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Objective To investigate the application effect of psychological intervention combined with parecoxib in rehabilitation of patients with bile duct carcinoma after the operation. Methods According to the different intervention models from January 2015 to March 2017 in the first people's hospital of Yongkang city surgical treatment of bile duct carcinoma,40 cases of patients groups: control group with routine nursing plus saline intervention, observation group with psychological nursing + Tenai (parecoxib sodium) mode of intervention; on the psychological state of the two groups before and after intervention to improve patients the cognitive function, to improve the situation, changes in pain scores were recorded, and the related data for comparative analysis. Results The psychological nursing + Tenai (parecoxib sodium) model (observation group) intervention in the treatment of patients with bile duct cancer surgery clinical effect is better than that of routine nursing mode + normal saline (control group) the clinical effect of intervention, the psychological state of patients to improve the situation, improve cognitive function, pain score changes were better than the control group, there was statistical significant differences (P<0.05). Conclusion The surgical treatment of patients with cholangiocarcinoma patients psychological nursing + Tenai (parecoxib sodium) intervention effect significantly, can effectively improve the patients psychological status, cognitive function, and can reduce postoperative pain fully, has an excellent role in promoting the rehabilitation of patients after surgery, worthy of clinical application.
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Objective To investigate the value of multiple sequential MRI in the differential diagnosis of vater ampulla carcinoma (VPC).Methods MRI data of 53 patients with VPC confirmed by surgery and pathology were analyzed retrospectively,which included 17ampullary carcinomas,15 pancreatic head carcinomas,10 duodenal papillary carcinomas and 11 distal common bile duct carcinomas.All patients underwent routine MRI plain scan,MRCP and multi-phase dynamic enhancement scan for the upper abdomen.The morphological characteristics and model of multi-phase dynamic enhancement of the tumor,and the morphological changes of pancreaticobiliary duct were focused,and relevant data were also measured.Results The differences of tumor size,central location,and signal homogeneity among the four different histological types showed statistical significance(P＜0.05),and their patterns of multi-phase dynamic enhancement also had differences.Double-segment sign was most found in VPC (26/53),four-segment sign was easy showed in pancreatic head carcinoma (8/15)and three-segment sign in distal common bile duct carcinoma (8/11).Beak sign was common seen in ampullary carcinoma(10/17),rat-tail sign was easy discovered in pancreatic head carcinoma (7/15) and truncated sign in distal common bile duct carcinoma(10/11).Diameter of major pancreatic duct in pancreatic head carcinoma was maximum and minimum in distal common bile duct carcinoma,and their difference had statistical significance(P＜0.05).Distance between obstructive end of bile common duct and major papilla of duodenum,and between obstructive end of major pancreatic duct and major papilla of duodenum as well as the pancreaticobiliary conjunction angle in pancreatic head carcinoma and distal common bile duct carcinoma were greater than that in ampullary carcinoma and duodenal papillary carcinoma.Conclusion MRI can prominently demonstrate various imaging characteristics of VPC with different histological origins.It is very valuable in the differential diagnosis of VPC with different histological types by comprehensive analysis of these findings.
