ObjectiveTo analyze effect of percutaneous transhepatic choledochus drainage (PTCD) for hilar cholangiocarcinoma. MethodsClinical data of 67 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2005 to Dec. 2010 were retrospectively analyzed. ResultsOf the 67 cases, 30 cases were performed PTCD, 20 cases were performed radical surgery after PTCD, and 17 cases were performed palliative surgery after PTCD. There were 59 cases who were followed-up for 3-30 months, and the median time was 9.3 months. The median survival time of patients who underwent PTCD, radical surgery, and palliative surgery were 10.2, 21.4, and 8.9 months respectively. The survival of patients who underwent radical surgery was better than those of underwent PTCD (χ2=13.6, P=0.000 4) and palliative surgery (χ2=15.2, P=0.003 8), and survival of patients who underwent PTCD was better than patients underwent palliative surgery (χ2=5.3, P=0.040 1). ConclusionsPTCD is contribute to preoperative diagnosis and evaluation, in addition, it can reduce unnecessary surgical exploration, guarantee the safety of the radical surgery, and provide follow-up care for palliative operation channel which is favorable for local internal radiation therapy.
【Abstract】ObjectiveTo report the diagnosis and treatment of hilar cholangiocarcinoma.MethodsThe relevant information about the hispathological feature, transfer ways, clinical manifestation, laboratory examination, imaging feature, immunohistochemical examination and treatment ways were gathered from previous original articles, and checking the latest issues of appropriate journals.ResultsThe clinical manifestation, laboratory examination, and imaging feature of hilar cholangiocarcinoma were due to the neoplasm obstructing bile duct and sequent infection of bile duct. The diagnosis was depanded on the combining clinical manifestation, laboratory examination and imaging feature. The value of immunohistochemical examination was not clear. Radical surgery was the best treatment of unique curing the neoplasm. By-pass surgery was used in the late phase patients to solve the obstruction of bile and digest duct. The effect of unique chemical treatment was not perfect. It did’t generally propose the treatment of orthotopic liver transplantation.ConclusionThe perfect prognosis of hilar cholangiocarcinoma is depended on early diagnosis and redical surgery.
Objective To establish perineural invasion xenograft model of hilar cholangiocarcinoma. Methods The cultured cells of cholangiocarcinoma cell line QBC939 were inoculated subcutaneously in the nude mice so as toestablish primary subcutaneous model of cholangiocarcinoma. The primary tumor tissues were inoculated intraperitoneallyaround the liver in the nude mice so as to establish the second generation intraperitoneal xenograft model. The successful xenografted tumor tissues were obtained for anatomical and pathological examinations. Results The tumor formation rate of primary subcutaneous xenograft of hilar cholangiocarcinoma was 100% （5/5）， and no nerve infiltration was observed. The tumor formation rate of the second generation intraperitoneal xenograft was 45% （9/20）， and two mice （2/9， 22%） manifested nerve infiltration. The rate of nerve infiltration was 10% （2/20）， and the tumor cells had different size and diversity， irregular shape， low differentiation， decreased cytoplasm and nucleus karyomegaly， visible atypical and fission phase， and no obvious gland tube structure by pathological examination. Conclusions Hilar cholangiocarcinoma cell has the particular features of perineural invasion， it is a good experiment platform for researching the mode and biological characteristics of perineural invasion of hilar cholangiocarcinoma by applicated QBC939 cell lines to establish the perineural invasion xenograft model of cholangiocarcinoma.
Objective To research the effect of γ-ray released from 103Pd radioactive stent on the expression of Fas gene and its relation with apoptosis of cholangiocarcinoma cell and the significances through the establishment of human cholangiocarcinoma model. Methods The model of nude mouse with implanted human cholangiocarcinoma was established. The mice were divided into study group and control group, 37 MBq 103Pd biliary stent was implanted in the study group and the ordinary metal biliary stent was implanted in the control group. The volume of tumor was measured, the cell apoptosis was detected by the TUNEL method and the expression of Fas gene of the cell apoptosis of the induced human cholangiocarcinoma was checked out by immunohistochemistry staining 10 d after the implantation. Results Compared with the control group, the growing speed of the volume of tumor in study group was significantly reduced (Plt;0.05), the expression positive rate of Fas gene was significantly higher (Plt;0.05), and the apoptotic rate of cancer cells was also higher (Plt;0.01). Conclusions The 103Pd radioactive stent can induce the cell apoptosis in nude mouse model with implanted human cholangiocarcinoma inhibit the cell growth of bile duct cancer and may promote the apoptosis of cancer cells by increasing the expression of Fas gene. It may be helpful for the further study of treatment for bile duct cancer using 103Pd radioactive stent.
