Expressions and significance of transforming growth factor β1, Survivin and Caspase-3 in patients with intrahepatic bile duct stones and bile duct stenosis / 中华肝胆外科杂志

Objective To investigate the expressions and the significance among the three markers TGF β1,Survivin and Caspase-3 in intrahepatic bile duct tissues in patients with intrahepatic bile duct stones.Method Total of 130 paraffin section of intrahepatic bile duct tissue were collected at Department of Pathology,The 904th Hospital of Joint Logistic Support Force of PLA from 2013 to 2018.Total of 50 patients with intrahepatic bile duct stones complicated with bile duct strictures (the stenosis group),40 patients with intrahepatic bile duct stones with chronic inflammation (the inflammation group),and 40 patients with normal liver tissues (the normal control group) were included in this study.The expressions of TGF β1,Survivin and Caspase-3 in liver tissues were detected by immunohistochemistry and compared among the 3 groups to find their correlations with the clinicopathological features of the disease of the patients.Results TGF β1 was expressed in 72.0％ of the patients in the stenosis group,37.5％ in the inflammatory group,and 15.0％ in the normal control group.The differences among the groups were significant (P ＜ 0.05);Survivin was expressed in 78.0％ of the patients in the stenosis group,47.5％ in the inflammatory group,and 25.0％ in the normal control group.The differences among the groups were significant (P ＜ 0.05);Caspase-3 was expressed in 10.0％ of the patients in the stenosis group,42.5％ in the inflammatory group,and 75.0％ in the normal control group.The differences among the groups were significant (P ＜ 0.05).Within the stenosis group,TGF β1 was negatively correlated with Caspase-3 (r =-0.882,P ＜ 0.05),and positively correlated with Survivin (r =0.889,P ＜ 0.05).Survivin and Caspase-3 were also negatively correlated (r=-0.923,P＜0.05).Conclusion Abnormal expressions of TGF β1,Survivin and Caspase-3 were involved in the formation of intrahepatic bile duct stones associated with bile duct strictures.

Cystic duct drainage into hepatic ducts: a primary study using three dimensional magnetic resonance cholangiopancreatography / 中华肝胆外科杂志

Objective To study the pattern of cystic duct (CD) drainage into hepatic ducts (CDIHD) by using three dimensional magnetic resonance cholangiopancreatography (3D M RCP) combined with conventional MRI sequences.Methods Thirty-eight patients with CDIHD were studied retrospectively and they served as the observation group.Another 38 patients who had no CDIHD were selected randomly and they served as the control group.The hepatic bile duct where the CD drained in the observation group,the site where the common hepatic duct (CCHD) started,and the types of the intrahepatic bile duct (IHBD) in the two groups were analyzed.The types of the IHBD were classified according to the modified Couinaud's criteria.Results There were 26 patients who had their CD draining into the right liver bile ducts,9 into the incomplete common hepatic duct,and 3 into the left hepatic duct in the observation group.For the types of IHBD in the observation/control groups,type A was observed in 15/19 patients,type B in 0/6,type C in 22/1,type D in 0/9,type E in 0/2,and type F in 1/1,respectively.The differences were significant (P ＜ 0.05).The number of patients who had their CCHD starting in the porta hepatis,superior duodenal bulb,posterior duodenal bulb,and pancreatic head in the observation/control groups,were 1/36,19/2,17/0,1/0,respectively.The differences were also significant (P ＜ 0.05).Conclusion In patients with CDIHD,CD most commonly drained into the right hepatic duct.Patients with CDIHD had a different IHBD type,and the IHBD confluence was lower.

Cystic duct drainage into hepatic ducts: a primary study using three dimensional magnetic resonance cholangiopancreatography / 中华肝胆外科杂志

