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Objective To explore the surgical modality and safety of hepatectomy for hepatic hemangiomas close adjoining the hepatic portal and vital blood vessels. Methods From June 2005 to June 2010 17patients of hepatic hemangiomas underwent hepatectomy. Data were retrospectively analyzed.Results All the 17 cases were operated on successfully. Six cases were treated with anatomic liver lobectomy including right hemibepatectomy through liver hanging maneuver by anterior approach in 2 cases,under right liver blood vessel blochade and anatomic right posterior hepatectomy in 2 cases, left hemihepatectomy in 2 cases. Eight cases were treated by hemangiomas enucleation, in 3 cases hemangioma was enuleated through liver parenchyma splitting under intermittent hepatic blood inflow exclusion. There was no postoperative mortality, postoperatively pleural effussion occured in 5 cases,wound infection occured in 1 case, and pulmonary infection occured in 1 case, all the cases were cured. Conclusions Different operation styles should be applied according to the position, size of hepatic hemangiomas close adjoining the hepatic portal and the important blood vessels.
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Pancreatic cancer has the characteristics of high malignancy, early dissemination within the pancreas,extrapancreatic nerve plexus invasion, lymph node metastasis and vascular invasion. The 5-year survival rate of pancreatic cancer patients was under 5% even for those who had undergone surgical resection. Based on the review of the literatures including 42 pancreatic cancer patients who survived for 5-20 years after the operation, we concluded that curative resection of pancreatic cancer was still a reliable means in achieving long-term survival; factors influencing the results of resection of pancreatic cancer were lymph nodes involvement, poor differentiated tumor, extrapancreatic nerve plexus invasion, tumor size, residual tumor, curative resection and adjuvant chemotherapy; early diagnosis, aggressive surgery for patients with indications of resection, appropriate surgical procedure and postoperative adjuvant chemotherapy are essential factors to ensure a long term survival of patients with pancreatic cancer.
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Objective To analyze characteristics of severe liver trauma and efficacy of different surgical procedures. Methods Clinical data of 109 patients with severe liver trauma treated in the recent 10 years were retrospectively analyzed. Debriding suture was performed in 32 patients, gauze tamponade in 5, debridement hepatectomy in 59 and anatomical hepatectomy in 13 patients. Results In all the 109 patients, 92 were cured and 17 died. The dead patients included 3 with grade Ⅲ trauma,9 with grade Ⅳ trauma, and 5 with grade V trauma. Among the dead patients, there were 3 patients with simple liver injury (17.6%) and 14 with associated injury (82.4%). Conclusion Right hepatic serious damage is the main type of severe liver trauma and is always complicated with associated injury and needs emergency treatment. Application of the most appropriate surgical approach according to the traumatic condition is important to promote the successful rate of treatment.
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Objective To summarize clinical experience of emergent surgery for severe liver trauma with rupture of major blood vessels. Methods The clinical data of 12 cases suffering from severe liver trauma with rupture of perihepatic and intrahepatic large blood vessels were retrospectively analyzed. These cases were from Dec 2000 to May 2008. All the cases underwent emergency operation, 6 cases were treated with liver lobectomy: among those 1 case with right posterior lobe liver resection, 1 case with irregular right lobe liver resection, 3 cases with left hemihepatectomy, and 1 case with left lateral lobectomy. Seven cases with rupture of major blood vessels were treated by repair or ligature and/or packing including repair of posthepatic inferior vena though the middle fissure in 2 cases, and through retrahepatic space in one case, interrupted suture of the portal vein in 2 cases, interrupted suture of the right hepatic veins in 2 cases. Mattress suture was applied to the ruptured hepatic veins in 7 cases including mattress suture of the branch of right hepatic vein and middle hepatic vein in 1 case, mattress suture of right hepatic vein in 1 case, suture of middle hepatic vein in 2 cases, and suture of left hepatic vein in 3 cases. One case was treated with ligation of hepatic artery and 3 cases with gauzes packing. Results Among all the 12 cases, 9 cases were cured, 3 cases died: two were caused by severe trauma together with hemorrhagic shock, one by sever brain injury together with hemorrhagic shock. Conclusions Prompt operation, precise stop bleeding and correct operation style are the key for successful rescue of patients suffering from severe liver trauma and massive bleeding.
