Research progress of animal model of iatrogenic benign biliary stricture / 中华肝胆外科杂志

With the popularity and development of minimally invasive surgery such as laparoscopic cholecystectomy, the incidence of iatrogenic biliary tract injury and biliary duct stenosis after injury has been increased significantly. The biliary duct injury of laparoscopic cholecystectomy is mainly heat damage, and the biliary duct tissue is prone to biliary duct stenosis after heat injury. Currently the treatment of complex iatrogenic biliary stricture has still been a difficult and unfinished problem. It’s necessary to explore the therapy options of iatrogenic biliary stricture based on animal models of biliary stricture. According to the literature at home and abroad, this article reviewed the methods and advantages and disadvantages of several models of benign biliary stricture.

The Nomogram model in predicting prognosis of hepatocellular carcinoma patients based on four inflammatory markers / 中华肝胆外科杂志

Objective:To construct a Nomogram model in predicting recurrence-free survival (RFS) and overall survival (OS) at six months, one year and two years after hepatocellular carcinoma (HCC) resection by using inflammatory markers combined with other routine clinical indicators.Methods:The data of 314 patients with HCC who underwent first time hepatectomy at Beijing Chaoyang Emergency Rescue Center and Air Force Characteristic Medical Center from January 2013 to January 2018 were analyzed. HCC patients who underwent hepatectomy at the First Medical Center of PLA General Hospital from January 2011 to January 2016 ( n=106) were used as the external validation group. Univariate and multivariate Cox proportional risk model was used to analyze independent risk factors of recurrence and death in HCC patients. A Nomogram model was constructed based on independent risk factors. Validation of the efficacy of the Nomogram model was done based on external data. Results:In the experimental group, 174 patients relapsed. The median RFS was 26 months. The 6 months, 1 year and 2 years RFS were 26.8%, 43.9%, and 68.8%, respectively. A total of 142 patients had died. The median survival time was 30 months. The 6 months, 1 year and 2 years OS were 5.9%, 23.6% and 63.1%, respectively. In the external validation group, 63 patients had developed recurrence, with a median RFS time of 28 months. The 6 months, 1 year and 2 years RFS were 26.4%, 45.3%, 54.7%, respectively. The median survival time was 31 months. The 6 months, 1 year and 2 years OS were 7.5%, 25.5%, 46.6%, respectively. Tumor size (>6.0 cm, HR: 1.447), vascular invasion ( HR: 1.408), TBil (>0.94 mg/dl, HR: 1.949), NLR (>2.54, HR: 2.843), AGR (≤0.88, HR: 2.447) were independent risk factors of HCC recurrence ( P<0.05). Tumor size (>6.0 cm, HR: 2.207), vascular invasion ( HR: 1.529), and NLR (>2.54, HR: 2.708) were independent risk factors of death for HCC patients ( P<0.05). The C-indexes of half-year, one-year and two-year RFS were 0.764 (95% CI: 0.677-0.854), 0.710 (95% CI: 0.615-0.824) and 0.673 (95% CI: 0.601-0.786), respectively. The C-indexes of half-year OS, one-year OS and two-year OS were 0.729 (95% CI: 0.648-0.841), 0.708 (95% CI: 0.608-0.813) and 0.664 (95% CI: 0.618-0.771), respectively. Conclusion:In this study, the construction of a Nomogram model in predicting prognosis of HCC patients was helpful to guide clinicians in improving preoperative treatment plans and in providing ideas for individualized treatment of patients.

Essentials of precision medicine in practice of surgical oncology for hepatobiliary tumors / 中华肝胆外科杂志

Precision,minimal invasiveness,digitalization,information technology and integrative medicine were considered as the future driving force of hepatobiliary surgery progress in the era of precision medicine,especially in the comprehensive management for patients with hepatobiliary (HB) tumors.Given the encouraging outcomes in the genomic technology-based precision treatment of cancers,we believe that a paradigm shift is emerging in the surgical management for HB tumors with cumulative practice in precision medicine.The current practice would be changed in:(1) the precision neoadjuvant therapy for unresectable HB tumors would come into practice to improve the long-term survival or increase the resec-tability;(2) precision management may become a first-line strategy to prevent the postoperative disease recurrence;(3)patients with recurrent intractable HB tumors could be conversed to the chronic status of surviving with tumor.Given the large population of HB tumors and current status of precision,the precision-based paradigm shift is inevitable in the surgical management for HB tumors.It's therefore mandatory for the new generation of hepatobiliary surgeons to comprehend the concept and technology of precesion medicine into the current practice.We compose this article to emphasize the role of precision medicine in practice of surgical oncology for HB tumors

