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Objective To retrospectively study the clinical value and the advantages in " planned hepatectomy" for the "central type" intrahepatic and extrahepatic choledochal cysts.Methods The clinical data of 7 patients with the "central type" of intrahepatic and extrahepatic choledochal cysts which were treated with "planned hepatectomy" from January 2014 through April 2017 at the Department of Biliary Tract Surgery of the Eastern Hepatobiliary Surgery Hospital,Second Military Medical University were retrospectively analyzed.Results All the patients completed radical resection of the intrahepatic and extrahepatic choledochal cysts in accordance with the " planned hepatectomy".The operations included 6 patients who were treated with percutaneous transhepatic cholangial drainage (PTCD) and 5 patients with portal vein embolization (PVE) prior to the surgical excision.Combined right liver resection was performed in 6 patients,and combined left liver resection in one patient.All the 7 patients had a history of chronic cholangitis.Liver volume tests demonstrated that the hemiliver volume to be removed (the embolized hemiliver) significantly decreased after PVE,whereas the hemilivers to be persevered were remarkably enlarged.No complication associated with PTCD and PVE occurred.The mean postoperative hospitalization was 12 days.Liver function tests suggested all the patients recovered well.No postoperative complication of bleeding,infection or liver function failure was observed,except in one patient who experienced pleural and abdominal effusion.Conclusions Combined subtotal hepatectomy may increase the risk of complications associated with the "central type" intrahepatic and extrahepatic choledochal cysts.The surgical strategy in planned hepatectomy can be used effectively to treat the "central type" of intrahepatic and extrahepatic choledochal cysts,with improved surgical safety,decrease in incidences of postoperative liver function failure and residual choledochal cysts.
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Objective To discuss the clinical feasibility and safety of modified invaginated pencreaticojejunostomy approach (Jiang's anastomosis) which was developed by the team of biliary surgery department from Shanghai Eastern Hepatobiliary Surgery Hospital.Methods Clinical data of 289 patients receiving modified invaginated pencreaticojejunostomy approach in pancreaticoduodenectomy were retrospectively studied.Wilcoxon signed-rank test,Chi-square and logistic regression tests were comprehensively used to evaluate the postoperative complications and the association with POPF.Results One hundred and sixtythree of 289 patients (54.6％) experienced postoperative complications after pancreaticoduodenectomy procedure.There were 45 onsets of severe complications,accounted for 17.6％ (45/255).Perioperative mortality was 3.1％ (9/289).The most common complications included celiac effusion and infection (26.6％),delayed gastric emptying (17.6％),gastroenterological tract fistula (12.4％),gastroenterological tract hemorrhage (9.7％).Additionally,the incidence of POPF was 9.3％,which all conformed as biochemical fistula (6.9％) and grade-B fistula (2.4％).Conclusions As a risk factor,POPF may play crucial role in celiac hemorrhage and infection associated with pancreaticoduodenectomy.Modified invaginated pencreaticojejunostomy approach (Jiang's anastomosis) with easy manipulation,wide indication,safe and effective performance,could be recommended to reduce POPF incidence.
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Gallbladder carcinoma (GC) is the most common malignant tumor in bile duct system.Xanthogranulomatous cholecystitis (XGC) is a benign inflammatory gallbladder disease.It is often misdiagnosed between them.This paper,through reviewing the literature and summarizing our own clinical experience,will give a better understanding on the two diseases,which was summarized as follows:inflammation is important both in the pathogenesis of GC and XGC,and we can make the correct diagnosis and choose an appropriate treatment by analy zing the feature of disease history,image data and rapid intraoperative pathological diagnosis.Radical resection remains the first choice in the treatment of GC,but the extent of resection is controversial.Normally,cholecystectomy is sufficient for curing XGC,but different surgeries are needed according to the specific disease conditions.
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Objective To summarize the experiences of a single treatment group in surgical treatment of hilar cholangiocarcinoma during the past 10 years. Methods From January 2000 to December 2009, 1572 patients with hilar cholangiocarcinoma were admitted to the Eastern Hepatobiliary Surgery Hospital, and the clini-cal data of 462 patients in our treatment group were retrospectively analyzed. Among the patients, 314 received surgical treatment, and the remaining 148 received conservative interventions or refused any therapy. Factors that may have influenced the prognosis were analyzed by the Kaplan-Meier method, Log-rank test and Cox proportional hazards model. The correlation of different factors was analyzed by the chi-square test. Results A total of 314 patients underwent surgical treatment and tumor resection was performed in 237 patients, including 174 with R0 resection, 17 with R1 resection, and 46 with R2 resection. There were 91 patients with postoperative complications and 10 in-hospital deaths. A total of 260 patients had been followed up for 5-113 months, and the overall 1-, 3-, and 5-year survival rates were 71.7% , 32.6% and 10.9% , respectively; the 1-, 3-, and 5-year survival rates of patients with R0 resection were 76. 9% , 48. 6% and 32. 7% , respectively, with a median survival time of 35 months. R0 resection, TNM staging, regional lymph node involvement and tumor differentiation were the independent prognostic factors (RR = 2. 1, 1.9,2.2, 1.7, P<0.05). Conclusions Curative resection is the treatment of choice for hilar cholangiocarcinoma. Preoperative systematic evaluation and preparation can improve the radical resection rate and reduce postoperative morbidity.