Objective To study the pattern of cystic duct (CD) drainage into hepatic ducts (CDIHD) by using three dimensional magnetic resonance cholangiopancreatography (3D M RCP) combined with conventional MRI sequences.Methods Thirty-eight patients with CDIHD were studied retrospectively and they served as the observation group.Another 38 patients who had no CDIHD were selected randomly and they served as the control group.The hepatic bile duct where the CD drained in the observation group,the site where the common hepatic duct (CCHD) started,and the types of the intrahepatic bile duct (IHBD) in the two groups were analyzed.The types of the IHBD were classified according to the modified Couinaud's criteria.Results There were 26 patients who had their CD draining into the right liver bile ducts,9 into the incomplete common hepatic duct,and 3 into the left hepatic duct in the observation group.For the types of IHBD in the observation/control groups,type A was observed in 15/19 patients,type B in 0/6,type C in 22/1,type D in 0/9,type E in 0/2,and type F in 1/1,respectively.The differences were significant (P ＜ 0.05).The number of patients who had their CCHD starting in the porta hepatis,superior duodenal bulb,posterior duodenal bulb,and pancreatic head in the observation/control groups,were 1/36,19/2,17/0,1/0,respectively.The differences were also significant (P ＜ 0.05).Conclusion In patients with CDIHD,CD most commonly drained into the right hepatic duct.Patients with CDIHD had a different IHBD type,and the IHBD confluence was lower.

Effects of cold preservation on the expression of GATA in intrahepatic bile duct / 中华消化外科杂志

Objective To investigate the effects of cold preservation on the expression of GATA in intrahepatic bile duct.Methods The intrahepatic bile duct tissues of SD rats were obtained by collagenase perfusion combined with mechanical separation.After being cut into fragments,the intrahepatic bile duct tissues were cultured in rat tail collagen gel for 48 hours before experiment.All the rats were divided into the control group,cold preservation 1 hour (CP1 h) group and cold preservation 12 hours (CP12 h) group.There were 5 rats in each group.The mRNA and protein expressions of GATA were detected by Real-Time polymerase chain reaction and Western blot.Measurement data with normal distribution were presented as (x) ± s.Comparison among 3 groups was done by ANOVA and pairwise comparisons were done by LSD test.Results The mRNA expressions of GATA3,GATA4,GATA6 were detected,while the mRNA expressions of GATA1,GATA2 and GATA5 were undetectable in intrahepatic bile duct tissue of the control group.The mRNA expressions of GATA4 in the CP1 h group,CP12 h group and the control group were 0.72 ± 0.08,0.56 ± 0.07 and 0.96 ± 0.06,with significant difference among the 3 groups (F =38.981,P ＜0.05).The mRNA expression of GATA4 in the CP12 h group was significantly lower than that in the CP1 h group and the control group,and the mRNA expression of GATA4 in the CP1 h group was significantly lower than that in the control group (P ＜ 0.05).The mRNA expression of GATA6 in the CP1 h group,CP12 h group and the control group were 0.83 ± 0.07,0.68 ± 0.12 and 0.98 ± 0.12,with significant difference among the 3 groups (F =10.175,P ＜ 0.05).The mRNA expression of GATA6 in the CP12 group was significantly lower than that in the CP1 h group and the control group,and the mRNA expression of GATA6 in the CP1 h group was significantly lower than that in the control group (P ＜ 0.05).The mRNA expressions of GATA3 in the CP1 h group,CP12 h group and the control group were 0.92 ± 0.06,0.89 ± 0.05 and 0.98 ± 0.11,with no significant difference among the 3 groups (F =1.674,P ＞ 0.05).The protein expressions of GATA4 in the CP1 h group,CP12 h group and the control group were 0.78 ± 0.07,0.64 ± 0.06 and 0.99 ± 0.10,with significant difference among the 3 groups (F =24.211,P ＜ 0.05).The protein expression of GATA4 in the CP12 h group was significantly lower than that in the CP1 h group and the control group,and the protein expression of GATA4 in the CP1 h group was significantly lower than that in the control group (P ＜ 0.05).The protein expressions of GATA6 in the CP1 h group,CP12 h group and the control group were 0.90 ± 0.04,0.75 ±0.06 and 0.98 ±0.11,with significant difference among the 3 groups (F=11.651,P＜0.05).The protein expression of GATA6 in the CP12 h group was significantly lower than that in the CP1 h group and the control group (P ＜ 0.05).Conclusion The expressions of GATA4 and GATA6 in the intrahepatic bile duct tissues are decreased significantly after cold preservation,which indicate that GATA4 and GATA6 might be involved in the pathophysiological process of the bile duct after cold preservation.