A comparative study of the effect of irreversible electroporation and radiofrequency ablation on rat liver neovascularization / 中华肝胆外科杂志

Objective To investigate the difference of hepatic microvessel density, neovasculariza-tion of regenerating liver tissue after ablation of two ways of irreversible electroporation and radiofrequency ablation in rats. Methods 90 male Sprague-Dawley rats were randomly divided into 3 groups, including the control group ( n =30), the irreversible electroporation group ( n =30 ) and the radiofrequency ablation group (n=30). 3,7 and 10 days were executed after the operation and draw material, expression of vascu-lar endothelial growth factor(VEGF) and CD34 in tissue was studied by immunohistochemistry, and the mi-crovascular density of tissue and VEGF positive cells were measured. Results The microvascular density of 3, 7 and 10 days in the control group was 50. 3 ± 12. 5, 54. 6 ± 11. 9 and 58. 2 ± 14. 7, the microvascular density of the radiofrequency ablation group was 18. 4 ± 4. 7, 17. 3 ± 5. 1 and 18. 1 ± 5. 9, respectively. The microvascular density of the irreversible electroporation group was 42. 8 ± 10. 4, 45. 6 ± 10. 2 and 49. 2 ± 13. 8, respectively. The positive cells of VEGF in control group was 50, 56 and 57 at 3, 7 and 10 days, and 32, 30 and 33 at 3, 7 and 10 days in radiofrequency ablation group, 44, 43 and 45 at 3, 7 and 10 days in irreversible electroporation group; expression of VEGF and CD34 in 3, 7, 10 d and the microvascular density of ablation area in radiofrequency ablation group was significantly lower than those in control group after irreversible electroporation and radiofrequency ablation. No significant differences were found between irreversible electroporation group and control group. Conclusion The irreversible electroporation can effectively protect the microvessels in the ablation area, ensure the tissue’s blood supply after the ablation, and provide a guarantee for the repair and regeneration of the tissue.

Surgical treatment of hepatic hemangiomas: a study of 908 patients / 中华肝胆外科杂志

Objective To study the surgical treatment of hepatic hemangiomas and the timing of surgery.Methods A retrospective study was conducted on 908 patients with giant hemangiomas who underwent surgery between December 1997 and December 2017.The clinical data,surgical indications,surgical outcomes,lesion size,and the effect of TAE were compared.Results The diameter (mean + /-S.D.)of the resected hepatic cavernous hemangiomas was (11.1 ± 6.2) cm (the longest diameter was 60 cm).585 patients (64.4％) underwent enucleation of hepatic hemangiomas and 323 patients (35.6％) underwent anatomical hepatectomy.Six patients died perioperatively (mortality rate 0.7％).The incidence of severe complication (Clavien-Dindo grade 3 ～ 5) was 3.8％.The incidence of severe postoperative complication for enucleation (2.7％) was significantly less than anatomic liver resection (5.6％,P ＜0.05).When the lesion was more than 20 cm,the complication and mortality rates were significantly higher than those less than 20 cm (P ＜ 0.05).The complication and mortality rates in patients who underwent TAE before surgery were significantly higher than those without TAE (P ＜ 0.05).Conclusions Surgical enucleation of hemangiomas was superior to anatomical hepatectomy.With increase in tumor size,the risk of surgery increased.Surgical treatment was safe and effective for giant hepatic hemangiomas.For giant hepatic hemangiomas with significant increase in size,prompt surgical treatment is recommended.

Study of different teaching methods in directing graduated students in the department of hepatobiliary surgery / 中华肝胆外科杂志

Objective To investigate the feasibility and realistic significance of different teaching methods in professional and scientific degree graduate students.Methods Twenty six graduate students (scientific 12,professional 14) were randomly selected as research object from Sep.2014 to Apr.2017,and the relationship between clinical or research outcome and type of degree,clinical or experiment time were analyzed.Results The experiment time of scientific degree graduate students was significantly longer than that of professional degree graduate students [(21.0 ± 1.6) vs.(11.0 ± 3.5) months],and professional degree graduate students paid more attention to clinical work,there was statistic difference between the two groups [(20.0 ±2.1) vs.(12.0 ±2.4) months,both P＜0.05].The qualification rate of basic clinical manipulation in the professional group was higher than that in the scientific group (85.7％ vs.75.0％,P ＜ 0.05).Conclusion Different type of teaching methods based on the type of student degree were feasible and proper for graduate students in surgery,and the terminal object of our teaching should be focus on the resolution of clinical problems.