ObjectiveTo explore the technique of hepatic artery reconstruction in complicated hilar cholangiocarcinoma surgery. MethodThe clinicopathologic data of 3 patients with complicated hilar cholangiocarcinoma with arterial invasion underwent hepatic artery reconstruction in the Department of Hepatopancreatobiliary Center of Beijing Tsinghua Changgung Hospital from March to July 2022 were retrospectively analyzed. ResultsAll 3 patients (case 1–3) were the males, aged 53, 68, and 56 years, respectively, and with hypertension or diabetes; the longitudinal diameters of the tumor were 3.5 cm, 3.0 cm, and 3.2 cm, respectively. All patients had the right hepatic artery invasion. Case 2 and 3 had the arterial stratification. The arterial defects after radical resection were 4.5 cm, 3 cm, and 3 cm, respectively. The right or right posterior hepatic artery was reconstructed by the autotransplantation of right gastroomental artery, the left hepatic artery, and the anterior superior pancreaticoduodenal artery, respectively. After operation, the reconstructed hepatic arteries were unobstructed and free of stenosis, and there were no complications such as bleeding, infection, and thrombosis by Doppler ultrasound and CT angiography. The results of postoperative pathological diagnosis were the hilar cholangiocarcinoma with arterial invasion, and all the incisal edges were negative. ConclusionFrom the preliminary results of 3 cases, it is safe, feasible, and effective to select proper autologous artery (matched in length and caliber) for reconstruction the defective invaded hepatic artery which resected together with hilar cholangiocarcinoma, but the technical difficulty is still relatively high.
ObjectiveTo investigate the expression of proapoptosis gene bad in intrahepatic cholangiocarcinoma (ICC) and its relationship to differentiation of the tumor.MethodsThe immunohistochemistry technique by Dako Envision system and rabbit antihuman bad polyclonal antibodies were adopted. The expression of bad was detected in 48 cases of ICC and 25 cases of control tissues.ResultsBad immunoreactivity in 48 cases of ICC was higher than that of bile duct epithelium in 25 cases of control tissues. And contrasted with 21 cases of well differentiated ICC, bad immunoreactivity was higher in 27 cases of middle and poor differentiated ICC.ConclusionThe expression of bad gene may be related to the differentiation of ICC.
ObjectiveTo summarize the surgical treatment and explore factors which influencing prognosis of hilar cholangiocarcinoma. MethodsClinical data of 189 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2000 to Dec. 2010 and clinicopathological factors that might influence survival were analyzed retrospectively. A multivariate factor analysis was performed through Cox proportional hazard model. ResultsOf 189 cases, 62 cases received radical resection, 54 cases received palliative surgery, and 73 cases received non-resection surgery. Operative procedure (RR=0.165), differentiated degree (RR=2.692), lymph node metastasis (RR=3.014), neural infiltration (RR=2.857), and vascular infiltration (RR=2.365) were found to be the statistically significant factors that influenced survival by multivariate factor analysis through the Cox proportional hazard model. ConclusionsRadical resection is the best treatment for hilar cholangiocarcinoma. Skeletonized hepatoduodenal ligament, complete excision of infiltrated nerve and blood vessel are important influence factors to improve the prognosis of hilar cholangiocarcinoma.
ObjectiveTo summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma who unerwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy, meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad.MethodsTo retrospectively summarized and analyzed the clinical data of one case of Bismuth type Ⅲa hilar cholangiocarcinoma. The preoperative total bilirubin of this patient was 346.8 μmol/L, and this patient underwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy after reducing jaundice by percutaneous transhepatic biliary drainage (PTBD). Then we retrieved domestic and foreign related literatures.ResultsOperative time of this patient was about 290 min and intraoperative bleeding was about 350 mL. No intraoperative blood transfusion occurred. The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis (0/14). The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication. The patient had been followed-up in the outpatient department for 3 years,and was generally in good condition. The evidence of recurrence or metastasis wasn’t found.ConclusionsPre-operative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications, extend liver resection for the patient with Bismuth type Ⅲa hilar cholangiocarcinoma, which can improve R0 resection rate and extend postoperative survival.
ObjectiveTo summarize the research progress of the relationship between biliary flora and cholangiocarcinoma.MethodThe literatures on the relationship between biliary flora and cholangiocarcinoma were collected and reviewed.ResultsBiliary flora was closely related to the occurrence and development of biliary tract diseases. The inflammatory environment of the biliary tract was an important factor in the occurrence and development of cholangiocarcinoma. Microbes might induce chronic inflammation of the host tissue, leading to cell proliferation and genetic mutation, and ultimately leading to the occurrence of cholangiocarcinoma. Bacterial infection might play an important role in the pathogenesis of cholangiocarcinoma.ConclusionThe study of the role of biliary flora in the development of cholangiocarcinoma may open up a new direction for the prevention and treatment of cholangiocarcinoma.
Objective To investigate the regulatory effect of somatostatin analogue (SMS201995,SMS) on proliferation and apoptosis in human cholangiocarcinoma cell line in vitro. MethodsProliferation curve, flow cytometry, agarose gel electrophoresis, Annexin VFITC and flow cytometric immunofluorescent technique were performed to identify the inhibitory effect on cell proliferation and the induction of apoptosis of human cholangiocarcinoma cells (SKChA1). ResultsSMS significantly reduced the SKChA1 cell growth by serum in long experiments and transiently accumulated it in G0/G1 phase. Dotplot analysis of cells duallabeled with Annexin VFITC and PI confirmed the induction of apoptosis by SMS in SKChA1 cells.AnnexinVFITC labeling was markedly enhanced following treatment with SMS for 24 h. DNA of treated SKChA1 cells appeared a ladder pattern characteristic of apoptosis. Besides, timedependent increase in bax and decrease in bcl2 occured during SMS treatment. Conclusion SMS could inhibit the proliferation activity and induce apoptosis of cholangiocarcinoma cell line SKChA1. The mechanisms of apoptosis might be correlated with the expression of apoptosisregulatory gene bax and bcl2.