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Objective To summarize experience of diagnosis and treatment of the mucin-producing bile duct tumors(MPBTs). Methods Clinicopathological features of 7 patients with MPBT undergoing surgery from Nov 2002 to May 2005,were retrospectively reviewed.The clinical radiography characteristics and the resection type were summarized respectively. Results Fluctuant iaundice was the most common manifestation of MPBTs,with different characteristics of magnetic resonance cholangiopancreatography when compared with gallbladder carcinoma,hilar cholangiocarcinoma and distal bile duct cancer.All the 7 patients with MPBT underwent successful surgical resection and were cured. Conclusion Appropriate diagnosis and treatment of MPBTs made it possible to achieve long-term survival of these patients.
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Objective To explore the clinical features, treatment and prognosis of intrabepatic biliary cystadenocarcinoma (IBC). Methods We retrospectively analyzed clinical data of 17 patients with pathologically confirmed IBC, treated between January 2002 and September 2007. Results Of the 17 patients, 4 were men and 13 were women, with a mean age of 49.3 years (range 45 -68). Serum level of AFP was normal in all patients. CA19-9 was abnormally elevated in only two patients and the other two had abnormal serum level of CEA. Seven cases underwent radical resection, 7 underwent complete tumor resection combined with removal of tumor thrombi in the bile duct, 3 received palliative surgery. On histopathological examination, 10 were biliary cystadenocarcinoma,2 were biliary cystadenoma with partial eanceration,2 were papillary cystadenocarcinoma,2 were mutinous papillary cystadenocarcinoma and 1 was of mixed cystadenocarcinoma and hepatocellular carcinoma. According to tumor differentiation, the number of well, moderate and poor-differentiated group was 7, 3 and 7 cases respectively. The medality of surgery (β= - 0.692, P = 0.01) and tumor differentiation (β = - 2.041, P = 0.007) effected the prognosis significantly. Conclusions IBC occurs mainly in elderly women. CA19-9 examination does not help in the establishment of diagnosis of IBC. The occurrence of tumor thrombosis in common bile duct doesn't necessarily indicate poor prognosis, hence a IBC patient will still have a satisfactory prognosis should the primary tumor be completely resected and tumor thrombi removed.
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The primary curative modality for hilar cholangiocarcinoma is surgery. Some reports suggest that radical resection may provide the best survival rate for patients with hilar cholangiocarcinoma. In resected patients, however, gross or microscopic residual disease is common. Local recurrence is the most common cause of failure and mortality. In the past 10 years, preoperative, intraoperative and postoperative radiotherapy has been used as an adjuvant treatment for these patients. Some studies have proved adjuvant radiotherapy on hilar cholangiocarcinoma may be of value.
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Objective The aim of this study was to analyze the causes of misdiagnosing xanthogranulomatous cholecystitis (XGC) as carcinoma of gallbladder.Methods Clinical data of 33 XGC patients admitted from 1996 to 2005 were retrospectively analyzed, among them 10 patients were misdiagnosed as carcinoma of the gallbladder preoperatively and intraoperatively. Results All these 10 patients underwent preoperative ultrasound and computed tomography (CT). Both ultrasound and CT were suggestive of carcinoma of the gallbladder in 5 cases, and chronic cholecystitis in one case. The ultrasound was suggestive of carcinoma while CT diagnosed as chronic cholecystitis in 2 cases. CT suggested a carcinoma while ultrasound was suggestive of cholecystitis in other 2 cases. Thickened gallbladder wall and dense carcinoma-like adhesions was unanimous phenomena. Cholecystectomy and partial hepatic wedge resection was performed in 3 cases; Six cases underwent cholecystectomy and partial hepatic wedge resection plus regional lymphadenectomy. One case received partial cholecystectomy, cholecystoenterostomy, and partial transverse colectomy. XGC was definitely diagnosed by postoperative pathological examination in all of patients. Conclusions XGC mimics the imaging features (CT, ultrasonography) and gross findings of gallbladder carcinoma making a misdiagnosis. Definite diagnosis of XGC is dependent on postoperative pathology.
