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Objective:To investigate the application value of P-loop digestive tract recons-truction in pancreaticoduodenectomy (PD).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 21 ampullary disease patients undergoing PD in the Liuzhou People′s Hospital Affiliated to Guangxi Medical University from April to December 2020 were collected. There were 13 males and 8 females, aged from 35 to 76 years, with a median age of 60 years. All the 21 patients underwent PD and digestive tract reconstruction using P-loop method based on the Child reconstruction. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination or telephone interview to detect survival and discomfort symptoms of patients up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or persentages. Results:(1) Surgical situations: all the 21 patients underwent PD successfully. The operation time, time of P-loop anastomosis and volume of intraoperative blood loss of 21 patients were (317±74)minutes, (14±3)minutes and 375 mL(range, 100-800 mL), respectively. Of the 21 patients, 17 cases had pancreatic texture as soft, 4 cases had pancreatic texture as hard, 3 cases had diameter of pancreas ≤3 mm, 18 cases had diameter of pancreas >3 mm, 14 cases were placed pancreatic duct stent, 7 cases were not placed pancreatic duct stent. (2) Postoperative situations: 2 of the 21 patients had grade A pancreatic fistula, and none of patient had grade B or grade C pancreatic fistula. One case had hepaticojejunal anastomotic fistula, 2 cases without pancreatic fistula had delayed gastric emptying and none of patient had abdominal infection or bleeding. The duration of postoperative hospital stay of 21 patients was (16±5)days, and none of patient died during postoperative 30 days. Results of postoperative histopathological examination showed there were 10 cases with duodenal papillary carcinoma, 4 cases with lower bile duct carcinoma, 3 cases with pancreatic head ductal adenocarcinoma, 1 case with duodenum stromal tumors, 1 case with gastric antrum carcinoma, 1 case with mass in the head of the pancreas of IgG4 and 1 case with choledochal cyst of type 3. (3) Follow-up: all 21 patients were followed up for 1.0 to 7.0 months, with a median follow-up time of 4.3 months. None of patient died. There was no abdominal pain, distension or dyspepsia during follow-up. One case was diagnosed as tumor liver metastasis at postoperative 5 months.Conclusion:P-loop digestive tract reconstruction in PD is safe and effective, with good short-term effect.
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Objective To investigate the suppression of mrp1 and MRP1 induced by small interfering RNA and the restoration of sensitivity to chemotherapeutic drugs in the multidrug-resistant hepatocellular carcinoma cell lines HepG2/mrp1. Methods mrp1-targeted small interfering RNA duplexes were designed and composed and introduced into multidrug-resistant hepatocellular carcinoma cell lines HepG2/mrp1. The suppression of mrp1 mRNA and its gene product MRP1 was examined by RT-PCR and flow cytometry (FCM), respectively. MTT assay was performed to measure the reverse effect of small interfering RNA based on the results of ICs0. Results The overexpression of mrp1 mRNA and MRP1 was effectively suppressed by small interfering RNAs. The level of mrp1 mRNA in the transfected HepG2/mrp1 cells was reduced to (86.36±2.76)% and MRP1 to (89.38±3.76)%compared with those of the controls. The resistance to ADR was reversed five-fold, which indicated the restoration of sensitivity to drugs. Conclusion Small interfering RNA can inhibit mrp1 expression effectively and reverse the multidrug resistance mediated by MRP1.
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Objective To construct the expressing vector of shRNA/mrp1 and study its expression in vitro. Methods 64bp oligonucleotides of pSUPER and the targeted senquence of siRNA/mrp1 were synthesized and annealed to form duplex strand, then were cloned into pSUPER to construct pSUPER-shRNA/mrp1 vector. Competenced Ecoli was transfected by vector of pSUPER-shRNA/ mrp1 to screen the positive clones for sequencing and extracting plasmid. The plasmids extracted were used to transfected HepG2/mrp1 cells with a control groups by negative vectors. The expression of mrp1 mRNA and MRP1 was measured by real-time PCR and resistance of HepG2/mrp1 by flowcytometry. Results pSUPER-shRNA/mrp1 was established successfully and was sequenced to test its accuracy. Expression of mrp1 mRNA in HepG2/mrp1-si was lower than that in HepG2/mrp1 (1-fold vs 179.76-fold, P<0.001). Compared to HepG2/mrp1, the expression of MRP1 in HepG2/mrp1-si was lower (11.2% vs 97.6%, P<0. 05). The sensitivity of HepG2/mrp1-si to adiramycin was higher than that of HepG2/mrp1(45.0-fold vs 1.2-fold, P<0.01). Meanwhile, the accumulation of DNR in HepG2/mrp1-si increased significantly as compared with the control (78.58 % vs 38.44%,P<0.05).Conclusion Vector of pSUPER-shRNA/mrp1 can be constructed by the technique of enzymatic incision. The multidrug resistance of HepG2/mrp1 can be reversed by RNA interference.
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Objective To explore the therapeutic effect of liver transplantation on hepatic alveolar echinococcosis (HAE) in late stage.Methods Five HAE cases in late stage failed to be treated by hepatic lobectomy underwent liver transplantation, in which 4 cases were performed under veno-venous bypass and 1 without bypass. Three cases were subjected to veno-venous bypass prior to mobilization of the liver. The end-to-end anastomosis was made between the hepatic artery and hepatic artery, and between the bile duct and bile duct. Two cases received placement of T tube in the bile duct. The mean duration of surgery was 8.3 h. Results One patient was reoperated because of the T tube falling off on the postoperative day 10, and one because of the bile leakage. Four patients recovered completely in the postoperative period, one died of multiple organ failure (MOF) and septi-caemia caused by pneumonia, acute rejection and embolism of the liver artery. Four patients were followed up for 21 months to 37 months, showing a good quality of their life. Conclusion Liver transplantation can be applied in treatment of hepatic alveolar echinococcosis in end stage, and can ensure a better clinical result.
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Objective To investigate the prevention and treatment strategy of bile duct injury (BDI) in laparoscopic cholecystectomy (LC). Methods Latest progress was reviewed based on recent documents and the experience on BDI in LC in our department. Results With the popularity of LC, BDI in LC is increasing. The reasons include illegibility and variability of local anatomy in gallbladder trigone,injury caused by galvanothermy, as well as operator’s over confidence. In order to prevent BDI, we should apply more blunt dissection, not to use electrocogulation if possible and to study local anatomy and its variance clearly. The common bile duct and common hepatic duct should be clearly identified. Intraoperative cholangiography, laparoscopic ultrasonography and hepatobiliary scintigraphy are selections as necessary.The treatment of BDI depends on the type of BDI and its site and local condition.The treatment includes end to end anastomosis, repairing the defect, choledochoduodenostomy, Roux en Y choledochojejunostomy and so on. T tube should be maintained in place for more than half a year after operation.Conclusion The key to improve the prognosis of BDI is prevention and treatment in proper time and in correct way.
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Objective To study the regulatory ability of peroxisome proliferator-activated receptor ?(PPAR?) ligands to the inflammatory response in human gallbladder epithelial cells. Methods Culture human gallbladder epithelial cells and identify them . Cells were treated for 24 hours with 0, 10 ?mol/L, 20 ?mol/L, 30 ?mol/L, 50 ?mol/L and 100 ?mol/L of Ciglitazone during cellular growth peak(5th day), then stimulated them with hIL-1? 5 ng/ml for 2 hours and measured the concentration of IL-6、IL-8 and TNF-? in cellular supernatants by riadioimmunoassay. Results Contrasted with control group, the expression of IL-6 and IL-8 in each test group were inhibited ((P