Primary hepatolithiasis complicating cholangiocarcinoma / 中华普通外科杂志

Objective To summarize the clinical features,diagnosis,treatment and prognosis of hepatolithiasis complicating cholangiocarcinoma. Methods From June 1958 to March 2011,709 cases of hepatolithiasis were admitted to Department of General Surgery,Peking University Third Hospital.The cases concomitant with cholangiocarcinoma were reviewed. Results 20 of 709 (2.8％ ) hepatolithiasis cases developed cholangiocarcinoma.17 cases (85％,17/20) were followed-up for 2 years (0 - 15 years).The hepatolithiasis course before the malignant diagnosis was 15 ± 1 1 years (3 -38 years).14 cases had frequent episodes of cholangitis,15 cases had liver cirrhosis.Preoperative diagnosis was established by CT,MRCP,B-ultrasound and tumor markers in 55％ (11/20) cases.4 cases underwent radical resection,7 received palliative resection,9 cases received conservative treatment.In radical resection,one lost to follow-up,one survived one year,two for 5 years.In palliative resection,2 lost to follow-up,two survived one year,one survived 3 years, one for 5 years. None in conservative group survived more than one year.Conclusions Cholangiocarcinoma developed from hepatolithiasis with a long history,frequent cholangitis,liver cirrhosis,especially in cases with imige showing thickness of bile duct or mass and rising tumor markers (CA19-9,CA125,CEA).The cases undergoing radical resection may have a favorable prognosis.

Adenosquamous and squamous cell carcinoma of the gallbladder / 中华普通外科杂志

Objective To explorethe clinical features of adenosquamous carcinoma,squamous cell carcinoma and adenocarcinoma of the gallbladder. Methods A retrospective analysis of 112 patients with gallbladder carcinoma was performed.The clinical features and outcomes of 11 patients with either adenosquamous or squamous cell carcinoma were compared with the other 101 patients of adenocarcinoma.Results The rate of tumor with T3 or T4 stage in adenosquamous/squamous cell carcinoma group and adenocarcinoma groupwere 100%and 53%(X2=7.013,P=0.008).The rate of distant metastasis in adenosquamous/squamous cell carcinoma group and edenocarcinoma at advanced stage(T3 or T4 stage)group were 0 and 35%(X2=3.900,P=0.048).The rate of lymph node invasion were 82% and 87%(X2=0.000,P=1.000).The rate of gastrointestinal tract invasion in adenosquamous/squamous cell carcinoma group and adenocarcinoma at advanced stage(T3 or T4 stage)group were 45% and 15%(X2=3.618,P=0.054).The median survival time for the two groups were 5 months and 4 months respectively(X2=0.359,P=0.549).Condusiom Adenosquamous/squamous cell carcinoma of the gallbladder had high local invasion capacity and usually were diagnosed at an advanced stage.The distant metastasis rate of adenosquamous/squamous cell carcinoma of the gallbladder was lower compared with adenocarcinoma.The lymph node invasion mte of adenosquamous/squamoua cell carcinoma was similar to adenocarcinoma.

Treatment of the cases with the papilla of Vater located in the diverticula by opening of diverticula adding Oddis sphincteroplasty / 中国实用外科杂志

Objective To introduce a surgical technique for the cases with the papilla of Vater located in the diverticula. Methods When diverticula was opened, there was a cuff shape edge left in the bottom, which reduced tensility of oversew, and the probability of postoperative leakage was reduced. Fistula Oddi sphincteroplasty was adopted oversewwing when it was splitted,and the length of each time was not more than 3mm,and the total length was not more than 2cm. ResultsNone of 11 cases died in postoperation, 3 of them occured biliary fistula,duodenal fistula,and pancreatic fistula, the rate of fistula was 27.27%. They were all followed-up, and the result was satisfactory.ConclusionAlthough the operation technique is ifficult,and there are many complications,it is a good technique.