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Objective To analyze factors influcing the surgical curative effect of hilar cholangiocarcinoma. Methods A retrospective clinical analysis was made on 198 patients with hilar cholangiocarcinoma, who were surgically treated in our hospital from 1997 to 2002. Jaundice (94.5%, 187 cases), pruritus (56.6%, 112 cases) and abdominal pain (33.8%, 67 cases) were the main symptoms. According to Bismuth-Corlette classification, there were 14 type Ⅰ cases, 19 type Ⅱ cases, 12 type Ⅲa caese, 15 type Ⅲb cases, 112 type Ⅳ cases and 26 unclassifiable cases. 144 patients received laparotomy, and tumor resection was performed in 120 cases, including radical resection in 59 caese (41.0%) and palliative resection in 61 cases. 54 cases were treated by endoscopic therapy or PTCD. 16 cases received postoperative adjuvant radiation. Results Occupation, preoperative maximum tatal serum bilirubin level, operative procedure and postoperative adjuvant radiation affected postoperative survival. The postoperative survival of ENBD group, ERBD or EMBE group, biliary exploration & drainage group, palliative resection group and radical resction group differed statistically as a whole (?2= 87.048?9, P
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Objective To investigate the inhibitory effects of IL-18 gene on HCC growth in vivo. MethodsThe recombinant adenovirus vector containing IL-18 gene was constructed and cotransfected into 293 cells together with EcoT22 I-digested Ad5 DNA-TPC, the recombinant adenoviruses were generated, and injected into a rat model bearing HCC. Results The recombinant adenovirus vector containing IL-18 gene inhibited the proliferation of HCC cell line CBRH 3. The rats receiving IL-18 gene injection within 3 days after inoculation of CBRH 3 all had long term survival, while those injected at day 5 or 7 survived a limited longer period than control groups (P
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To study parameters influencing the prognosis of patients suffering from gallbladder carcinoma.MethodsA retrospective clinical analysis was made on 56 cases of gallbladder carcinoma, admitted to our hospital between 1995～2001.ResultsThere were 20 males and 36 femals. Thirty four patients(61%) complicated with gallstons.Abdominal pain(47/56,84%) and jaundice(23/56,41%) were the major complaints.Ultrasonography,CT scan and CA 19 9 measurement were helpful for preoperative diagnosis. Thirty cases(including 5 Nevin stage Ⅱ cases,3 stage Ⅲ cases,4 stage Ⅳ cases,and 18 stage Ⅴ cases) received radical or extended radical chelecystectomy, 11 cases with Nevin stage Ⅴ underwent palliative resection and 15 cases of Nevin stage Ⅴ were subjected to bypass procedure and/ or biopsy.The statistical analysis showed staging of Nevin,surgical procedure,gallstone,adjuvant radiotherapy and chemotherapy significantly affected the survival.Conclusions Early diagnosis, radical resection, active and comprehensive adjuvant radiotherapy with/or chemotherapy help to improve the prognosis of gallbladder carcinoma.
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Objective To investigate the risk factors of early postoperative complications in patients undergoing pancreaticoduodenectomy. MethodsClinical data of 200 patients undergoing pancreaticoduodenectomy in our hospital from December 1999 to September 2002 were collected and analyzed retrospectively. Nine clinical factors were recruited for the study in relation to surgical complications. ResultsThe overall early postoperative complication rate was 21% (42/200). Logistic regression analysis revealed that no T tube drainage(OR=10.015), preoperative total serum bilirubin level over 171.1?mol/L(OR=7.756), preoperative diabetes (OR=4.086), end-to-end pancreaticojejunostomy (OR=2.616), intraoperative blood transfusion over 1000 ml (OR=2.410), over 65 years old (OR=2.162) were important factors for early complications. ConclusionsT tube drainage, end-to-side mucosa-to-mucosa pancreaticojejunostomy and good surgical expertise can decrease early morbidity rate.
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Objective To study the effect of PEI on disseminating HCC cells in the peripheral blood in patients with recurrent HCC. MethodsWe examined blood samples from 29 recurrent HCC patients by nested RT-PCR for the determination of AFP?mRNA before and 1, 2, 3 and 4 weeks after PEI.ResultsBefore PEI 14 (48%) patients out of the 29 cases with recurrent HCC were positive with AFP?mRNA. Four weeks after a course of PEI only 2 cases (7%) remained AFP?mRNA positive.ConclutionsPEI effectively eradicating disseminating HCC cells in the peripheral blood shows a favourable potential for the treatment of recurrent HCC.