Clinical research of treatment effect of minimally invasive excision in intrahepatic bile duct stones / 局解手术学杂志

Objective To investigate the treatment effect of minimally invasive excision in intrahepatic bile duct stones. Methods Ac-cording to different treatment methods, 280 patients with intrahepatic bile duct stones were divided into the treatment group (180 cases) and the control group(100 cases). The control group were given open hepatic lobectomy while the treatment group were given minimally invasive treatment of hepatic lobectomy by laparoscopy. Results All patients had successfully completed surgery and the stones were removed. Compared the operation time,intraoperative blood loss,and blood transfusion of the two groups,and there were no statistically significance (P>0. 05). The postoperative hospitalization,time of drainage tube remove, time of analgestic drug use in treatment group were obviously lower than those in control group,which had statistically significance (P<0. 05). The common postoperative complications of the two groups were bile leakage,wound infection,pleural effusion and subphrenic abscess,et al. The complication rate of treatment group was 2. 2%, while it was 10. 1% in the control group, which had significant difference (P<0. 05). All the patients were followed-up for 6 months, and there was no death in patients. Conclusion Intrahepatic bile duct stones in progress could be treated by hepatic resection surgery. Laparoscopic techniques could accelerate the recovery of patients and reduce the complication rate,and it would become a new treatment option.

Polyarteritis nodosa presented as a dilatation of the intrahepatic bile duct

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems. PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver. We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver.

Disappearance of Intrahepatic Bile Duct Hepatocellular Carcinoma after Endoscopic Retrograde Cholangiopancreatography and Transarterial Chemoinfusion: A Case Report / 대한소화기학회지

Invasion of the bile duct by hepatocellular carcinoma (HCC), which is called intrahepatic bile duct HCC, is rare and has a poor prognosis. Early diagnosis and surgical resection is important for treatment. A 58-year-old man who underwent hepatic resection for HCC 4 years ago and received transarterial chemoembolization (TACE) 2 years after the operation for recurred HCC presented with jaundice. CT scan revealed a tumor in the common bile duct without intrahepatic lesion. Therefore, ERCP was done to perform biopsy and biliary drainage. Histological examination was compatible with hepatocellular carcinoma. However, the tumor could not be visualized at angiography and thus, only transarterial chemoinfusion was performed without embolization. The tumor had disappeared on follow-up CT scan, and the patient has been disease free for 23 months without evidence of recurrence. Herein, we report a case of intrahepatic bile duct HCC which disappeared after ERCP.

A Case of Fascioliasis in the Intrahepatic Duct with Concurrent Clonochiasis / 대한소화기학회지

The main causes of biliary obstruction are stones and cancers. Fascioliasis is a very rare case which causes biliary obstruction. Fascioliasis is a zoonosis caused by Fasciola hepatica which infects herbivores like sheep and cattle. F. hepatica lives in the biliary system or the liver parenchyma of a host. In Korea, the occurrence of this infection in human is very rare and only few cases have been reported. A 32-year-old male presented with upper abdominal pain and jaundice. His laboratory finding revealed elevated liver transaminases. Abdomen CT scan showed mild left intrahepatic bile duct dilatation. On ERCP, adult F. hepatica worms were found and were thus removed. Concurrently, clonorchiasis was diagnosed by stool exam and serologic enzyme-linked immunosorbent assay test. Clonorchiasis was treated with praziquantel. Herein, we report a case of intrahepatic bile duct dilatation due to F. hepatica infection with concurrent Clonorchis sinensis infestation.

Spontaneous rupture of intrahepatic bile duct following portal vein embolization in a patient with perihilar cholangiocarcinoma: a case of successful curative resection

We herein present a case of spontaneous rupture of intrahepatic bile duct in a patient with perihilar cholangiocarcinoma, which were successfully treated by curative resection. A 60-year-old male patient with perihilar cholangiocarcinoma was decompressed with single percutaneous transhepatic biliary drainage. Two days after right portal vein embolization, the patient suffered from paralytic ileus with marked abdominal distension. Imaging study revealed that marked fluid collection around the liver and whole abdomen, suggesting intrahepatic bile duct rupture. With abdominal drainage and biliary decompression for 2 weeks, the biliary rupture was controlled. To enhance the safety of right hepatectomy, additional right hepatic vein embolization was performed. The patient underwent routine surgical procedures for right hepatectomy, caudate lobectomy and bile duct resection, and recovered uneventfully and discharged 18 days after surgery. This is the first report of a case of spontaneous rupture of intrahepatic bile duct in a patient with perihilar cholangiocarcinoma.

