ABSTRACT
Objective To evaluate the clinical efficacy of laparoscopic hepatectomy and open hepatectomy for the treatment of hepatocellular carcinoma.Methods Two hundred and sixteen patients with hepatocellular carcinoma who were admitted to the Chongqing Three Gorges Central Hospital from October 2014 to December 2017 were enrolled in this study,52 patients undergoing laparoscopic hepatectomy (laparoscopic group) and 164 patients undergoing open hepatectomy,52 patients (open group) were matched by propensity score matching method to reduce confounding bias.The operation time,tumor sizes,resection margin,time of hepatic inflow occlusion,volume of blood loss,blood transfusion,postoperative complication rate,drainage tube removal time,postoperative anal exhaust time,duration of postoperative hospital stay and survival rates were compared.T test was used for the measurement data in line with the normal distribution,and the results were represented by (Mean ± SD) tandard deviation;Wilcoxon test was used for the measurement data in the skewed distribution,and M(range) was used for represention,and the chi-square test or Fisher's exact probability test was used for the counting data.Kaplan-meier method was used to describe the survival curve,and log-rank test was used to compare the survival rate.Cox regression model was used to evaluate the risk factors affecting the survival of patients with hepatocellular carcinoma.Results All patients were recovered with no perioperative death.The operation time,tumor sizes,resection margin,time of hepatic inflow occlusion were (226.1 ±67.5) min,(49.2 ± 15.5) mm,(14.3 ± 4.9) mm,(34.1±18.1) min and (227.0 ±55.7) min,(49.4 ±16.6) mm,(14.6 ±4.0) mm,(38.2 ± 16.1) min,with no significant differences between the two groups(P ＞ 0.05).The volume of blood loss,blood transfusion,postoperative complication rate,drainage tube removal time,postoperative anal exhaust time,duration of postoperative hospital stay were 325(50-1 200) ml,11.5％,15.4％,(4.8 ±0.9) d,3(2-5) d,(11.9± 3.5) d and 375(100-2 000) ml,19.2％,23.1％,(5.9 ±0.8) d,4(3-5) d,(14.9 ±6.2) d,with significant differences between the 2 groups(P ＜0.05).1-and 3-year overall survival rates were 93.4％,83.7％ and 1-and 3-year disease-free survival rates were 87.7％,71.2％ in laparoscopic group;1-and 3-year overall survival rates were 94.1％,82.5％ and 1-and 3-year disease-free survival rates were 88.3％,70.8％ in open group,with no significant differences between the 2 groups(P ＞0.05).Cox regression analysis revealed that ICG R15,tumor size and tumor differentiation were independent risk factors of survival (hazard ratio ＞ 1,P ＜ 0.005).Conclusions Application of Laparoscopic hepatectomy for the treatment of selective hepatocellular carcinoma patients has better short-term efficacy than open hepatectomy and long-term efficacy is comparably.The propensity score matching can reduce confounding bias and have value for clinical research.
ABSTRACT
Objective To isolate and culture rats liver KCS ,and to explore the effect of IRE1-XBP1 pathway on regulation of polarization in activated Kupffer cells (KCs) .Methods (1)Rat KCs were isolated by Ⅳ type collagenase digestion and gradient cen-trifugation methods .(2)KCs were transfected and randomly divided into four groups :XBP1-shRNA group ,Ctrl-shRNA group , AdV-XBP1 group and Ctrl-AdV group .(3)The transfection level of KCs XBP1 ,IL-6 ,IFN-γ ,TNF-α and IL-17 were detected by RT-PCR ;the protein expression level of JAK1 ,JAK2 ,STAT1 and STAT3 were evaluated by Western blot .(4)The changes of KCs expression type in each group were detected by flow cytometry (FCM ) and the laser confocal .(5)T cells derived from rat spleen cells were co-cultured within the 4 groups of KCs mentioned above ;T cells proliferation was measured by Brdu labeling assay .(6)T cells apoptosis was determined by Annexin V /PI FCM analysis .(7)The density of IL-6 ,IFN-γ ,TNF-α ,IL-17 and IL-10 in the su-pernatant of co culture was assessed by ELISA .Results (1)The mRNA and protein level of XBP1 were measured by RT-PCR and western blot ,those in XBP1-shRNA group were significantly reduced compared with those in the other three groups ,while in AdV-XBP1 groups ,results demonstrated entirely the opposite tendency (P< 0 .05) .(2)The expression of marker molecules on the sur-face of KCs such as M HC Ⅱ ,CD86 and CD40 in XBP1-shRNA group were significantly lower (P< 0 .05) ,but CD204 and CD206 expression were much higher compared with the other three (P< 0 .05) .However the expression tendency of these surface markers were shown the opposite results in AdV-XBP1 group (P < 0 .05) .(3)Western blot revealed the XBP1-shRNA could statistically suppress the protein levels and phosphorylation of JAK 1 ,JAK2 ,STAT1 and STAT3 ,which involved in the pro inflammatory cyto-kines regulation and KCs polarization (P< 0 .05) .But in AdV-XBP1 group ,these protein and its phosphorylation were markedly promoted (P< 0 .05) .ELISA results collaborated with Western blot .(4)3 d after co cultured with KCs transfected with XBP1-shR-NA ,the levels of T lymphocyte proliferation and pro inflammatory cytokines secretion were significantly reduced ,but the levels of T lymphocyte apoptosis and anti inflammatory cytokines secretion were remarkably enhanced (P< 0 .05) .Conclusion Blockage of IRE1-XBP1 activation could alter the phenotype of active KCs to M 2 like type and attenuated the capacity of antigen present of KCs ,while up regulated the expression of IRE1-XBP1 pathway could change the phenotype of KCs to M 1 type plus the promotion of antigen present capacity .
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the down stream involvement of the bile duct in hepatolithiasis.</p><p><b>METHODS</b>Mechanical damage to bile duct epithelia and long standing cholangitis as result of hepatolithiasis play an important role in the carcinogenesis of bile duct epithelia and stricture of the intra- and extra-hepatic bile duct. Macromorphological and microscopic changes in bile duct mucosa of 100 consecutive patients with hepatolithiasis were investigated using intra- or post-operative cholangioscopy. Biopsy specimens of lesions obtained during cholangioscopy were studied with immunohistochemical staining and flow cytometry to determine proliferative activity and DNA content. Five cases of well-proven cholangiocarcinoma were simultaneously studied as controls.</p><p><b>RESULTS</b>Of the 100 patients, those with chronic cholangitis accounted for 86% (86/100), proliferative lesions 11% (11/100), adenomatous polyps 1% (1/100), and adenocarcinoma 2% (2/100). The obvious mucosal lesion associated with hepatolithiasis was located down-stream of the bile duct, predominantly in the hilar region, e.g. orifices of the right/left hepatic duct and common hepatic duct (73% mucosa lesions in the hilar region). The intensity of cancer embryonic antigen stain and the proliferative cell nuclear antigen index increased with the development of bile duct lesions. Aneuploid DNA presented mainly in the high degree malignant adenocarcinomas (> 80% of cases).</p><p><b>CONCLUSIONS</b>The obvious mucosal lesions associated with hepatolithiasis were located down-stream of the bile duct, predominantly in the hilar region (73% of mucosal lesions). The proliferative activity of examined bile duct mucosa lesions increased with the development of pathological deterioration, which may contribute to the development of hilar bile duct stricture and hilar cholangiocarcinoma.</p>