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Objective To investigate the effects of somatostatin analogue (SMS201 995, SMS) on the cell cycle of human cholangiocarcinoma SK ChA 1 cells and cell cycle regulated gene cyclinD1 and p16. Methods SK ChA 1 cells were synchronized by serum starvation. Cells at different phases were harvested at 48 h after SMS treatment of the synchronized SK ChA 1 cells. The distribution of cell cycles was analyzed by flow cytometry. The expression levels of cyclinD1 and p16 gene were detected by SABC immunohistochemistry and in situ hybidization. Results SMS could significantly inhibit the poorly serum synchronized SK ChA 1 cells to reenter the cell cycle from G 0/G 1 phase at 6 h and 12 h ( P
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Objective To screen a gastric carcinoma subcell line with higher metastatic potential and to explore the relationship between the liver metastatic potential and liver microenvironment with the screened subcell line Methods A gastric carcinoma subcell line was screened via procedures of orthotopic transplantation of subcutaneous tumor of its parent cell line SGC 7901 in nude mice and primary tissue culture of its liver metastatic focus Expressions of bFGFR, TGF?R 1 and c Met(hepatocyte growth factor receptor) in both the subcell line and its parent cell line were determined by immunohistochemistry Results A gastric carcinoma cell subcell line(named SGC 7901LM 2) was established from its parent cell line SGC 7901 with higher metastatic potential, and the expression of c Met increased significantly in the screened subcell line Conclusion The screened gastric carcinoma subcell line with higher metastatic potential is helpful for the further studies of liver metastasis of gastric carcinoma The elevated expression of c Met may be helpful to the liver metastatic potential of SGC 7901LM 2
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Objective To illustrate the relationship between the temporary alteration of renal functions of rats with obstructive jaundice due to ischemia reperfusion injury(RI) and lipid peroxidation and the expression of heat shock protein 70 in rat kidney. Methods Wistar rats were divided into 4 groups of sham operation group(S group), sham operation and renal RI group(SRI group), common bile duct ligation group(J group), common bile duct ligation and renal RI group(JRI group). One week after bile duct ligation, rat bilateral renal arteries were transiently occluded for 10 minutes. The variations of renal function were observed at different time phases after renal reperfusion. Simultaneously, the expression of heat shock protein 70 in kidney was evaluated by immunohistochemistry. Results In JRI group, endogenous creatinine clearance rate(Ccr) decreased progressively along with the prolongation of the duration of reperfusion. In J and JRI groups, the level of malondealdehyde(MDA) in renal tissue increased but superoxide dismutase(SOD) decreased. In JRI group, the expression of heat shock protein 70 reached its peak at the 4th hour after reperfusion and began to decrease at the 12 th hour and became lowest at the 24 th hour. No expression of HSP70 was found in other groups. Conclusion The sensitivity of rat kidneys with obstructive jaundice to ischemia reperfusion injury is significantly elevated. Ischemia reperfusion injury, as well as lipid oxidative stress, may be involved in acute renal failure(ARF) after obstructive jaundice surgery. The expression of heat shock protein 70 is a protective response to RI.
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Objective To investigate the clinical advantages of enteral nutrition (EN) for acute pancreatitis(AP)comparing with parenteral nutrition (PN) and its prospect. Methods Literatures using MESH Browser in Medline were collected and reviewed. Results Being of much higher cost and complications, total parenteral nutrition (TPN) ever regarded as most importantly for AP nutritional support, is now challenged by EN. Clinical evidence suggests enteral (jejunal) nutrition may diminish intestinal permeability to endotoxin and diminish bacterial translocation, thus reducing the cytokine drive to the generalized inflammatory response and preventing organ dysfunction, as well as achieving “pancreatic rest” equivalent to the TPN. Conclusion Early enteral nutrition should be used preferentially for patients with severe acute pancreatitis without paralytic ileus.
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Objective To explore the lesion mechanism and the apoptosis related protein changes of kidney in rat suffered from obstructive jaundice. Methods Choledocho-ligation methods was used to create rat obstructive jaundice model. Six rats in the normal control group and thirty rats of experiment group were observed at day 1, 3, 6,10 and 14 after rat model establishment. HE staining for kidney pathological changes, TUNEL staining for cell apoptosis, SABC for apoptotic related proteins of survivin and bax, xanthine oxidase method for SOD activity and thiobarbiturate method for MAD content were carried out. Results Renal tubular epithelial cell necrosis, cell shedding and aggregation were the main pathological changes in the experiment group. In the experiment group, the apoptosis ratio increased significantly, and reached the peak of (25.2?2.8)% on postoperative day 14. The relative gray value of survivin in the experiment group decreased significantly and of bax increased significantly. The plasma SOD activity in the normal group was (193.6?23.5) U/L, but it in the experiment group decreased significantly. The plasma MDA content and the endotoxin level in the experiment group increased significantly. Conclusion Cell apoptosis is one of the lesion mechanisms of kidney in rats suffered from obstructive jaundice. The down-regulation of survivin and the up-regulation of bax may be the biological factor in the occurrence of apoptosis. The increasing of free radical and endotoxin are important factors in the kidney lesion.