Holmium laser coagulation under choledochoscope for the treatment of intrahepatic hemobilia / 中华消化外科杂志

Objective To investigate the efficacy of holmium laser coagulation under choledochoscope for the treatment of intrahepatic hemobilia.Methods The clinical data of 55 patients with intrahepatic hemobilia who received holmium laser coagulation under choledochoscope at the General Hospital of Chengdu Military Area from June 2003 to August 2011 were retrospectively analyzed.After the hemobilia was confirmed with choledochoscopy,an optical fiber of holmium laser was inserted into the intrahepatic bile duct from the hole of choledochoscope.The top of the optical fiber was posed close to the bleeding region,and then the laser was stimulated for coagulation under direct vision.If the observation of the bleeding area was influenced by the bleeding,the porta hepatis was temporarily occluded with a rubber hose combined with pressurized liquid injection bag.For patients with distal bile duct stenosis and bleeding,the narrow area was first expanded by biliary balloon or laser,then hemostasis was completed after the flow of bile duct was restored.Results The hemorrhage of the 55 patients was controlled,with an average time of 5.5 minutes (range,2-15 minutes).Temporary hepatic portal clamping was applied for 16 patients (27 times),and the average blocking time was 2.2 minutes (range,1-4 minutes).Biliary rehaemorrahagia occurred after operation in 2 patients,and they were cured by non-surgical treatment.All patients were discharged after successful hemostasis.The time of follow-up was 35-49 days.The epithelium of the bile duct coagulated by intraoperative holmium laser restored flat in 41 patients,and new biliary stricture was not found in the other 14 patients.Conclusion Holmium laser coagulation under choledochoscope for intrahepatic hemobilia is simple and effective.

Application of Anatomical Liver Resection in Treatment of Bilateral Hepatolithiasis / 昆明医科大学学报

Objective To explore the value of anatomical liver resection in the treatment of bilateral intrahepatic biliary lithiasis. Methods We collected the clinical data of 32 patients with bilateral intrahepatic biliary lithiasis who received anatomical liver resection and 25 patients who recevied non-anatomical liver resection from May 2010 to May 2012 in our hospital and Sun Yat-sen Memorial Hospital. We comapred the therapeutic efficacy of these two operative modalities in the diagnosis and treatment of bilateral intrahepatic biliary lithiasis. Results The intraoperative blood loss was 436 ±48.162 mL in patients who received anatomical liver resection, and was significantly less than that in the control group (763 ± 37.645ml) ( 0.05 ), but there 1 patients died of liver failure in the control group. Conclusions Anatomical liver resection is a favorable method to completely remove the lesions under the premise of retaining the residual liver function as much as possible. The rate of remnant biliary lithiasis and recurrence is lower and the recovery is quicker in these patients after anatomical liver resection. Thus, anatomical liver resection is worthy of promotion.

Ascariosis vía biliar intrahepática: informe de caso / Intrahepatic biliary ascariosis: case report

La ascariosis es frecuente en la población infantil a nivel mundial, porque no requiere factores territoriales y/o ambientales especiales, la ascariosis hepática es la complicación menos frecuente de la infección parasitaria por este geohelminto intestinal. Sin embargo, el cuadro de ascariosis biliar complicada con abscesos hepáticos se observa en zonas endémicas en nuestra América Latina, donde debe ser un diagnóstico a considerar en pacientes con sintomatología biliar obstructiva, principalmente en niños, ya que por el tamaño pequeño de sus órganos tienen mayor probabilidad de desarrollar un síndrome obstructivo y, consecuentemente diversas complicaciones. La migración de los parásitos puede causar peritonitis después de penetrar la pared abdominal y obstrucción coledociana con los consiguientes cólicos biliares, colangitis o pancreatitis. Este nematodo tiene la habilidad de entrar en ductos, como la vía biliar intra y extrahepática, y al morir dentro de la misma provoca serias complicaciones como obstrucción, colangitis y abscesos secundarios. Caso clínico: Se presenta el caso de una niña de 2 años y 10 meses de edad con antecedente de geofagia, desnutrición proteico-calórica crónica grado II y nivel socioeconómico bajo, que se presentó con historia de eliminación de gusanos redondos por la boca y el recto, distensión abdominal, dolor abdominal, vómitos y fiebre diaria no cuantificada, de dos semanas de evolución. Se realizó ultrasonido abdominal donde se encontró imágenes hipoecogénicas de estructura tubular, que a la presión del transductor se repliegan en forma de "C" o en herradura. La paciente desarrolló distensión abdominal, caracterizada por tensión y dolor abdominal intenso. Discusión: La ascariosis hepatobiliar, aunque rara, se reporta de forma común en países endémicos y tiene una alta morbi-mortalidad si no se diagnostica y se instaura el manejo adecuado tempranamente. Es imperativo que los médicos paceños conozcan esta parasitosis para que con un adecuado manejo contribuyan a disminuir la mortalidad, principalmente infantil, por esta causa. Es necesario implementar medidas de prevención y control eficaces para las geohelmintiasis en La Paz.

