OBJECTIVE: To explore the mechanism of benign biliary stricture caused by bile duct trauma.METHODS: A model of trauma of the common bile duct was established in 28 dogs and then repaired.The anastomotic tissues were t...OBJECTIVE: To explore the mechanism of benign biliary stricture caused by bile duct trauma.METHODS: A model of trauma of the common bile duct was established in 28 dogs and then repaired.The anastomotic tissues were taken on 3 days, 1 week, 3 weeks, 3 months, and 6 months respectivelyafter operation and examined by using light microscopy and electromicroscopy. Macrophage. transforminggrowth factor beta I (TGF-β1) and α-smooth muscle actin (α-SMA) were studied immunohistochemically.RESULTS: The mucosal epithelium of the common bile duct restored poorly, chronic inflammation lastedfor a long time, fibroblasts proliferated actively, extracellular matrix overdeposited, and myofibroblastsfunctioned actively during the whole healing process. Immunohistochemical test showed a high expressionof macrophage, TGF-β1 and α-SMA during the healing process lasting a long duration. Macrophages werefound in the lamina propria under mucosa, TGF-β1 in the granular tissue, fibroblasts and endothelial cellsof blood vessels, while α-SMA in the myofibroblasts and smooth muscle tissue.CONCLUSIONS: The healing of the bile duct is in the mode of overhealing. Myofibroblast is the maincause for contracture of scar and stricture of the bile duct. The high expression of macrophage, TGF-β1and α-SMA is closely related to active proliferation of fibroblasts, extracellular matrix overdeposition andscar contracture of the bile duct.展开更多
Objective: To explore the formation mechanism of benign biliary stricture. Methods: A model of trauma of common bile duct was established in 28 dogs and then repaired. The anasomosis tissues were taken on the 1st week...Objective: To explore the formation mechanism of benign biliary stricture. Methods: A model of trauma of common bile duct was established in 28 dogs and then repaired. The anasomosis tissues were taken on the 1st week, 3rd week and the 3rd month, 6th month respectively after operation and examined by using light microscopy and electromicroscopy. Macrophage, TGF-β1 and α-SMA were studied immunohistochemically. Results: The mucosal epithelium of common bile duct restored poorly, chronic inflammation lasted for a long time, fibroblasts proliferated actively, extracellular matrix overdeposited; and myofibroblasts functioned actively and existed during the whole healing process. Immunohistochemical test showed a high expression of macrophage, TGF-β1 and α-SMA during healing process lasting a long duration. Macrophages were found in the lamina propria under mucosa, TGF-β1 in the granulation tissue, fibroblasts and endothelial cells of blood vesssels, while α-SMA in the myofiroblasts and smooth muscle tissue. Conclusion: The healing of bile duct is in the mode of overhealing. Myofibroblast is the main cause for contracture of scar and stricture of bile duct. The high expression of macrophage, TGF-β1 and α-SMA is closely related to active proliferation of fibroblasts, extracelluar matrix overdeposition and scar contracture of bile duct.展开更多