Early profile and clinical significance of serum delta bilirubin after orthotopic liver transplantation / 中国微创外科杂志

Objective To investigate the early variations and clinical value of serum delta bilirubin after orthotopic liver transplantation. Methods Orthotopic liver transplantation was performed in 27 cases.Of them,10 cases were uneventful;8 patients suffered from acute rejection.According to the outcome,18 patients (including 10 uneventful cases and 8 cases with acute rejection) survived while other 9 died.Daily determination of serum delta bilirubin was examined in all patients. Results The changing patterns of serum delta bilirubin were different between uneventful patients and those with acute rejection.For those uneventful patients,?B% tended to increase after operation.On the 21st day after transplantation,it reached(37.5?11.2)%.To the contrary,after acute rejection occurred,?B% decreased from basal level(26.4?9.8)% to(20.2?12.7)%(n=8,t=2.12,P=0.07).Serum concentration of total bilirubin (TB) and conjugated bilirubin (CB) significantly increased after acute rejection arose.The difference between peak and basal level of TB and CB was (150.3?113.2)?mol/L(n=8)and(118.5?93.4)?mol/L(n=8)respectively(t=3.75,P=0.007;t=3.59,P=0.009).On the 14th day after operation,?B% in patients with good outcome(n=18) significantly higher than that in patients who died(n=9)(33.4%?12.2% vs 22.0%?10.0%,t=2.42,P=0.02).Conclusions Two weeks after operations,?B% is correlative to the outcome of the patients.But as for the diagnosis of the acute rejection,?B% shows no advantages over serum TB or CB.

Treatment of hepatolithiasis by combination of stricture repairment and partial hepatectomy preserving a subcutaneous blind bowel loop / 中国普通外科杂志

Objective To enhance therapeutic effects of hepatolithiasis by improving surgical procedures. Methods Forty eight patients suffering from hepatolithiasis with bile duct stricture were treated in this study, in whom 27% (13/48) of the stone was located in the left lobe, 19% (9/48) in the right, and 54% (26/48) in bilateral lobe. Stone coexisted with stricture in 71% (34/48). Hepatic duct and stricture were opened, making a basin at the porta, and repaired by one end of a segment of jejunum. The other end was set subcutaneously. At the same time, a portion of the liver habouring stone was resected. Results Forty four out of 48 patients were followed up (92%) with an average of 5 years. The rate of recurrent stone was 20% (9/44), the rate of cholangitis was 16% (7/44), and 84% of cases fared very well. Postoperatively, 7 cases underwent lithotomy by choledochoscope through the subcutaneous blind loop. Conclusion This procedure decreases the relapsing cholangitis effectively.

The prognostic significance of different surgical procedures on stage T2 gallbladder carcinoma / 中国普通外科杂志

Objective To explore the relationship between surgical procedure and prognosis of gallbladder carcinama invading the whole layer without extension beyond serosa. Methods A retrospective analysis on 24 patients with pathologic stage T2 gallbladder carcinoma invading the whole layer without extension beyond serosa was performed. Kaplan-Meier method was used to analyze the survival rate and disease-free survival rate between the patients undergoing radical resection ( n = 14) and the patients undergoing simple cholecystectomy (re = 10). Results The 1,3 and 5-year survival rates for patients undergoing radical resection were 100%、71% and 54% respectively, whereas the rates that for patients undergoing simple cholecystectomy were 70%、30% and 20% respectively. There was significant difference between the survival time of these two groups ( X2 =4. 659, P = 0. 031). The median clinical tumor-free survival time in radical resection group and simple cholecystectomy group were 45 months and 13.5 months respectively. There was significant difference between the clinical tumor-free survival time of these two groups ( X2 = 3. 854, P = 0. 049 ). Conclusions A radical resection is indicated for patients with pathologic stage T2 gallbladder carcinoma. Radical resection is an effective method to improve the survival rate for pathologic stage T2 gallbladder carcinoma.