Irreversible electroporation for treatment of locally advanced pancreatic cancer / 中华肝胆外科杂志

Objective To evaluate the overall survival in patients with locally advanced pancreatic cancer (LAC) treated with irreversible electroporation (IRE) and chemotherapy.Methods A retrospective study on the overall survival of 30 patients with LAC treated with IRE,and 30 patients with LAC treated with chemotherapy from July 2015 to October 2016 in the PLA General Hospital was conducted.Results For the 30 patients with LAC who underwent IRE successfully,there were 21 women and 9 men.The median age was 59 (36 ～81) years.Twenty-four patients had primary pancreatic head cancer and 6 had body cancer.Twelve (40.0％) of these patients had chemotherapy after the IRE ablation.The 90-day mortality in the IRE treated patients was 3 (10.0％).For the 30 patients with LAC who were treated with chemotherapy,the 90-day mortality was 6 (20.0％).In comparison of the IRE treated patients with the chemotherapy treated patients,improvements on disease-free survival (6 months vs.4 months,P ＜ 0.05) and overall survival (11 months vs.5.6 months,P ＜ 0.05) were observed.Conclusion IRE ablation of LAC was safe and could potentially improve overall survival when compared with the standard chemotherapy treatment.

Effect of donor in brain death on liver transplantation / 中华肝胆外科杂志

Liver transplantation is one of the main treatments for acute and chronic liver failure currently.In recent years,with the lack of donor liver transplantation and the in creasing number of patients,the major donator of liver transplant is brain dead patients.In brain-dead state,organ functions de cline gradually.Changes in hemodynamics and immunity could lead to inflammation and alter hormone release.Organ survival and patients'prognosis can be unpredictable.The study of the above phenomenal mechanisms is still at an early stage.This article summarized the current liver transplant treatments by explai ning the pathophysiology of donor organ damage and reviewing the prognosis.The aim of this article was to provide a perspective for future study on this topic.

Selective bowel decontamination improves the prognosis of extended hepatectomy in rats / 中华肝胆外科杂志

Objective To investigate the effect of selective bowel decontamination (SBD) on prognosis of 90％ hepatectomy in rats.Methods We adopted rat model of subtotal hepatectomy(90％,SHx),gentamicin + polymyxin + nystatinor saline of the same amount was administrated preoperatively.Liver damage makers,portal and systemic lipopolysaccharide(LPS),mucosal damage,signaling pathways and liver regeneration were investigated.Results We found that SHx resulted in significantly enhancedsystemic LPS.Inhibition of gastrointestinal gram-negative bacteria by SBD significantly reduced LPS levels and improved survival after SHx.SBD protected intestinal mucosa barrier,alleviated liver parenchymal damage and inflammation and promoted liver regeneration.Conclusion SBD is beneficial and necessary for extended heptactomy.

Gastric hepatoid adenocarcinoma： a report of 25 patients / 中华肝胆外科杂志

Objective To study the clinicopathological features and prognosis of Gastric hepatoid adenocarcinoma (GHA) and aims to guide future clinical practice.Method We retrospectively studied the clinical data of 25 patients with pathologically confirmed GHA who were admitted to our hospital from January 2003 to December 2015.Results There were 19 males and 6 females.The average age was 61.2 years.The clinical manifestations were non-specific.Pathologically,majority of GHA presented with ulcerative type,poor differentiation and extensive vascular cancerous embolus.Preoperative liver metastases were found in 12 patients,and postoperative liver metastases in 15 patients.Conclusions GHA is a special primary gastric adenocarcinoma which possesses both hepatocellular carcinoma-like and adenocarcinoma-like histology.GHA is characterized by a significantly elevated serum AFP and early hepatic metastasis.GHA is therefore often misdiagnosed as primary hepatocellular carcinoma.The main treatment option remains to be surgical resection,and the prognosis is poor.