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Objective To compare the clinical curative effect between laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in treatment of terminal bile duct carcinoma.Methods Clincal data of 40 patients with advanced terminal bile duct carcinoma who underwent pancreaticoduodenectomy in our hospital from March 2008 to March 2013 were collected,of which 12 patients were in LPD group and 28 patients in OPD group.Results Hospitalization expense and operative time of patients were in LPD group were both more or longer than those of OPD group (P ＜ 0.05),but haemorrhage,pulling out the drainage tube time,pulling out the stomach tube time,active time post-operation,aeration time,absolute resting on bed time,and hospitalization time in LPD group were lower or shorter than those of OPD group (P ＜ 0.05).There were 15 patients suffered with postoperative complication,including 5 patients in LPD group and 10 patients in OPD group,and there was no significant difference between the two groups in total incidence of postoperative complication (P ＞ 0.05).In the specific postoperative complication,the incidences of biliary fistula of LPD group were higher than those of OPD group (P ＜ 0.05),but incidences of pancreatic fistula,systemic infection,pulmonary infection,incision infection,and delayed gastric emptying between two groups were no significant difference (P ＞ 0.05).All patients were followed up for 1-36 months with the median time of 27 months.During the follow-up periods,in LPD group,8 patients suffered with recurrence,6 patients suffered with tumor metastasis,and 8 patients died;in OPD group,18 patients suffered with recurrence,13 patients suffered with tumor metastasis,and 18 patients died.There were no significant difference between two groups in the recurrence rate,metastasis rate,and mortality (P ＞ 0.05).Conclusion According to the results of the current study,for patients with common bile duct cancer,LPD group was superior to OPD group in the postoperative recovery.But compared with OPD group,it had no obvious advantage in reducing biliary fistula,pancreatic fistula,infection,delayed gastric emptying,and so on,and it also had no obvious advantage in improving the long-term survival situation.However,due to the relatively small sample size of the two groups,the results of this study may lead to some bias,the curative effect of two kinds of surgical comparison still need more clinical research to further explore.
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Objective To analyze the therapeutic effect of percutaneous transhepatic cholangial drainage (PTCD) in the treatment of bile duct obstruction in patients with malignant hilar bile duct carcinoma,and to discuss the clinical application and practical value of PTCD.Methods A total of 55 patients with malignant biliary obstruction were divided into the PTCD group (30 cases who recieved percutaneous transhepatic cholangial drainage) and the control group (25 cases who recieved endoscopic stent implantation).Observed the preoperative and postoperative biochemical indexes of PTCD group,including serum total bilirubin (TB),serum direct bilirubin (DB),serum alanine aminotransferase (ALT) and serum glutamic acid amino turn shift of aspartate aminotransferase(AST) and serum alkaline phosphatase(AKP).Compared the effect rate and postoperative survival time of the two groups through postoperative follow-up.Results The TB,DB,ALT,AST and APK of PTCD group one week after operation changed obviously compared with the relative index before opreation with statistically significant differences (P<0.05), which indicated a significant improvement of biochemical indicators.The treatment efficiency of the PTCD group and the control group were 83.3% and 64.0% respectively, and survival time of the two groups were(7.5±2.6)months and(4.8±2.8)months respectively.Results of the PTCD group was significantly better than that of the control group,and the differences were statistically significant(P<0.05).Conclusion All the patients with PTCD get better biochemical indicators and longer postoperative survival time,and the interventional therapy PTCD can be used as an effective clinical treatment method for bile duct obstruction with malignant hilar bile duct carcinoma.
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Objective To investigate and summarize the clinical characteristic of autoimmune pancreati-tis(AIP).Methods Clinical data of 13 patients with AIP, admitted to the West China Hospital from 2009 to 2013, were retrospectively analyzed .Results The median age of the 13 patients was 48 years old.The main clinical manifestations included epigastric pain or discomfort (8 cases), obstructive jaundice(7 cases)and weight loss(10 cases).Diffuse enlargement of pancreas and localized pancreatic enlargement were observed in 6 cases, pseudocyst and pancreatic stones were observed in 1 case.Dilation of pancreatic duct was found in 4 cases.Bili-ary stricture and thickened wall of bile duct were detected in 8 cases, dilated gallbladder with delayed enhance-ment of the thickened wall in 7 cases, retroperitoneal fibrosis surrounding the aorta in 1 case, abdominal lymph-adenopathy in 6 cases, stenosis of splenic vein in 4 cases, and Sjogren's disease and ulcerative colitis in 1 case. The positive rate of serum IgG, RF, ANA was 71.43%(5/7), 42.86%(3/7), and 42.86%(3/7), respec-tively.8 patients were misdiagnosed and underwent surgery .Steroid therapy was administered in all patients with satisfactory response.Conclusions AIP is a rare and autoimmune disease ,without speci? c symptoms,and often be misdiagnosed as pancreatic cancer or bile duct carcinoma .We must give more attention to AIP and keep pa-tients from undergoing unnecessary surgery .