The ascariosis is common among children worldwide, because it does not require special territorial and/or environmental factors, the liver ascariosis is the least frequent complication of parasitic infection by the intestinal geohelminto. However, table of biliary ascariosis complicated with liver abscesses is observed in areas endemic in our Latin America, where it must be a diagnosis to be considered in patients with biliary obstructive, mainly in children symptoms, since by the small size of their bodies they are more likely to develop an obstructive syndrome and, as a result various complications. The migration of parasites can cause peritonitis after penetrating the abdominal wall and blockage coledociana attendant Biliary colic, cholangitis or pancreatitis. This nematode has the ability to enterinto pipeline, as a biliary intra and extrahepática, and to die within the same causes serious complications such as obstruction and cholangitis secondary abscesses. Clinical case. The case of a girl of 2 years and 10 months of age with antecedent of geophagy, proteico-calórica chronic malnutrition grade II and socioeconomic level low, which was presented with history of elimination of round worms by the mouth and rectum, abdominal bloating, abdominal pain, vomiting and daily fever not quantified, two weeks of evolution. Abdominal ultrasound found images hipoecogénicas of tubular structure, that the pressure of the transducer is self-replicate "C”-shaped or Horseshoe took place. The patient developed abdominal distention, characterized by tension and intense abdominal pain. Discussion: Ascariosis Hepatobiliary, although rare, reports in common form in endemic countries and has a high morbidity and mortality if not diagnosed and establishing appropriate early management. It is imperative that boasts doctors are aware of this parasitosis that with proper management contribute to decrease mainly child mortality from this cause. It is necessary to implement prevention and control measures effective for the geohelmintiasis in La Paz.

A Case of Clonorchiasis with Focal Intrahepatic Duct Dilatation Mimicking an Intrahepatic Cholangiocarcinoma

Biliary strictures can be caused by various diseases. Intrahepatic duct (IHD) strictures are usually related to IHD stones and cholangitis. However, focal IHD strictures without IHD stones often create diagnostic problems. Parasitic diseases such as clonorchiasis can be a rare cause of an IHD stricture. Human clonorchiasis (Clonorchis sinensis infection) is an endemic parasitic disease in Eastern Asia, including Korea, and patients acquire the infestation by eating raw fish. On radiological examinations, clonorchiasis shows typically diffuse, minimal, or mild dilatation of the small IHD, particularly in the periphery, without dilatation of the extrahepatic duct. However, diagnosis of clonorchiasis can sometimes be difficult when radiological changes are atypical. We report a case of focal left IHD dilatation caused by clonorchiasis that was confused with a malignancy.

A Case of Clonorchiasis with Focal Intrahepatic Duct Dilatation Mimicking an Intrahepatic Cholangiocarcinoma

Biliary strictures can be caused by various diseases. Intrahepatic duct (IHD) strictures are usually related to IHD stones and cholangitis. However, focal IHD strictures without IHD stones often create diagnostic problems. Parasitic diseases such as clonorchiasis can be a rare cause of an IHD stricture. Human clonorchiasis (Clonorchis sinensis infection) is an endemic parasitic disease in Eastern Asia, including Korea, and patients acquire the infestation by eating raw fish. On radiological examinations, clonorchiasis shows typically diffuse, minimal, or mild dilatation of the small IHD, particularly in the periphery, without dilatation of the extrahepatic duct. However, diagnosis of clonorchiasis can sometimes be difficult when radiological changes are atypical. We report a case of focal left IHD dilatation caused by clonorchiasis that was confused with a malignancy.