Objective To investigate the diagnosis and treatment of trauma of hepatic portal bile duct. Methods Eight cases of trauma of the hepatic portal bile duct were reviewed. All short-term splits were treated with repair p...Objective To investigate the diagnosis and treatment of trauma of hepatic portal bile duct. Methods Eight cases of trauma of the hepatic portal bile duct were reviewed. All short-term splits were treated with repair plus drainage with supporting tube. In 7 cases, there were combined injuries of 2 or more than 2 organs. The combined injuries were respectively treated. Long-term complication of bile duct stenosis was managed with internal drainage. Results Five cases were found during operation. Of these 5 patients, 3 were with the traumatic split less than 50% diameter and 2 with that more than 50% diameter. After repair,1 of the former 3 died and 2 remained in good condition. However, 1 of the latter 2 died and 1 was reoperated on due to bile duct stricture after the repair. Other 3 cases were found due to postoperative bile leakage. They were treated with internal drainage and good results achieved. Conclusion It is difficult to make a definite diagnosis of traumatic injury of hepatic protal bile展开更多
AIM: Persistent cholestasis is a rare complication of severe trauma or infections, Little is known about the possible pathomechanisms and the clinical course,METHODS: Secondary sclerosing cholangitis was diagnosed in ...AIM: Persistent cholestasis is a rare complication of severe trauma or infections, Little is known about the possible pathomechanisms and the clinical course,METHODS: Secondary sclerosing cholangitis was diagnosed in five patients with persistent jaundice after severe trauma (one burn injury, three accidents, one power current injury). Medical charts were retrospectively reviewed with regard to possible trigger mechanisms for cholestasis, and the clinical course was recorded.RESULTS: Diagnosis of secondary sclerosing cholangitis was based in all patients on the primary sclerosing cholangitis (PSC)-like destruction of the intrahepatic bile ducts at cholangiography after exclusion of PSC. In four patients, arterial hypotension with subsequent ischemia may have caused the bile duct damage, whereas in the case of power current injury direct thermal damage was assumed to be the trigger mechanism. The course of secondary liver fibrosis was rapidly progressive and proceeded to liver cirrhosis in all four patients with a follow-up ＞2 years. Therapeutic possibilities were limited.CONCLUSION: Posttraumatic sclerosing cholangitis is a rare but rapidly progressive disease, probably caused by ischemia of the intrahepatic bile ducts via the peribiliary capillary plexus due to arterial hypotension. Gastroenterologists should be aware of this disease in patients with persistent cholestasis after severe trauma.展开更多
目的 探究与分析腹腔镜胆总管探查(laparoscopic common bile duct exploration,LCDE)手术与开腹手术治疗胆总管结石的效果。方法 回顾性分析2015年2月—2020年2月兴化市第五人民医院收治的胆总管结石患者46例的临床资料,按照不同手术...目的 探究与分析腹腔镜胆总管探查(laparoscopic common bile duct exploration,LCDE)手术与开腹手术治疗胆总管结石的效果。方法 回顾性分析2015年2月—2020年2月兴化市第五人民医院收治的胆总管结石患者46例的临床资料,按照不同手术治疗方法分为LCDE组(n=22)与开腹组(n=24),LCDE组给予腹腔镜胆道探查取石术治疗胆总管结石,开腹组给予开腹手术治疗胆总管结石。对比两组围术期指标、术后并发症发生率及手术治疗前后的创伤指标。结果 LCDE组切口长度、手术时间、术中出血量、引流时间、排气时间、住院费用、住院时间分别为(0.86±0.18)cm、(97.54±16.55)min、(85.64±23.10)mL、(96.80±21.33)min、(2.13±0.57)d、(7 560.14±284.33)元、(5.26±2.10)d,均优于开腹组,差异有统计学意义(t=16.318、3.203、5.560、6.893、8.960、29.170、4.240,P<0.05)。LCDE组手术后WBC计数、中性粒细胞比例、淋巴细胞比例分别为(7.23±1.65)×10~9/L、(57.17±3.75)%、(37.60±3.25)%,均优于开腹组,差异有统计学意义(t=5.827、15.635、25.865,P<0.05)。结论 LCDE与开腹手术相比治疗胆总管结石的围术期指标表现更好,不容易造成明显的创伤,安全性及可行性均较高。展开更多
