Objective To investigate the roles of NF-κB and EGFR in hepatolithiasis associated with intrahepatic cholangiocarcinoma. Methods Ninety cases of liver tissue specimens from hepatectomies performed in the 2nd Affiliated Hospital of Sun Yat-sen University between August 1989 and June 2009 were enrolled in the study. Among them, 33 cases of hepatolithiasis associated with intrahepatic cholangiocarcinoma were considered as observing group, 32 cases of hepatolithiasis as control group, and 25 cases of normal bile duct tissues as normal control group. The SP method of immunohistochemical staining was applied to detect the expressions of NF-κB and EGFR in intrahepatic biliary ducts epithelial cells, and their relations with clinicopathologic factors and the accumulated survival rate of hepatolithiasis associated with intrahepatic cholangiocarcinoma were analyzed. Results Expression rates of NF-κB and EGFR were gradually raised from normal control group, control group to observing group (Plt;0.01). Expression of EGFR in tumor patients was related to histopathologic differentiation grading and the depth of tumor invasion (Plt;0.05), but not to gender, age, or lymph node metastasis (Pgt;0.05)； there were no significant relationships between the expression of NF-κB and factors described above (Pgt;0.05). The survival rate of patients with tumor expressed EGFR was significantly lower than that of patients with tumor non-expressed EGFR (Plt;0.01). Conclusions NF-κB expression is in the early stage during intrahepatic cholangiocarcinoma genesis. NF-κB and EGFR play cooperating roles during hepatolithiasis carcinogenesis process. Over expression of EGFR is related with poor differentiation and prognosis of tumor.
ObjectiveTo summarize clinical experiences of combination of laparoscope,choledochoscope,and balloon nasobiliary exploration (LCBNE) in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter (0.3-0.8 cm) of common bile duct (CBD). MethodsFrom April 2010 to May 2015,there were 43 cases of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD underwent LCBNE,involving choledochotomy,choledochoscopic exploration,electrohydralic lithothipsy,balloon nasobiliary dilatation for removing cholelith,nasobiliary drainage,and the primary closure of incision. ResultsThe procedure was successful in 27 cases of removing the bile duct residual stones through the choledochoscopic procedure,9 cases through the balloon nasobiliary procedure,and 7 cases were converted to endoscopic sphincterotomy for choledocholithasis.No case was converted to open CBD exploration.No case had residual stone.Bile leakage occurred in 1 case,which was cured by peritoneal drainage and nasobiliary drainage.One patient had a slight pancreatitis after operation.One patient had the stenosis of primary suture of CBD incision.Total postoperative complications rate was 7.0%(3/43).No case had perforations of intestine and bile duct,bleeding,severe pancreatitis,and death after operation. ConclusionFrom preliminary results of limited cases in this study,if patients are indicated,combination of LCBNE in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD is safe and effective.
目的 探索急性化脓性梗阻性胆管炎20世纪90年代后期与80年代以前的差异，探讨对本病治疗的方向。 方法 收集我院1996～2000年病例，并与我院1950～1981年资料进行比较。 结果 ①发病率显著降低，从46.08%降至15.62%； ②发病年龄延后10～20岁； ③入院时病情相对较轻，有休克者从51.39%降至22.80%； ④病死率明显下降，从25.78%降至3.50%； ⑤再手术患者显著增加，从12.12%增至55.20%。造成上述差异的原因与患者就诊早，及时的治疗，医务人员的水平提高，药品与医学的发展等有关。 结论 对急性梗阻性化脓性胆管炎患者，虽然发病率和死亡率已明显下降，仍需足够重视，因术后T管造影和B超检查发现肝内残石或胆管狭窄者，高达85.1%，复发再手术率达55.2%，远不能令人满意。为提高远期效果，应在急诊手术引流后，待患者病情平稳后，再进一步检查和彻底处理肝内病变。
The quantitative studies of secretory granules andand lysosomes in gallbladder epithelium and gallbladder bile glycoprotein were performed in 20 gallstone patients and 15 gallstone-free subjects. The results showed that the number, the volume density and the total secrectory granules were significantly increased in gallstone patients compared with gallstone-free controls. The gallstone patients had a markedly reduced number,volume destiny and total lysosome area compared with gallstone-free subjects. The glycoprotein concenrtation in gallblader bile was increased up to 21.04±4.92g/L in gallstone paients,as compare with 13.02±5.72g/L(Plt;0.05)in the stone-free controls. The qualitity of secretory granules and lysosomes was directly proprtational to that of bile glycproteins. Evidence and secrectory granules and lysosomes was directly proporional to taht of bile glycoproteins. Evidence and argument are presentded suggesting that gallblader epithelium secrectory granules affect the concentration of bile glycoprotein and lysosomemay be related to the intracellular degradation of secretory granules.