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Objective To investigate the effects of nerve growth factor (NGF) on the expression of 67-kDa laminin receptor (67LR) in human bile duct carcinoma QBC939 cells, and study the possible mechanism of perineural invasion and metastasis of bile duct carcinoma. Methods ( 1 ) The expression of a high-affinity receptor for NGF, TrkA, was detected by immunofluorescence staining. ( 2 ) QBC393 cells were pretreated by β-NGF at different concentrations ( 1, 10, 100,200 μg/L), and then the mRNA and protein expressions of 67LR were examined by Real-Time PCR and Western blot assay. QBC939 cells were divided into control group and β-NGF (1, 10, 100,200 μg/L) groups. (3) The ideal concentration of β-NGF was selected according to the results of previous tests, and then the mRNA and protein expressions of 67LR were re-examined by adding specific TrkA inhibitor K252a at different concentrations ( 100,200,300 nmol/L). QBC939 cells were divided into control group, β-NGF 100 μg/L group and K252a ( 100,200,300 nmol/L) groups. All data were analyzed by one-way analysis of variance or LSD-test. Results (1) A strong expression of TrkA was detected in the membrane of QBC939 cells. (2) The mRNA and protein expressions of 67LR in QBC939 cells were 0.35 ± 0.06 and 0. 32 ± 0.05 in the control group, 0.38 ±0.14 and 0.50 ±0.09 in the β-NGF 1 μg/L group, 0.62 ±0.14 and 0. 69 ±0. 13 in β-NGF 10 μg/L group, 0.90 ± 0.08 and 0.93 ± 0.07 in the β-NGF 100 μg/L group, and 0. 70 ± 0. 10 and 0. 76 ±0.07 in the β-NGF 200 μg/L group, there were significant differences among the five groups (F = 22. 4, 14. 6,P ＜0.05). The mRNA and protein expressions of 67LR in the β-NGF 100 μg/L group were significantly higher than those in the control group ( t = 19. 0, 21.0, P ＜ 0. 05 ). (3) The mRNA and protein expressions of 67LR in the QBC939 cells were 0.35 ±0.10 and 0.41 ±0.10 in the control group, 0. 88 ±0. 14 and 0.84 ±0.10 in the β-NGF 100 μg/L group, 0.80±0.08 and 0.76 ±0.04 in the K252a 100 nmol/L group, 0.67 ±0.12 and 0.61 ± 0.09 in the K252a 200 nmol/L group, and 0. 43 ± 0.07 and 0. 50 ± 0. 12 in the K252a 300 nmol/L group, there were significant differences among the five groups ( F = 14. 1, 8. 9, P ＜ 0.05 ). There were no significant differences in the mRNA and protein expressions of 67LR between the K252a 300 nmol/L group and the control group (t =1.02, 0. 85, P＞0.05). Conclusion In bile duct carcinoma cells, NGF enhances the expression of 67LR by combining with TrkA, which might be the mechanism of NGF mediating perineural invasion of bile duct carcinoma.
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BACKGROUND/AIMS: Endoscopic stent insertion with self expandable metal stent (SEMS) is one of the standard palliative treatments for the patients with unresectable bile duct carcinoma. The aim of this study was to determine whether detection of longitudinal spread of extrahepatic bile duct carcinoma by intraductal US (IDUS) would be helpful in the selection of metal stent for the palliative drainage in bile duct carcinoma. METHODS: Seventeen patients with histologically proven unresectable extrahepatic bile duct carcinoma who underwent endoscopic retrograde cholangiography with IDUS were included. Longitudinal cancer extension along the bile duct was determined and, then, compared with the cholangiographic image. The type and length of SEMS was selected based on IDUS findings. RESULTS: IDUS demonstrated more extensive tumor spread than ERC in 7 of 17 (41.2%) patients with the hepatic side of strictures and in 7 of 16 (43.8%) patients with the duodenal side of strictures. Five of 17 (29.4%) patients have changed the plan of endoscopic biliary drainage with SEMS after IDUS. There was no early dysfunction associated with endoscopic biliary drainage. CONCLUSIONS: IDUS prior to biliary drainage would be useful in demonstrating longitudinal extension of extrahepatic bile duct carcinoma. It has a potential role in helping stent selection and identifying factors which predict early stent dysfunction.