Bone marrow-derived mesenchymal stem cells improved prognosis in rats with extended liver resection / 中华肝胆外科杂志

Objective To study the role of mesenchymal stem cells (MSC) in an animal model combining ischemia-reperfusion with 85％ liver resection.Methods Eight-week-old male SD rats received BM-MSC by tail vein and then underwent 30-min ischemia followed by 85％ liver resection.The survival rate was monitored for 7 days after surgery.Liver regeneration was assessed on day 2 after hepatectomy.Liver damage,liver cell apoptosis,and cytokine expression in the first 24 h after hepatectomy were also assessed.Results BM-MSC mostly homed to the spleen.Transplantation significantly inhibited myeloperoxidase [(19.9 ± 6.0) mg/g vs.(41.4 ± 10.2) mg/g] and downregulated proinflammatory cytokines.BM-MSC significantly reduced the ALT and AST levels [AST (1 475 ± 275) IU/L vs.(2 550 ± 441) IU/L,P ＜ 0.05;ALT (738 ± 101) IU/L vs.(1 113 ± 268) IU/L,P ＜ 0.05].The attenuation of liver injury was also verified histologically 24 h after surgery.Liver cell apoptosis was markedly reduced.Moreover,BM-MSC infusion significantly promoted remnant liver regeneration.As a result,the survival rate was improved by BM-MSC treatment in this model (95％ vs 70％,P ＜ 0.05).Conclusion In an animal model combining ischemia-reperfusion with 85％ liver resection,BM-MSC infusion attenuated liver injury and promoted hepatocyte regeneration,resulting in improved survival rate.

Gastric hepatoid adenocarcinoma: a specific type of gastric adenocarcinoma easily misdiagnosed as hepatocellular carcinoma / 中华肝胆外科杂志

Gastric hepatoid adenocarcinoma (GHA) is a rare but important sub-type of gastric adenocarcinoma characterized by high serum α-fetoprotein,early lymphatic and hepatic metastasis,and poor prognosis.Clinically,the presentation could be atypical,liver neoplasm could be the initial finding.With similar clinicopathological presentation as hepatocellular carcinoma (HCC),prompt and correct diagnosis can be a challenge,especially in endemic areas with a high incidence of HCC.Once diagnosed,surgical removal remains the treatment of choice.This review focus on advancement on the biological,histological and immunohistological features,and the clinicopathological presentation of GHA.

Perioperative safety and effect of irreversible electroporation in the management of locally advanced pancreatic carcinoma / 中华肝胆外科杂志

Objective To evaluate the perioperative safety and effect of irreversible electroporation (IRE) in the treatment of locally advanced pancreatic carcinoma (LAPC).Methods Twenty patients with imaging and cytohystological diagnosis of unresectable locally advanced pancreatic carcinoma were enrolled to undergo IRE treatment.The perioperative IRE-related complications were primarily analyzed to evaluate the safety of the procedure.The tumor reduction and biological response were analyzed through CT/MRI imaging and serous level of CA19-9.Results All patients were successfully treated with an average tumor size of(4.2 ± 0.6) cm and an average procedure time of (52.0 ± 23.3) minutes.Three intraoperative procedure-related complications were observed (15.0％) including two transient hypertension and one transient superventricular tachycardia.Six postoperative complications were described including two Grade A pancreatic fistula,one infection of incision,one portal vein thrombosis,one gastrointestinal hemorrhage and two functional delayed gastric emptying.The symptom remission rate was 73.7％ and lower serum CA19-9 level was recorded in all patients at discharge.Conclusions IRE is a safe and feasible procedure in the treatment of LAPC, and a reasonable operation strategy of IRE is helpful to consolidate the safety and efficacy.

Radical surgery for adenocarcinoma of body and tail of pancreas: current status and future perspectives / 中华肝胆外科杂志

Radical resection is crucial in the surgical treatment of adenocarcinoma of the body and tail of pancreas.It usually refers to negative resection margin and dissection of regional lymph nodes.In recent reports,the definition of R0 margin has been updated,and radical antegrade modular pancreatosplenectomy (RAMPS),which was first described by Strasberg et al,contributes to achieving negative tangential margins.In some cases,extended radical resections were adopted in an attempt to achieve R0 margin.However,it would increase operation related morbidity and mortality,which should be taken into account before the procedure.Lymph nodes metastasis is an important prognostic factor.Extended lymph nodes dissection does not seem to bring survival benefits,while itg helpful in assessing the tumor stages and patients' prognosis.Laparoscopic distal pancreatectomy (LDP) has been applied in the treatment of ductal adenocarcinoma of the pancreas in reports with small sample sizes.But it remains controversial whether LDP is superior comparing to conventional open methods in regards to oncological outcomes.Curently,surgery is the promising method that may cure adenocarcinoma of the body and tail of pancreas.Highlighting radical resection will bring more survival benefits to patients.