目的探讨医源性胆道损伤的防治方法。方法对本院1990年3月至2000年3月收治的101例医源性胆道损伤资料进行回顾性分析。结果胆囊切除时胆囊三角区解剖不清是发生医源性胆道损伤的主要原因,占44.6%(45/101)。医源性胆道损伤的诊断主要依...目的探讨医源性胆道损伤的防治方法。方法对本院1990年3月至2000年3月收治的101例医源性胆道损伤资料进行回顾性分析。结果胆囊切除时胆囊三角区解剖不清是发生医源性胆道损伤的主要原因,占44.6%(45/101)。医源性胆道损伤的诊断主要依赖于临床症状体征、腹腔穿刺和影像学检查,其中 B 超诊断率可达93.9%(94/101)。按损伤部位可将其分成六型,临床上以Ⅲ型多见,占83.7%(84/101)。根据损伤类型而选择相应的外科手术方式可明显提高治愈率,本组达100%(101/101)。结论胆囊切除前遵循“辨-切-辨”三字原则是预防医源性胆道损伤的关键,而损伤类型则决定了外科手术方式的正确选择。展开更多
文摘OBJECTIVE: To explore the mechanism of benign biliary stricture caused by bile duct trauma.METHODS: A model of trauma of the common bile duct was established in 28 dogs and then repaired.The anastomotic tissues were taken on 3 days, 1 week, 3 weeks, 3 months, and 6 months respectivelyafter operation and examined by using light microscopy and electromicroscopy. Macrophage. transforminggrowth factor beta I (TGF-β1) and α-smooth muscle actin (α-SMA) were studied immunohistochemically.RESULTS: The mucosal epithelium of the common bile duct restored poorly, chronic inflammation lastedfor a long time, fibroblasts proliferated actively, extracellular matrix overdeposited, and myofibroblastsfunctioned actively during the whole healing process. Immunohistochemical test showed a high expressionof macrophage, TGF-β1 and α-SMA during the healing process lasting a long duration. Macrophages werefound in the lamina propria under mucosa, TGF-β1 in the granular tissue, fibroblasts and endothelial cellsof blood vessels, while α-SMA in the myofibroblasts and smooth muscle tissue.CONCLUSIONS: The healing of the bile duct is in the mode of overhealing. Myofibroblast is the maincause for contracture of scar and stricture of the bile duct. The high expression of macrophage, TGF-β1and α-SMA is closely related to active proliferation of fibroblasts, extracellular matrix overdeposition andscar contracture of the bile duct.
基金Supported by Shaanxi Scientific Fund(2002-K10-G8)
文摘Objective: To explore the formation mechanism of benign biliary stricture. Methods: A model of trauma of common bile duct was established in 28 dogs and then repaired. The anasomosis tissues were taken on the 1st week, 3rd week and the 3rd month, 6th month respectively after operation and examined by using light microscopy and electromicroscopy. Macrophage, TGF-β1 and α-SMA were studied immunohistochemically. Results: The mucosal epithelium of common bile duct restored poorly, chronic inflammation lasted for a long time, fibroblasts proliferated actively, extracellular matrix overdeposited; and myofibroblasts functioned actively and existed during the whole healing process. Immunohistochemical test showed a high expression of macrophage, TGF-β1 and α-SMA during healing process lasting a long duration. Macrophages were found in the lamina propria under mucosa, TGF-β1 in the granulation tissue, fibroblasts and endothelial cells of blood vesssels, while α-SMA in the myofiroblasts and smooth muscle tissue. Conclusion: The healing of bile duct is in the mode of overhealing. Myofibroblast is the main cause for contracture of scar and stricture of bile duct. The high expression of macrophage, TGF-β1 and α-SMA is closely related to active proliferation of fibroblasts, extracelluar matrix overdeposition and scar contracture of bile duct.