Subject(s)
Female , Humans , Male , Bile Duct Neoplasms/surgery , Bile Ducts, Extrahepatic/surgery , Carcinoma/surgery , Cholangiopancreatography, Endoscopic Retrograde , Drainage/methods , StentsABSTRACT
Objective To analyze the factors influencing the prognosis of patients with bile duct carcinoma after resection. Methods The clinical data of 120 patients with bile duct carcinoma receiving resection in our hospital from 1980 to 2004 were collected retrospectively and clinicopathologic factors that might influence survival were analysed. A multiple factor analysis was performed through Cox proportional hazard model. Results The overall 1-year, 3-year and 5-year survival rates were 71.7%, 32.5% and 19.2% respectively. The single factor analysis showed that the major significant factors influencing survival of these patients were histological type of the lesions, lymph node metastasis, pancreatic infiltration, duodenal infiltration, resected surgical margin, perineural infiltration, peripheral vascular infiltration and depth of tumor infiltration (P
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PURPOSE: For bile duct carcinomas, local treatment including surgical resection plays an important role. In the case of hilar bile duct carcinoma, the rate of resection is low and local recurrences are frequent, even after radical resection. Radiotherapy, one of the local remedies, may influence the treatment result. The aims of this study were to determine the effect of radiotherapy after surgical resection on the length of survival, as well as the radiation toxicity, in patients with hilar bile duct carcinoma. METHODS: Seventy patients with hilar bile duct carcinoma were included in this study; 46 underwent surgical resection only while 24 additionally received external beam radiotherapy after resection. The authors compared the survival rate between the two groups and investigated the complications following radiotherapy. RESULTS: The overall 5-year survival rate after surgical resection was 28.3%; 20.1% and 31.3% in patients with and without radiotherapy, respectively. The difference was not significant (P> 0.10). In patients with positive surgical margin, the 5-year survival rate for the radiation group was superior to that of the non-radiation group (21.8% vs. 10.1%), but aqain the difference was not statistically significant (P> 0.10). In patients with lymph node metastasis the survival rates for radiation and non-radiation groups showed no significant difference(median survival, 7 vs. 13 months) (P> 0.10). Leukopenia (n=2) and digestive complications including gastroduodenal ulcers (n=2) occurred after radiotherapy. CONCLUSION: External beam radiotherapy after radical resection had no significant effect on the length of survival in patients with resectable hilar bile duct carcinomas.
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Humans , Bile Ducts , Bile , Leukopenia , Lymph Nodes , Neoplasm Metastasis , Peptic Ulcer , Radiotherapy , Recurrence , Survival RateABSTRACT
Objective To investigate the apoptosis of human bile duct carcinoma cell induced by Apoptin gene transfection in vitro. Methods Apoptin gene was amplified by polymerase chain reaction (PCR) and then inserted into pAdtrack-CMV containing green fluorescent protein gene through T4 DNA ligase. The reconstructed plasmids were identified by enzyme digestion and sequencing. Apoptin expression vector was transfected into human bile duct carcinoma cell line QBC_(939). The apoptosis of human bile duct carcinoma cell induced by Apoptin gene was detected by TUNEL. Results Reconstructed pAdtrack-CMV containing Apoptin gene was obtained successfully. TUNEL test showed that there was significant difference in apoptosis index between Apoptin gene transfection and the control group (P
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Asymptomatic intrahepatic early-stage bile duct carcinoma without jaundice is difficult to diagnose because it does not have any characteristic clinical signs and symptoms. The clinical implication of early-stage intrahepatic ductal cholangiocarcinoma is great, because it allows curative resection and excellent long-term survival. Recently we experienced early-stage intrahepatic cholangiocarcinoma which was incidentally detected by a clue of elevated serum alkaline phosphatase and gamma-GT without jaundice and any symptoms. Abdominal US showed focal intrahepatic bile duct dilatation. ERCP could not demonstrate the lesion, while MRCP revealed the obstructed duct (S6) with proximal dilatation. For evaluation of a focal intrahepatic stricture, PTCS examination and biopsy were done. With the help of MRCP and PTCS, the lesion was diagnosed as papillary adenocarcinoma preoperatively. The patient was underwent right liver lobectomy and confirmed early-stage intrahepatic ductal adenocarcinoma and she is well-being without cancer recurrence for a follow-up period of 1 year.