Research progress on prevention and treatment of portal vein thrombosis after splenectomy for patients with hepatic cirrhosis / 中华肝胆外科杂志

Portal vein thrombosis is a common though serious complication after splenectomy in patients with liver cirrhosis and portal hypertension.Its pathogenesis may be primarily associated with the coagulation mechanism and the changes of hemorheology.The clinical presentations of portal vein thrombosis after splenectomy depend on the course of disease,as well as site and degree of obstruction.The principle of treatment is to improve microcirculation,relieve the platelet aggregation and prevent further progress of the thrombosis.But in clinical settings,signs and symptoms of portal vein thrombosis were generally atypical.Any misdiagnosis or delayed treatment may expose the patients under risk.This article focuses on the risk factors,potential mechanisms and recent progress on the prevention of post-splenectomy portal vein thrombosis.

Surgical treatment of patients with pancreatic ductal stones: a report of 60 cases / 中华肝胆外科杂志

Objective To analyze the perioperative complications and prognosis of surgical treatment of pancreatic ductal stones.Methods 60 patients diagnosed to have pancreatic ductal stones and were admitted into our hospital from January 2009 and December 2014 were enrolled into this retrospective study.There were 47 males and 13 females.The average age was (44.1 ± 12.0).Results All patients underwent surgical operation and there was no perioperative death.Perioperative complications occurred in 7 patients (11.7％), including pancreatic fistula in 4 patients, delayed gastric emptying in 1 patient, abdominal infection in 1 patient, anastomotic bleeding in 1 patient.Eight patients developed elevated amylase levels.The fasting time was 3.4 ± 1.2 days and the hospital stay was 10.0 ±4.0 days.The follow-up rate was 88.3％ (53/60), at a mean follow-up of 27 months.In 51 patients who presented with abdominal pain, 43 patients (84.3％) had complete pain relief and 7 patients (13.7％) had partial pain relief.In 14 patients with preoperative diabetes mellitus, 1 patient had improvement and 2 patients recovered from diabetes.Two additional patients were diagnosed to have diabetes two years after the operation.Of the 2 patients who were shown to have pancreatic cancer on histopathological study, 1 patient was lost to follow-up while another patient died at 27 months after the operation.The patients diagnosed to have epithelial dysplasia were followed-up and none developed pancreatic cancer.Conclusions The relationship between chronic pancreatitis and pancreatic ductal stones was very close.Chronic pancreatitis also caused exocrine and endocrine dysfunction.Surgical operation plays an important role in symptomatic relief and in delaying pancreatic dysfunction.

Nanoknife ablation of the pancreas in vivo experiment / 中华肝胆外科杂志

Objective Nanoknife,also called irreversible electroporation,is a new technique of tissue ablation.Short,microsecond electrical pulses with high voltage are applied to the cell membrane,causing pores to form within the membrane and finally leading to cell death.The current study was to investigate the efficacy and safety of the nanoknife in the ablation of the healthy pig pancreas.Methods Three healthy pigs underwent open pancreatic tissue ablation with nanoknife,and blood leukocytes and amylase were detected before and after treatment.Three pigs were sacrificed and gross specimens were collected on day 5,day 10 and day 15 after the procedure,respectively.HE staining and TUNEL staining were conducted and tissue,cellular and subcellular structures were observed under the ordinary microscope and transmission electron microscopy.Results Three experimental pigs recovered well after the procedure.No significant adhesions were found surrounding the pancreatic tissue,and the ablation zone was slightly harder.Transiently increased leukocyte count and amylase level were observed after the ablation,which decreased to the normal level on day 3 after treatment.Under light microscope,the pancreatic tissues in ablation zone appeared to be significantly different from the normal surrounding regions,with more cell death and more apoptotic cells detected by TUNEL staining.The subcellular structure changes also changed under electron microscope.But the main pancreatic duct and its large branches,together with arteriovenous distributions did not change much.Conclusions Nanoknife pancreatic tissue ablation can induce irreversible damage.In the ablation area,pancreatic duct and vascular structures are kept intact.Within a reasonable voltage range and appropriate electrical pulses setting,nanoknife ablation is safe in vivo experiment.