Percutaneous ultrasound-guided thermal ablation of intrahepatic cholangiocarcinoma / 中华肝胆外科杂志

Objective To evaluate the clinical value of percutaneous ultrasound (US)-guided thermal ablation of intrahepatic cholangiocarcinoma. Methods 14 patients (19 nodules) with histolog-ically proven intrahepatic cholangiocarcinoma (ICC) were treated with percutaneous US-guided thermal ablation from Oct. 1998 to Aug. 2009 in our hospital. The local treatment response, complication and survival were retrospectively analyzed. Results 18 (18/19, 94.7%) nodules had complete necrosis, and 1 (1/19, 5.3%) nodule had residual tumor after ablation. There was no mortality associated with thermal ablation. Only 1 (1/14, 7.1%) patient developed portal vein thrombosis. The follow-up ranged from 1.3 to 72.9 months (mean, 19.0±15.1 months; median, 7.25 months), 10 (10/14,71.4%) patients survived less than 1 year, 2 (2/14,14.3%) survived 1-5 years, and 2 (2/14,14.3%) survived more than 5 years. Of the 14 patients, 9 (9/14, 64.3%) had died and 5 (5/14,35.7%) were alive. The causes of death included tumor progression (8/9, 88.9%) and liver failure (1/9, 11.1%). 9 (9/14,64.3%) patients developed recurrence on follow-up. The disease-free survival ranged from 1.1 to 72. 9 months (mean 16.6±26. 3 months; median 4.1 months). Conclusion Percutaneous US-guided thermal ablation therapy using microwave ablation (MWA) or radiofrequency ablation (RFA) is a safe and effective therapy for intrahepatic cholangiocarcinoma.

Introduction of 7th AJCC TNM Staging for Liver and Intrahepatic Bile Duct Malignancies

PURPOSE: Cancer staging is essential in clinical cancer practice in medical and surgical oncology. Staging based on the guidelines of the American Joint Committee on Cancer (AJCC) is the most popular and is widely used in clinical fields. Early this year, the 7th edition of the AJCC cancer staging manual was published. I have compared and described the changes in the new edition from the older version to facilitate staging in clinical settings, especially for liver and intrahepatic bile duct malignancies. METHODS: On the basis of the new 2010 edition of the 7th AJCC TNM cancer staging manual, I have compared hepatobiliary malignancy in Chapter 18, liver malignancy and intrahepatic bile duct malignancy in Chapter 19. RESULTS: One of the major changes in the 7th AJCC manual compared to the 6th AJCC staging manual published in 2002 is separation of the Liver and Intrahepatic bile duct cancer chapters. In the previous edition, intrahepatic bile duct cancer was included in the liver malignancy chapter. CONCLUSION: There are no universal and permanent staging systems for cancer. The staging systems are ever changing to adjust for changes in treatment and prognosis of malignancies. We need to collect data in order to modify the staging correctly in collaboration with multi-institutional efforts to reduce biases in staging liver and intrahepatic bile duct cancers.

Synchronous Undifferentiated Carcinoma of Gallbladder in a Patient with Intrahepatic Intraductal Papillary Mucinous Neoplasia (b-IPMN)

Simultaneous development of intrahepatic bile duct and gallbladder carcinoma is extremely rare. We report herein the case of an 86-year-old man found to have double cancer of the gallbladder and intrahepatic bile duct. Computed tomography and magnetic resonance cholangiopancreatography revealed a polypoid mass in the gallbladder and dilatation of the intrahepatic bile duct with intraductal papillary tumor in the left side of the liver. The patient underwent left hepatectomy, cholecystectomy with lymphadenectomy around the hepatoduodenal ligament. Pathological examination of the gallbladder revealed undifferentiated giant cell type carcinoma invading the muscularis propria. On the other hand, the liver tumor was intrahepatic intraductal papillary mucinous carcinoma in situ. Therefore, this was an extremely rare case of synchronous carcinoma of the gallbladder associated with intrahepatic cholangiocarcinoma.

Analysis of constitution of cholelithiasis in Qingdao Municipal Hospital: changes in occurrence of cholelithiasis in Jiaodong Region / 中华肝胆外科杂志

Objective To analyze the clinical features of patients with cholelithiasis treated in our hospital in the recent 10 years to explore the changing tendency of the spectrum of cholelithiasis in the Jiaodong region. Methods The clinical data of 2899 patients receiving operation for cholelithiasis in this hospital between January 1998 and January 2008 were retrospectively analyzed. The clinical parameters of sex, age and the lesion sites were reviewed. Compared with the clinical data of cholelithiasis patients in 1991, the data of the 2899 patients were statistically analyzed by SPSS 12.0 package.Results Significant differences existed in sex, e peak morbidity, and lesion sites. The ratio of male patients and female patients with cholelithiasis in differents site had obvious diversity. The constituent ratio of the female was manifestly higher than that of the male. The peak morbidity age range of cholecystolithiasis was 40 to 69. The peak age of gallbladder stones combined with common bile duct stones was 70 to 79, which was the same as that of common bile duct stones. The peak age of intrahepatic bile duct stones was 40 to 59. The constituent ratio of cholecystolithiasis was obviously higher than cholelithiasis in other sites. The incidence of cholecystolithiasis increased with age. Conclusion In the recent 10 years, female's ratio of gallbladder stones and intrahepatic stones was higher than male's.The morbidity of cholelithiasis significantly increased in aged patients. The spectrum of cholelithiasis has changed significantly.