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<p><b>OBJECTIVE</b>To explore and evaluate the effect of radio frequency ablation (RFA) in treatment of hepatic VX(2) tumor in rabbits.</p><p><b>METHODS</b>The hepatoma was treated with RFA in rabbits. The complete necrotic rate of the tumors, pathological changes, CT images and the animals' survival time were observed.</p><p><b>RESULTS</b>(1) ALT in serum increased significantly on the first day and decreased to the control level during 4th-7th day following RFA. (2) On the second week, CT scans showed that complete necrotic foci became larger, and the density of which was asymmetrical. Enhanced CT scans showed no obvious intensification inside; however, ringed intensification appeared along edges of the foci. Biopsy showed that the dark necrotic tissue was surrounded by ringed granulation tissue. Incomplete necrotic tumor foci resembled the complete necrotic foci in no enhanced CT images; however, asymmetrical intensification was observed in enhanced CT scans in the incomplete necrotic foci. Macroscopic observation showed irregular tumor tissue between the necrotic tissue and the peripheral normal tissue. Biopsy showed tumor recurrence in it. (3) Compared with the control, survival time of the animals was longer, and metastases rate in lungs and the fatality rate were lower in the treatment group.</p><p><b>CONCLUSIONS</b>RFA, with little injury, is an effective method in the treatment of hepatoma. Enhanced CT scans are consistent with pathological morphometrics of the tumor foci after RFA. The enhanced CT scan is a valuable check-up, which could be used to observe the therapeutic effect after RFA.</p>
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Animals , Rabbits , Carcinoma, Hepatocellular , Catheter Ablation , Liver Neoplasms , Diagnostic Imaging , General Surgery , Necrosis , Neoplasm Recurrence, Local , Radionuclide Imaging , Tomography, X-Ray ComputedABSTRACT
Objection To study the p21 WAF1 and p53 protein expression in patients with cholangiocarcinoma and its relation to the pathologic grading and metastasis of the tumor.[WT5”HZ] Methods Using immunohistochemical method, we examined p21 WAF1 and p53 protein expression in 48 cases of cholangiocarcinoma and 8 cases of biliary duct tissue with chronic inflammation.[WT5”HZ] Results The expression of p21 WAF1 and p53 was positive in 25% and 54% respectively of the cases with cholangiocarcinoma, and 88% and 0% respectively of the cases in normal bile duct tissue with chronic inflammation (all P
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Objective To investigate the changes of free calcium distribution in hepatocytes after administration of phenylephedrine. Methods The changes of fluorescence intensity were observed by confocal laser scanning microscopy after administration of phenylephedrine alone or pretreated with phentolamine before phenylephedrine administration. Results The fluorescence intensity increased rapidly after administration of phenylephedrine to hepatocytes. When liver cells were pretreated by phentolamine before phenylephedrine administration, the changes of fluorescence intensity not obvious. Meanwhile, the inconformity of the fluorescence intensity in hepatocytes suggested the existence of the second subarea of free calcium distribution. Conclusion Ca2+ signal can be arisen by phenylephedrine via the α-receptor in hepatocytes in vitro. The distribution and dynamic changes of free calcium in hepatocytes display some characteristics.
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Objective To establish the animal model of denervation of sympathetic nerve and to explore the effects of denervation of the sympathetic nerve on liver regeneration after partial resection. Methods The animal model of denervation of sympathetic nerve was made with 6-OHDA. A total of thirty male Wistar rats were divided equally into experimental and control group. The left and middle lobe of liver were resected with improved Higgins and Anderson's method. Meanwhile, denervation was made in the experimental group. All the rats were killed by haemospasia on the 7 th day after operation. HMI, RLR and MI were measured. The rates of DNA synthesis were detected by 3H-TdR method. Results The concentration of NE decreased extremely on day 3 to day 14 after administration of 6-ONDA. No death happened in all the rats 7 days after liver resection. HMI, RLR, MI and 3H-TdR incorporation significantly decreased in experimental group compared with that in control (P<0.01). Conclusion The chemical denervation of sympathetic nerve can be aroused by administration of 6-OHDA. Regeneration of the liver is inhibited by the denervation of sympathetic nerves.
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Objective To explore the relationship between te lomerase activity and bile duct carcinoma and its significance in clinical diag nosis. Methods Telomerase activities were examined in 23 cases of bile duct carcinoma, 5 cases of carcinoma adjacent tissues and 5 cases of nor mal bile duct tissues respectively with telomerase PCR-ELISA method. Results Telomerase activity was detected in 18 of 23 cases (78.3%) of b ile duct carcinoma, and was not found in 5 cases of carcinoma adjacent tissues a nd 5 cases of normal bile duct tissues. The detection rate of telomerase activit y had no correlation with patients' age, sex, tumor site and size but significan tly correlated to metastasis of tumor (P<0.05). Conclusion The level of telomerase activity was significantly higher in bile duct carcino ma and may be served as one of the clinical marker for malignant neoplasm becaus e of its spsecificity.