Hepatic artery reconstruction in operations for hilar cholangiocarcinaoma / 中华肝胆外科杂志

Objective To investigate the feasibility and outcome of resection and reconstruction of hepatic artery in hilar cholangiocacinoma (HCC).Methods The data of 29 patients with HCC with hepatic artery reconstruction carried out from March 2009 to August 2013 in our center were retrospectively analyzed.23 right hepatic arteries and 6 common hepatic arteries were involved.In-situ anastomosis was carried out in 20 patients and a double anastomosis using gastrodoudenal artery grafts was carried out in 9 patients.Results There were no arterial thrombosis or other related complications on prolonged follow-up.Conclusion Hepatic artery resection and reconstruction should be carried out if the artery was invaded by a hilar cholangiocarcinoma to produce a high resection rate and a better outcome.

Bypass reconstruction of hepatic artery using gastro-duodenal artery in radical operation for hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To summarize the clinical experience of hepatic artery bypass reconstruction using gastroduodenal artery in radical resection of hilar cholangiocarcinoma,and to provide assistance for surgeons applying artery reconstruction technique correctly in radical operation of hilar cholangiocarcinoma.Methods 9 cases of hilar cholangiocarcinoma with hepatic artery invasion wcrc subjected to radical resection combined with tumor invaded hepatic artery resection and reconstruction.Hepatic artery bypass reconstruction was performed by end-to end anastomosis,using the gastroduodenal artery interposition graft.The clinical data of these patients were reviewed retrospectively.Results All tumors of these cases with hilar cholangiocarcinoma were involved right hepatic artery,and the in volvement length was not less than 2 cm.The artery reconstruction was one-time successfully per formed in all cases.The median time required for anastomosis was (23.0±3.1) min.No postoperative complications,the dysfunction of gastrointestinal peristalsis or abnormal gastric drainage volume for example,related to the gastro-duodenal artery resection was observed.None of the patients devel oped any complications related to the arterial bypass reconstruction in the follow-up period,which was confirmed by abdominal CT scan.Conclusion Hepatic bypass reconstruction using gastro duodenal artery graft decreases the morbidity related to artery reconstruction and has little effect on gastrointes tinal function,which is the optimal choice for arterial reconstruction in radical operation for hilar cholangiocarcinoma.

The influence of double-effect activation of cholinergic anti-inflammatory pathway on liver injury and inflammatory response in obstructive jaundice rats / 中华肝胆外科杂志

Objective To investigate the influence of double-effect activation of cholinergic antiinflammatory pathway on the liver injury and inflammatory response in obstructive jaundice rats by applying cholinesterase inhibitor and cholinergic M receptor blocker to activate alpha 7 nicotinic acetylcholine receptor.Methods 22 adult male Wistar rats were randomly assigned into three groups:sham operation (SO) group (n=6),bile duct ligation (BDL) induced obstructive jaundice with (BDL treatment group) or without treatment (BDL control group) (n=8 each).The medicine treatment group was given anisodamine (25 mg/kg) and neostigmine (25 μg/kg) daily via intraperitoneal injection after surgery,the control group was given equal amount of normal saline.The body weights of rats in each group were measured every other day.After 12 days,the rats were killed,and the pathological changes of liver injury,liver function and the expression levels of proinflammatory cytokines in the serum and liver tissue were observed.Results The body weight of BDL rats was significantly lower than the SO group rats,and the growth rate of BDL treatment group rats was the same as the rats in BDL control group 3 days after the starting of treatment.The AST,ALT,bilirubin and gamma-GT levels of BDL control and treatment groups were significantly higher than the SO group (P＜0.05),but there was no significant difference between BDL control and treatment groups.The serum albumin level of BDL treatment group was obviously higher than that of BDL control group,but the pathological liver injury was significantly slighter.The gene expression levels of TNF-alpha,IL-1 beta and IL-6 in the liver tissue were significantly higher in BDL groups than SO group (P＜0.05),but BDL treatment group was significantly lower than BDL control group (P＜0.05).In addition the serum TNF-alpha and IL-1 beta concentrations of BDL treatment group and control group were significantly higher than the SO group (P＜0.05),but the BDL treatment group was obviously lower than that BDL control group (P＜0.05).Conclusion The combine application of cholinesterase inhibitor and cholinergic M receptor blocker to activate the cholinergic anti-inflammatory pathway can significantly inhibit the obstructive jaundice induced proinflammatory gene expression and liver injury.