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Objective To investigate the etiology of iatrogenic bile duct injury and experience in its diagnosis and treatment. Methods A retrospective study was conducted on the clinical data of 86 patients with iatrogenic trauma in the bile duct. Results These 86 cases have received a total of 156 sessions of surgical procedures, including 2 explorations in 66 cases,3 explorations in 6 cases. Lateral bile duct injury in 22 cases was treated by suture repair and T tube stent. Eight cases suffering from iatrogenic transection of the common bile duct were retrieved by cholangiojejunostomy and T tube stent. Nine cases with inadvertent CBD ligature were managed by a lysis and T tube stent. Roux en Y cholangiojejunostomy was adopted in 77 cases. Sixty cases were followed up for 1～10 years, with good result in 90% of the cases. Conclusions Most CBD iatrogenic injury cases were encountered as a result of cholecystectomy.Roux en Y cholangiojejunostomy is the choice of therapy.
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Objective To investigate the relationship between liver metastasis and prognosis in postoperative distal bile duct cancer patients Methods In this study 128 cases of distal bile duct cancer undergoing surgical procedures were analyzed retrospectively Using Kaplan meier method to calculate their survival rates, ? 2 test to analyze the difference of sample rates Logistic regression analysis was performed to determine the factors influencing liver metastasis and log rank univariate analysis was used to assess the role of liver metastasis in the long survival Results Liver metastasis is a major cause of postoperative death Pathological types of the carcinoma and pancreatic invasion are significant predictors of liver metastasis Conclusion Aggressive treatment of postoperative liver metastasis is an important strategy to improve the long survival of postoperative bile duct cancer patients
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Objectives To evaluate the methodology of preoperative diagnosis for Mirizzi syndrome. Methods Fifteen cases of Mirizzi syndrome were retrospectively investigated. The data of semeiology and imaging including B-type ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) and MR cholangiopancreatography (MRCP) were compared with each other and analyzed. Results Preoperative data were consistent with and suggestive of Mirizzi syndrome in 93% (14/15) of cases, and in 67% (10/15) of cases, respectively. Conclusions Preoperative B-type ultrasound is the primary examination. ERCP and MRCP further elevate preoperative definite diagnosis. In patients with preoperative tentative diagnosis of Mirizzi syndrome, jaundice lasting for more than 7 week is suggestive of cholecystocholedochal fistula.
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Objective To study the protection against hepatic ischemia-reperfusion injury by human IL-10 gene transduction in rats. Methods Ad-hIL10-EGFP (1. 0 ? 109 plaque forming units/ml) was administered into SD rats by intravenous injection 72 hours before hepatic ischemia-reperfusion injury was induced. Liver function were tested and HE pathology was observed. The expression of hIL-10 was studied with ELISA or immunohistochemical method, the expression of EGFP was observed in frozen sections under the fluoroscopy. The apoptosis of hepatocytes was observed with Tunel's assay. Results Compared with control rats, the expression of EGFP and hIL-10 was observed, serum hIL-10 level was (815.74 ? 284. 76) ng/ml, liver function of treatment rats were improved, the paraffin sections showed that the hepatocytes were not significantly swelling and liver pathology ameliorated, the number of apoptosis cells decreased (P
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AFP from fetal serum and serum of patients with primary hepatic cancer were purified by affinity chromatography. Then, the lentil lectin-reactive and nonreactive variants of these purified glycoproteins were prepared by affinity chromatography with immobilized lectin. Glycopeptides and oligosaccharides were prepared from variants by protease treatment and hydrazinolysis, respectively, and subjected to carbohydrate and amino acid analysis. A small difference in the carbohydrate compositions of each variant was observed. Analysis of chemical compositions of AFP variants is useful for the differential diagnosis between benign liver diseases and primary hepatic cancer.
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In this paper, we report the study concerning the preparation and application of anti-human heterogeneous AFP-R-LCA monoclonal antibodies (VG5 VD12 VB5 VA8 VD12). These McAbs had higher affinity and specificity to AFP-R-LCA than the routinely used anti-AFP polyclonal antibody. Competitive assays indicated that they could bind to new antigenic determinants which are different from the previously reported a and b sites. In an assay of the McAbs, we first set up a two site sandwich ELISA method and then tested, using this method, serum samples from 69 patients with PHC, 67 patients with benign liver diseases, 30 pregnant women and 30 normal controls. The results showed that this two site sandwich ELISA method had low pseudo-positive rate. The detection range was 5 1000 ng/ml, with the properties of simplicity, accuracy and reproducibility. It could be used not only for the early diagnosis of PHC in patients with AFP levels less than 400 ng/ml, but also for the differential diagnosis of PHC from benign liver diseases.