ABSTRACT
Objective:To study the results of using a sequential menagement of conservative treatment, percutaneous transhepatic cholangial drainage(PTCD), laparoscopic cholecystectomy(LC) combined with laparoscopic common bile duct exploration(LCBDE) and primary duce closure(PDC) in patients with cholecystolithiasis and common bile duct stone(CBDS) who presented with acute cholangitis.Methods:The clinical data of 397 patients with CBDS and cholecystolithiasis who presented with acute cholangitis from January 2015 to August 2020 were retrospectively analyzed, including 230 patients from the West Campus, Beijing Chaoyang Hospital, Capital Medical University, 95 patients from the Second People's Hospital of Binzhou and 72 patients from Rizhao Central Hospital. Conservative treatment, PTCD and LC+ LCBDE+ PDC were used sequentially. The interval between PTCD and LCBDE, the decrease of serum total bilirubin and alanine aminotransferase after PTCD, the operative time of LC+ LCBDE+ PDC, and the intraoperative blood loss were analyzed. Postoperative indwelling time of abdominal drainage tube and PTCD tube time, postoperative hospital stay, postoperative complications, etc.Results:These were 15 males and 18 femals with the mean age of 57.5 years old. The mean serum total bilirubin and alanine aminotransferase levels decreased from (148.3±36.8) μmol/L and (172.6±26.9) U/L before PTCD to (32.6±5.9) μmol/L and (45.7±7.2) U/L after PTCD, respectively. The interval between PTCD and LCBDE was (25.3±2.6) d. The operation time of LC+ LCBDE+ PDC was (95.4±14.2) min. The intraoperative blood loss was (35.2±9.5 )ml and the mean postoperative hospital stay was (12.4±3.5) d. The postoperative indwelling time of abdominal drainage tubes and PTCD tubes were (10.6±2.3) d and (25.8±4.7) d, respectively. After surgery, bile leakage occurred in 3 patients (9.1%), abdominal hemorrhage in 1 patient (3.0%), biliary bleeding in 1 patient (3.0%), navel incision infection in 1 patient (3.0%), lower common bile duct stenosis in 2 patients (6.1%). All complications responded well to conservation treatment.Conclusions:Sequential treatment using conservative treatment, PTCD combined with LC+ LCBDE+ PDC in patients with cholecystolithiasis and CBDS who presented with acute cholangitis was safe, and efficacious using the minimally invasive approach. This approach is worth promoting to other centers.
ABSTRACT
To investigate the expression of cytokeratin 18(CYK18) in hepatocellular carcinoma(HCC) cell membrane and the relationship between the serum levels of tissue polypeptide specific antigen (TPS) and the proliferating activity of HCC cells. The serum levels of TPS were determined by TPS TM ELISA in 96 patients with HCC. Four micrometer paraffin embeded sections of liver specimens from these patients were immunostained with the strept avidin biotin complex immunoperoxidase technique (IHC SABC). All of the HCC preparations were positively stained by CYK 18 and proliferating cell nuclear antigen (PCNA) with IHC SABC.The results of PCNA stainings were: + in 62 5%, in 26 0%, in 8 3%,and in 3 1% .The median levels of TPS in the four groups were: + 137 98 U/L, 685 3 U/L, in 1 126 U/L and 4 672U/L respectively. There were significant differences among these groups ( P
ABSTRACT
To investigate the value of tissue polypeptide specific antigen(TPS) in the diagnosis of hepatocellular carcinoma (HCC), the serum levels of TPS and alfa fetoprotein (AFP) were measured by TPS TM ELISA and enzyme immunoassay respectively in 96 patients with HCC, 30 patients with cirrhosis, 20 patients with hepatitis and 20 healthy controls.The diagnostic sensitivity of TPS and AFP is 89 6% and 73 0% respectively.There is a significant difference between them ( P