common bile duct stones admitted to Wuxi people's Hospital affiliated to Nanjing Medical University from January 2015 to December 2017 were retrospectively analyzed. According to the different surgical methods, the study group and the control group were divided into 75 cases. The study group was treated with ESBD, and the control group was treated with endoscopic sphincterotomy (EST). The changes of inflammation [high mobility group protein B1 (HMGB1), glycoprotein antigen 19-9 (CA19-9) and procalcitonin (PCT)] and stress response [C peptide (C-P), natural killer cell (NK) and cortisol (Cor)], blood amylase (AMS) and trypsinogen-2 (Try-2) were compared between the two groups.Results: The levels of C-P, NK and Cor, the HMGB1, CA19-9 and PCT, and the AMS and Try-2 in two groups before the operation were not significant difference (P>0.05). The levels of NK, CA19-9 was significantly decreased and C-P, Cor, HMGB1, PCT, AMS and Try-2 were significantly increased in both groups after operation (P<0.05). The levels of CP and Cor levels in the study group were (1.16±0.13) nmol/L and (150.23±15.12) nmol/L, respectively, which were lower than the control group (P<0.05). The levels of NK was (25.27±2.39)%, which were higher than the control group (P<0.05). The HMGB1, CA19-9 and PCT levels in the study group were (12.02±1.10) μg/L, (20.31±2.26) U/mL and (5.33±0.53) μg/L, respectively, which were lower than the control group (P<0.05). The AMS and Try-2 levels in the study group were (250.02±25.20) U/L and (36.11±3.51) ng/mL, respectively, which were lower than the control group (P<0.05).Conclusion: ESBD can effectively alleviate inflammatory reaction and stress response, and has little effect on blood amylase and urinary trypsin-2 in patients with common bile duct stones, which is worthy of clinical promotion.
文摘BACKGROUND: In orthotopic liver transplantation, ische-mic-reperfusion is one of the most important factors thatcause the incidence of biliary complicance. The aim of thisstudy was to investigate the effects of ischemia reperfusionon epithelial cells apoptosis and proliferation of intrahepaticbile duct (IBD) (>20 μm).METHODS: 30-minute warm ischemia was applied to ratlivers respectively, and experiment was performed on days2,7, 14, 28 after reperfusion. Apoptosis was determined insitu by morphology and TUNEL, and cholangiocyte proli-feration was evaluated in situ by morphometry of liver sec-tions stained for cytokeratin-19 ( CK-19) and by prolifera-ting cellular nuclear antigen staining in liver sections.RESULTS: Two days after ischemia reperfusion, apoptosisof cells was observed in large intrahepatic bile ducts (>20μm) (5.6%±1.2%) , but the number of large intrahepaticbile ducts reduced (0.32 ±0.06). Seven days after ischemiareperfusion, the apoptosis index of cholangiocytes de-creased to 1.2%±0.3%, and the number of intrahepatic bileducts began to proliferate and returned to nearly normal onday 28.CONCLUSION: Ischemia reperfusion causes a decrease inthe number of intrahepatic bile ducts (>20 μm) as a resultof a higher rate of apoptosis and absence of initial prolifera-tion.
文摘BACKGROUND: Despite its rare incidence, few cases of left-side gallbladder have been already published. METHODS: We reported herein the case of a 29-year-old man with a left liver tumor in whom left lateral bisegmen- tectomy was mandatory. It represents the first description of a sinistroposition of both gallbladder and common bile duct. RESULTS: Surgical exploration revealed a left-side gall- bladder , located under the left lobe of the liver. During he- patic parenchyma dissection at the left side of the round liga- ment and the Rex recessus, the common bile duct was in- jured. Complete separation of hepatic pedicle structures showed that the upper biliary convergence passed on the left side of the Rex recessus before reaching the hepatoduo- denal ligament. CONCLUSION: Only careful dissection of the hepatoduo- denal ligament up to Rex recessus level prior to liver paren- chyma resection could avoid biliary tract injury during left lobectomy.