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Humans , Adenocarcinoma , Adenocarcinoma, Papillary , Alkaline Phosphatase , Bile Ducts , Bile Ducts, Intrahepatic , Biopsy , Cholangiocarcinoma , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic , Dilatation , Follow-Up Studies , Jaundice , Liver , Recurrence , CholangiocarcinomaABSTRACT
Cutaneous metastasis of common bile duct carcinoma is rare. we report a case of cutaneous metastasis of distal common bile duct carcinoma in a 48-year-old female who has asymptomatic multiple erythematous nodules on the occipital area. She had been diagnosed with distal common bile duct carcinoma 2 years ago. Histopathologic examination of the cutaneous lesion showed well to moderately differentiated adenocarcinoma.
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Female , Humans , Middle Aged , Adenocarcinoma , Common Bile Duct , Neoplasm MetastasisABSTRACT
PURPOSE: A major hepatobiliary resection (MHBR), liver resection of more than one lobe, has been recommended by some surgeons for advanced carcinomas (Ca) of the gallbladder (GB) and the hilar bile duct (HBD). However, high operative mortality and morbidity have been reported and its survival benefit has not been clearly documented. METHODS: We report the results of MHBR for such tumors to determine the safety and the effectiveness of this operation, which has been performed for GB Ca invading the right hepatic pedicle or liver bed by 2 cm or more and for HBD Ca of Bismuth type III or IV. The cases of fifty consecutive cases who received MHBR for GB Ca (n=11) or HBD Ca (n=39) during a 5 year-period were reviewed. RESULTS: Thirty right-sided and 20 left-sided hepatectomies were performed. There was no operative or hospital death. Minor and major complications developed in 64% of the cases. All the complications improved with conservative management, except two in which re operations were required, one due to portal vein thrombosis and the other to bleeding of the retro peritoneal dissection site. No specific factors were associated with the high complication rate. The long-term outcome of HBD Ca was better than that of GB Ca. In HBD Ca, differentiated cancer and less transfusion were associated with a better prognosis. CONCLUSION: MHBR was conducted with acceptable morbidity and no mortality. In terms of the long-term outcome, MHBR is recommended for HBD Ca whereas it should be considered more carefully for GB Ca.
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Bile Ducts , Biliary Tract , Bismuth , Gallbladder , Hemorrhage , Hepatectomy , Liver , Mortality , Prognosis , Venous ThrombosisABSTRACT
PURPOSE: A major hepatobiliary resection (MHBR), liver resection of more than one lobe, has been recommended by some surgeons for advanced carcinomas (Ca) of the gallbladder (GB) and the hilar bile duct (HBD). However, high operative mortality and morbidity have been reported and its survival benefit has not been clearly documented. METHODS: We report the results of MHBR for such tumors to determine the safety and the effectiveness of this operation, which has been performed for GB Ca invading the right hepatic pedicle or liver bed by 2 cm or more and for HBD Ca of Bismuth type III or IV. The cases of fifty consecutive cases who received MHBR for GB Ca (n=11) or HBD Ca (n=39) during a 5 year-period were reviewed. RESULTS: Thirty right-sided and 20 left-sided hepatectomies were performed. There was no operative or hospital death. Minor and major complications developed in 64% of the cases. All the complications improved with conservative management, except two in which re operations were required, one due to portal vein thrombosis and the other to bleeding of the retro peritoneal dissection site. No specific factors were associated with the high complication rate. The long-term outcome of HBD Ca was better than that of GB Ca. In HBD Ca, differentiated cancer and less transfusion were associated with a better prognosis. CONCLUSION: MHBR was conducted with acceptable morbidity and no mortality. In terms of the long-term outcome, MHBR is recommended for HBD Ca whereas it should be considered more carefully for GB Ca.