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Objective To study the clinical features and treatment on hepatocellular carcinoma(HCC) with obstructive jaundice as primary symptom. Method We collected 39 cases of patients of HCC with obstructive jaundice as primary symptom in our hospital,the clinical features and treatments were studyed.Results The incidence of such patients was 6.3% in all HCC patients and all patients were operaed;the positive diagnostic rate of B ultrasonud and T was 88.2% and 80% respectively ,it was 48.7% in cases with intraportal thrombi.Conclutions Preperative correct diagnosis depends on image test,hepatectomy with biliary duct drainage is the mainstay for treatment .
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ObjectiveTo explore the effects of gastrin on the bcl-2-associated apoptotic pathways in cholangiocarcinoma.MethodsTUNEL technique and quantitative RT-PCR were used to examine the effects of gastrin-17(G-17) on the beauvericin-induced apoptotic index (AI) and expressions of bcl-2 and bax mRNAs. Antisense oligodeoxynucleotide (ODN) technology was conducted to investigate the role of bcl-2 in the gastrin-mediated inhibition of apoptosis in human cholangiocarcinoma cell line QBC939. ResultsThe AI and bcl-2 mRNA expression significantly decreased and increased respectively in the cells exposed to gastrin-17 compared with those of control cells (P
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Objective To study the effect of somatostatin analogue (SMS201-995,SMS) on apoptosis of human cholangiocarcinoma SK-ChA-1 cells and apoptosis-regulated gene bcl-2 and bax. Methods The changes of apoptosis and bcl-2/bax gene expression were detected by DNA gel electrophoresis, flowcytometric analysis and immunohistochemistry, in situ hybridization methods in cholangiocarcinoma SK-ChA-1 cells after treated with SMS(100?ng/ml) for 6, 12 and 24 hours.Results The characteristic ladder was not detected by agarose gel electrophoresis after treated with SMS(100?ng/ml) for 6 hours. When the cells were treated for 12 and 24 hours, the ladder of DNA electrophoresis was observed. While the cells were treated with SMS for 6, 12 and 24 hours, the percentage of annexin V-positive cells were (22?5)% ,(39?7)% and(58?10)%. Besides,SMS inhibited bcl-2 protein expression and increased bax protein and mRNA expression. Conclusion SMS can induce SK-ChA-1 cell apoptosis mainly with regulation of bcl-2 and bax gene expression.
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Objective To evaluate the clinical and pathological features and treatment of primary hepatocellular carcinoma invading on to the bile duct.[WT5”HZ]Methods [WT5”BZ]39 cases of hepatocellular carcinoma of icteric type were collected in our hospital.[WT5”HZ]Results [WT5”BZ]The incidence was 6% in all hepatocellular carcinoma patients.Preoperative correct diagnosis was achieved in only 33% of the 39 cases.The positive diagnostic rate of B ultrasound and CT was 88% and 80%respectively,and 49% of cases suffered from intraportal thrombi concomitantly.[WT5”HZ]Conclusion [WT5”BZ]Preoperative correct diagnosis depends on image test,hepatectomy with biliary duct drainage is the mainstay for treatment.
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Bile duct injury caused by abdominal trauma, usually accompanied with injuries of other abdominal organs, is rarely seen. For the reason of its complexity and often delayed diagnosis and treatment, bile duct injury usually leads to severe complications such as abdominal infection. This paper reports a group of 10 cases of bile duct injury treated in our center in the recent decade.
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Objective To investigate the clinicopathological characteristics, diagnosis and treatment of primary duodenal malignant tumors (PDMTs). Methods The clinical data of 47 PDMTs confirmed by pathology were retrospectively analyzed. Results Pathological types were adenocarcinoma in 42 cases, leiomyosarcoma in 4, and carcinoid in 1.The most common location of the tumor was the descending portion (35), especially the peri-papillary region (28) of the duodenum. The most common symptoms and signs were abdominal pain, jaundice, upper gastrointestinal hemorrhage, obstruction ,and weight loss. The main diagnostic modalities were gastroduodenoscopy, GI barium meal, ERCP, ultrasound (US) and CT. US together with ERCP was the most useful in improving the diagnosis of peripapilla tumors in the duodenum. Panceraticoduodenectomy and some palliative procedures were performed for 25 and 20 cases, respectively.Surgical mortality and postoperative morbidity were 2.2% (1/45) and 20% (9/45),retrospectively. The 3-year and 5-year survival for those adenocarcinoma without distant metastasis undergoing pancreaticoduodenectomy were 50% and 32%. No long survival was found after the palliative operation. Conclusions Adenocarcinoma is the most common pathological type of PDMTs.No specific symptoms were shown in the early stage of PDMTs, US, CT and ERCP are the main diagnostic procedures. Radical pancraticoduodenectomy can prolong survival time and should be attempted for those without systemic dissemination.Palliative operations should be considered for tumors in advanced stage.