目的：探讨急性胆源性胰腺炎(ABP)手术时机和术式的选择。方法：回顾性分析247例急性胆源性胰腺炎的临床资料。 结果：非手术治疗10例，死亡4例；12例急诊手术后发生并发症5例，死亡2例；169 例延期手术术后发生并发症1例，治愈；56例择期手术无并发症发生。结论：以胆道梗阻为主的ABP应急诊手术解除胆道梗阻；胆道无梗阻先采用非手术治疗，胰腺炎控制后，再处理胆道病变。
ObjectiveTo investigate the clinical value of MRCP and (or) MRI on combination of choledochoscopy and duodenoscopy during the course of therapeutic laparoscopy with preoperative or intraoperative help diagnosis and treatment of gallbladder stone with common bile duct stones of diameter in the normal range. MethodsThe clinical data of 998 patients with calculus of bile duct with diameter in the normal range of common bile duct (common bile duct diameter of 0.2-0.8 cm) by MRCP and (or) MRI assist in diagnosis and treatment from Oct. 2001 to Dec. 2015 in the Second People's Hospital of Chengdu City were retrospectively analized. ResultsThe 998 cases of common bile duct diameter≤0.8 cm were diagnosed and treated by using MRCP and (or) MRI examination. Choledochoscopy group: There were 399 cases, 352 cases (88.2%) were successful removed the bile duct residual stones through the choledochoscopic procedure, converted to intraoperative endoscopic sphincterotomy in 47 cases (11.8%). The false positive rate of MRCP and (or) MRI was 3.7% (13/352), the false negative rate of color Doppler ultrasound was 79.3% (279/352). Duodenoscopy treatment group: It was performed in 408 cases. The stones of common bile duct removed with duodenoscopic papillo-tomy in 381 cases (93.4%), the stone expulsion after duodenoscopic papillotomy in 18 cases (4.4%), 9 cases (2.2%) were shifted to other operation. False negative rate of color Doppler ultrasound was 79.5% (303/381). Three endoscopy group: There were 191 cases that intraoperative choledochoscopic exploration or intraoperative endoscopic papillotomy. The false positive rate of MRCP and (or) MRI was 2.6% (5/191), the false negative rate of color Doppler ultrasound was 76.4% (146/191). ConclusionsRoutine use of MRCP and MRI, in preoperative or intraoperative help diagnosis and treatment of gallbladder stone with common bile duct stones of diameter in the normal range, on combination of choledochoscopy and duodenoscopy during the course of therapeutic laparoscopy. It is necessary, feasible, effective and safe.
Objective To investigate the value of indocyanine green fluorescence imaging in common bile duct reexploration. Methods The clinical data of 32 patients who underwent open common bile duct reexploration in the Affiliated Hospital of Southwest Medical University from January 2018 to December 2020 were collected retrospectively. All patients divided into the control group (conventional exploration group, 20 patients) and the fluorescence imaging group (using indocyanine green fluorescence imaging, 12 patients) according to the operational manner. The intraoperative and postoperative results of two groups were analyzed. Results The operative time [(165.2±6.9) min vs. (130.8±5.5) min], the time to find extrahepatic bile duct [(43.9±3.8) min vs. (23.1±4.1) min] and the amount of bleeding [(207.7±7.7) mL vs. (127.5±15.3) mL] in the control group were longer or more than those in the fluorescence imaging group (P<0.05). The incidence of postoperative infection in the control group [7 cases (35.0%) vs. 0 cases (0.0%)] and the length of hospital stay [(10.8±2.8) d vs. (7.1±1.3) d] were higher or longer than those in the fluorescence imaging group (P<0.05). There were no significant difference between the two groups in the incidence of postoperative bile fistula [6 cases (30.0%) vs. 2 cases (16.7%)] and the incidence of residual stones [3 cases (15.0%) vs. 3 cases (25.0%), P＞0.05]. Conclusion Indocyanine green fluorescence imaging appears to be a feasible, expeditious, useful, and effective imaging method while performing reexploration.
Using radioimmunoassay (RIA) and immunohistochemical LASB technique, the level of serum estradiol (E2), testosterone (T), progesterone (P), estrogen receptors (ER) and progesterone receptors (PR) in 30 male patients with gallstones were detected. The results showed that the level of serum P, E2/T and PR was higher. This suggests that the metabolic disorder of gonadal hormones play an important role in gallstone formation.