Subject(s)
Bile Ducts , Biliary Tract , Bismuth , Gallbladder , Hemorrhage , Hepatectomy , Liver , Mortality , Prognosis , Venous ThrombosisABSTRACT
BACKGROUND AND AIMS: In the management of patients with extrahepatic bile duct carcinoma, histologic diagnosis is crucial to determine therapeutic modalities, to predict their outcomes, and to avoid an unnecessary operation. Though various methods were developed, none of them yielded satisfactory results. A combination of those methods was reported to yield superior sensitivity and specificity to a single method. To evaluate the diagnostic efficacy, endoscopic transpapillary biopsy (ETPB) and exfoliative bile aspiration cytology (BAC) was performed in 40 patients with extrahepatic bile duct carcinoma. METHODS: After visualization of the biliary tree and the lesion by endoscopic retrograde cholangiopancreatography (ERCP), ETPB (n=40) and BAC (n=28) was done in one session with or without endoscopic sphincterotomy (EST) and the results of two methods were analyzed. RESULTS: The final diagnoses were made by surgical pathology and by clinical follow-ups of more than a year. The locations of the 40 bile duct carcinomas were in the upper area in 25, the middle in 14 and the lower in 1. ETPB was performed in all patients and BAC in 28 patients. The overall sensitivity of the ETPB was 65.0% (26/40). According to the morphology and location, the sensitivity of ETPB was 65.6% (11/32) for sclerotic, 60.0% (3/5) for papillary, and 66.7% (2/3) for the protruding type, and 68.0% (17/25) for the upper bile duct lesion, 64.3% (9/14) for the middle, and 0% (0/1) for the lower. The overall sensitivity of the BAC was 71.4% (20/28). According to the morphology and location, the sensitivity of BAC was 80.0% (16/20) for sclerotic, 20% (1/5) for papillary, and 100% (3/3) for the protruding type, and 82.4% (14/17) for the upper bile duct lesion and 54.5% (6/11) for the middle bile duct lesion. When the two tests were combined, the sensitivity rose to 96.4% (27/28). CONCLUSIONS: A combination of ETPB and BAC is useful in making a histologic diagnosis in patients with bile duct carcinoma.
Subject(s)
Humans , Bile Duct Neoplasms , Bile Ducts , Bile Ducts, Extrahepatic , Bile , Biliary Tract , Biopsy , Cholangiopancreatography, Endoscopic Retrograde , Diagnosis , Follow-Up Studies , Pathology, Surgical , Sensitivity and Specificity , Sphincterotomy, EndoscopicABSTRACT
Objective To investigate the effect of hydroxycam ptothecine on PS2 and COX-2 in nude mice by human bile duct carcinoma QBC939 cells in order to analyze the correlation between PS2 and COX-2 expressions and the development of the tumor.Methods After the model of the transplanted tumor of subcutaneous tissues located the nude mice was constructed by human bile duct carcinoma QBC939 cells,30 nude mice were randomly divided into 3 groups,namely,control group,hydroxycamptothecine low-dose group and high-dose group.The growth of the transplanted tumor was observed and immunohistochemical staining combined with image analysis was used to determine the expression of PS2 and COX-2 in the tumor tissues.Results Compared with that of the control group,the content of PS2 in the tumor tissues was increased in hydroxycamptothecine low-dose group and high-dose group.The content of COX-2 was decreased and the growth of the transplanted tumor was inhibited in both hydroxycamptothecine low-dose group and high-dose group(P