Effect of implantation of bone marrow mononuclear cells on ischemic-type intrahepatic biliary lesion in rabbits / 中华肝胆外科杂志

Objective To investigate the effect of implantation of bone marrow mononuclear cells (BM-MNCs)on neovascularization and ischemic-type intrahepatic biliary lesion in rabbits.Methods The animals were divided into the sham-operation group, experimental model group and BM-MNCs implantation group with 10 rabbits in each. The animal model of ischemic-type intrahepatic biliary lesion was established by clamping the hepatic artery and common bile duct. The BM-MNCswere isolated from the tibial plateau by means of density gradient centrifugation and were implanted through the common hepatic artery. Changes of some biochemical markers such as ALT, AST, ALP,γ-GT, TBIL and DBIL etc. were detected. In 4 weeks after operation, the cholangiography, histopathological manifestation, differentiation of BM-MNCs, and microvessel density were observed.Results At each observation time, the degree of change of biochemical markers in group C was lower than that in group B. The engrafted cells could differentiate into vascular endothelial cells. The intrahepatic biliary lesion of group B was severer than that of group C but had fewer new capillary blood vessels around it. Conclusion The implantation of BM-MNCs can promote neovascularization and increase blood supply to the ischemic bile duct to diminish or prevent ischemic-type intrahepatic biliary lesion.

Expression of mucins in intrahepatic bile duct tissues after cold preservation / 中华消化外科杂志

Objective To investigate the expression of Muc1,Muc3A and Muc4 in cultured intrahepatic bile duct(IBD)tissues from different hepatic segments after cold preservation.Methods The IBD tissues of SD rats were obtained by collagen perfusion combining mechanical separation and then were divided into large and small IBD.The 2 parts of IBD were seeded in rat tail collagen gel and were cultured for 48 hours,then the IBD tissues from 10 rats were stored in UW solution at 4℃ for 1 hour(group I,n=5)and 12 hours(group Ⅱ,n=5),respectively,and the IBD tissues from the rest 5 rats were cultured in incubator at 37℃ for 24 hours (control group,n=5).The expressions of Muc1,Muc3A and Muc4 were detected by RT-PCR and Western blot.All data were analysed via ANOVA or LSD test.Results The expressions of Muc1,Muc3 A and Muc4 were detected both in large and small IBD tissues.The mRNA expressions of Muc1,Muc3A and Muc4 were decreased in large IBD as time passed by,which were 0.95±0.14,0.26±0.04 and 0.24±0.06 in group Ⅰ,0.18±0.03,0.14±0.04 and 0.22±0.07 in group Ⅱ,1.00±0.20,1.00±0.09 and 1.00±0.21 in control group,with significant difference among the 3 groups(F=8.8,57.1,10.8,P＜0.05).The mRNA expressions of Muc1 and Muc3A in group Ⅱ were significantly lower than in group Ⅰ(P＜0.05).The protein expressions of Muc1 and Mue3A in large IBD were also decreased as time passed by,which were 0.82±0.13,0.73±0.10 in group Ⅰ,0.56±0.11,0.33±0.04 in group Ⅱ,1.05±0.41,1.06±0.38 in control group,with significant difference among the 3 groups(F=3.9,12.6,P＜0.05).The protein expression of Muc1 of group Ⅱ was significantly lower than in control group(P＜0.05),and the protein expression of Muc4 in group Ⅱ was significantly lower than in group Ⅰ(P＜0.05).The mRNA expressions of Muc3A in small IBD were increased as time passed by,which were 0.15±0.04 in group Ⅰ,0.19±0.05 in group Ⅱ and 0.06±0.03 in control group.Conclusion Decreases of Muc1,Muc3A and Muc4 in IBD after long time cold preservation may weaken the selfprotection of biliary epithelium and case sever injury to bile duct.