ABSTRACT
Objective@#To study the therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy(EUS-HG) for patients with high malignant biliary obstructive jaundice.@*Methods@#A total of 56 patients with high malignant obstructive jaundice hospitalized at the Second Affiliated Hospital of Nanjing Medical University and the Second Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2017 were included in the study. There were 29 males and 27 females with median age of 72 (60-82) years. Patients were randomized into two groups according to the random number table, the EUS-HG group (n=20) treated with EUS-HG and the percuteneous transhepatic cholangiodrainge(PTCD) group (n=36) treated with PTCD. The operative success rate, curative effect, complications and operation cost were compared between the two groups, and the median unblock period of plastic double pig tail stent was observed.@*Results@#(1)The success rates were 100% in both groups. (2) Preoperative and one-month postoperative levels of the following were tested and compared. Levels of total bilirubin were 362.15±138.27 μmol/L, 56.85±28.57 μmol/L in the EUS-HG group and 356.47±130.69 μmol/L, 60.93±25.79 μmol/L in the PTCD group, respectively. Levels of alkaline phosphatase were 896.57±357.29 U/L, 146.59±48.63 U/L in the EUS-HG group and 883.65±364.32 U/L, 151.57±49.73 U/L in the PTCD group, respectively. Levels of alanine aminotransferase were 252.36±38.77 U/L, 60.29±31.57 U/L in the EUS-HG group and 246.26±32.57 U/L, 62.56±32.87 U/L in the PTCD group. Levels of aspartate aminotransferase were 259.37±30.64 U/L, 62.28±26.58 U/L in the EUS-HG group and 242.37±29.52 U/L, 60.28±29.57 U/L in the PTCD group, and there was no significant difference between the two groups (P>0. 05). CRP levels were 52.57±31.95 mg/L, 16.95±8.77 mg/L in the EUS-HG group and 53.42±35.79 mg/L, 25.13±14.77 mg/L in the PTCD group (P<0.05). (3)There was significant difference in remission rate of anorexia and abdominal distension between the two groups [80.0%(16/20) VS 52.8%(19/36), P<0.05]. There was no significant difference in symptom relief of jaundice, pruritus or abdominal pain between the two groups [90.0%(18 /20)VS 91.7%(33/36), P>0.05]. (4) The incidence of total complications in the EUS-HG group (20.0%, 4/20) was significantly lower than that in the PTCD group (47.2%, 17/36, P<0.05). (5)The cost of operation in the EUS-HG group (22 685.26±2 356.16 yuan) was slightly higher than that in the PTCD group (20 529.57±4 135.63 yuan, P>0.05). (6) The median unblock period of double pig tail plastic stents in EUS-HG group patients was 102 days.@*Conclusion@#EUS-HG is a safe and effective method for the treatment of high malignant biliary obstructive jaundice. It can be used as the first choice for treatment after failure of conventional ERCP.
ABSTRACT
Objective To study the therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy( EUS-HG) for patients with high malignant biliary obstructive jaundice. Methods A total of 56 patients with high malignant obstructive jaundice hospitalized at the Second Affiliated Hospital of Nanjing Medical University and the Second Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2017 were included in the study. There were 29 males and 27 females with median age of 72 (60-82) years. Patients were randomized into two groups according to the random number table, the EUS-HG group ( n=20) treated with EUS-HG and the percuteneous transhepatic cholangiodrainge( PTCD) group (n=36) treated with PTCD. The operative success rate, curative effect, complications and operation cost were compared between the two groups, and the median unblock period of plastic double pig tail stent was observed. Results (1) The success rates were 100％ in both groups. (2) Preoperative and one-month postoperative levels of the following were tested and compared. Levels of total bilirubin were 362. 15 ± 138. 27 μmol/L, 56. 85 ± 28. 57 μmol/L in the EUS-HG group and 356. 47 ± 130. 69 μmol/L, 60. 93 ± 25. 79 μmol/L in the PTCD group, respectively. Levels of alkaline phosphatase were 896. 57±357. 29 U/L, 146. 59±48. 63 U/L in the EUS-HG group and 883. 65 ± 364. 32 U/L, 151. 57 ± 49. 73 U/L in the PTCD group, respectively. Levels of alanine aminotransferase were 252. 36±38. 77 U/L, 60. 29±31. 57 U/L in the EUS-HG group and 246. 26 ± 32. 57 U/L, 62. 56 ± 32. 87 U/L in the PTCD group. Levels of aspartate aminotransferase were 259. 37 ± 30. 64 U/L, 62. 28 ± 26. 58 U/L in the EUS-HG group and 242. 37 ± 29. 52 U/L, 60. 28±29. 57 U/L in the PTCD group, and there was no significant difference between the two groups (P>0. 05). CRP levels were 52. 57±31. 95 mg/L, 16. 95±8. 77 mg/L in the EUS-HG group and 53. 42± 35. 79 mg/L, 25. 13 ± 14. 77 mg/L in the PTCD group ( P<0. 05) . ( 3 ) There was significant difference in remission rate of anorexia and abdominal distension between the two groups [ 80. 0％( 16/20) VS 52. 8％( 19/36) , P<0. 05] . There was no significant difference in symptom relief of jaundice, pruritus or abdominal pain between the two groups [ 90. 0％( 18 /20) VS 91. 7％( 33/36) ,P>0. 05] . ( 4) The incidence of total complications in the EUS-HG group ( 20. 0％,4/20) was significantly lower than that in the PTCD group (47. 2％,17/36, P<0. 05). (5)The cost of operation in the EUS-HG group (22685. 26±2356. 16 yuan) was slightly higher than that in the PTCD group (20529. 57±4135. 63 yuan, P>0. 05). (6) The median unblock period of double pig tail plastic stents in EUS-HG group patients was 102 days. Conclusion EUS-HG is a safe and effective method for the treatment of high malignant biliary obstructive jaundice. It can be used as the first choice for treatment after failure of conventional ERCP.
ABSTRACT
Objective To elucidate the roles of TANK-binding kinase-1(TBKl)in hepatitis B virus (HBV)infection induced interferon antiviral immunity.Methods Peripheral blood monocytes were separated by CD14 magnetic microbeads from healthy volunteers(HV)and chronic hepatitis B(CHB)patients.Purified mDCs were induced and proliferated in the culture medium with human granulocyte-macrophage concentration of 25 mg/L were stimulated.The mRNA expressions of TBK1,interferon regulatory factor (IRF)3 and interferon(IFN)-βwere quantified by real time polymerase chain reaction(PCR).The levels of IFN-β in supernatants were determined by enzyme-linked immunosorbent assay(ELISA).Reslllts The mRNA levels of TBK1,IRF3 and IFN-β did not change significantly at 0,12,24 and 48 h after the significantly at 0, 12, 24 and 48 h in CHB group, whereas, it was significantly up-regulated at 12 h in HV group. Conclusions Our results suggest that there may be some disorders in host antiviral signal transduction pathways downstream the binding between ligands and receptors on mDC surface. The insufficient IFN-β expression after HBV infection may result in persistent chronic infection.