文摘Objective To investigate the diagnosis and treatment of trauma of hepatic portal bile duct. Methods Eight cases of trauma of the hepatic portal bile duct were reviewed. All short-term splits were treated with repair plus drainage with supporting tube. In 7 cases, there were combined injuries of 2 or more than 2 organs. The combined injuries were respectively treated. Long-term complication of bile duct stenosis was managed with internal drainage. Results Five cases were found during operation. Of these 5 patients, 3 were with the traumatic split less than 50% diameter and 2 with that more than 50% diameter. After repair,1 of the former 3 died and 2 remained in good condition. However, 1 of the latter 2 died and 1 was reoperated on due to bile duct stricture after the repair. Other 3 cases were found due to postoperative bile leakage. They were treated with internal drainage and good results achieved. Conclusion It is difficult to make a definite diagnosis of traumatic injury of hepatic protal bile
文摘AIM: Persistent cholestasis is a rare complication of severe trauma or infections, Little is known about the possible pathomechanisms and the clinical course,METHODS: Secondary sclerosing cholangitis was diagnosed in five patients with persistent jaundice after severe trauma (one burn injury, three accidents, one power current injury). Medical charts were retrospectively reviewed with regard to possible trigger mechanisms for cholestasis, and the clinical course was recorded.RESULTS: Diagnosis of secondary sclerosing cholangitis was based in all patients on the primary sclerosing cholangitis (PSC)-like destruction of the intrahepatic bile ducts at cholangiography after exclusion of PSC. In four patients, arterial hypotension with subsequent ischemia may have caused the bile duct damage, whereas in the case of power current injury direct thermal damage was assumed to be the trigger mechanism. The course of secondary liver fibrosis was rapidly progressive and proceeded to liver cirrhosis in all four patients with a follow-up ＞2 years. Therapeutic possibilities were limited.CONCLUSION: Posttraumatic sclerosing cholangitis is a rare but rapidly progressive disease, probably caused by ischemia of the intrahepatic bile ducts via the peribiliary capillary plexus due to arterial hypotension. Gastroenterologists should be aware of this disease in patients with persistent cholestasis after severe trauma.
文摘目的 探究与分析腹腔镜胆总管探查(laparoscopic common bile duct exploration,LCDE)手术与开腹手术治疗胆总管结石的效果。方法 回顾性分析2015年2月—2020年2月兴化市第五人民医院收治的胆总管结石患者46例的临床资料,按照不同手术治疗方法分为LCDE组(n=22)与开腹组(n=24),LCDE组给予腹腔镜胆道探查取石术治疗胆总管结石,开腹组给予开腹手术治疗胆总管结石。对比两组围术期指标、术后并发症发生率及手术治疗前后的创伤指标。结果 LCDE组切口长度、手术时间、术中出血量、引流时间、排气时间、住院费用、住院时间分别为(0.86±0.18)cm、(97.54±16.55)min、(85.64±23.10)mL、(96.80±21.33)min、(2.13±0.57)d、(7 560.14±284.33)元、(5.26±2.10)d,均优于开腹组,差异有统计学意义(t=16.318、3.203、5.560、6.893、8.960、29.170、4.240,P<0.05)。LCDE组手术后WBC计数、中性粒细胞比例、淋巴细胞比例分别为(7.23±1.65)×10~9/L、(57.17±3.75)%、(37.60±3.25)%,均优于开腹组,差异有统计学意义(t=5.827、15.635、25.865,P<0.05)。结论 LCDE与开腹手术相比治疗胆总管结石的围术期指标表现更好,不容易造成明显的创伤,安全性及可行性均较高。
文摘目的探讨医源性胆道损伤的防治方法。方法对本院1990年3月至2000年3月收治的101例医源性胆道损伤资料进行回顾性分析。结果胆囊切除时胆囊三角区解剖不清是发生医源性胆道损伤的主要原因,占44.6%(45/101)。医源性胆道损伤的诊断主要依赖于临床症状体征、腹腔穿刺和影像学检查,其中 B 超诊断率可达93.9%(94/101)。按损伤部位可将其分成六型,临床上以Ⅲ型多见,占83.7%(84/101)。根据损伤类型而选择相应的外科手术方式可明显提高治愈率,本组达100%(101/101)。结论胆囊切除前遵循“辨-切-辨”三字原则是预防医源性胆道损伤的关键,而损伤类型则决定了外科手术方式的正确选择。
