Volume 15,Issue 3,2006 Table of Contents

1 Surgical treatment of hilar cholangiocarcinoma：a report of 102 cases

BAI Dong-xiao , YAO De-mao , PAN Cheng-en , QIN Xing-lei , WANG Zuo-ren

2006, 15(3):3-169. DOI: 10.7659/j.issn.1005-6947.2006.03.003

[Abstract](1256) [HTML](0) [PDF 935.63 K](630)

Abstract:
Abstract:Objective:To evaluate the method of surgical therapy of hilar cholangiocarcinoma. Methods:The clinical data of 102 surgically treated patients with hilar cholangiocarcinoma admitted into our hospital from August 1990 to August 2003 were retrospectively analyzed. Results:In this cohort of 102 cases of hilar cholangicarcinoma,58 cases(56.9%) underwent sugical resection. In 27(26.5%) of these 58 cases, a radical resection was performed,and 31 cases(30.4%) had a palliative resection.Bile duct drainage was done in 44 cases(43.1%),that included 20 cases with internal drainage by cholangioenterostomy and 24 cases with external biliary drainage.The 1-,2-,3- and 5-year survival in the radical resection group was 88.89%,51.85%,37.03% and 22.22%,respectively,and in the palliative resection group was 51.61%,6.45%,3.22% and 0%,respective.In the cholangioenterostomy internal drainage group and the external biliary drainage group,the 1-year survival rate was 29.4% and 23.80%,respectively,and there were no 2-year survivors.Conclusions:Better treatment results for hilar cholangiocarcinoma can only be obtained by surgical resection, especially by radical resection.

2 Hepatolithiasis associated with hepatocholangiocarcinoma：a report of 24 cases

CHEN Ru-fu , LI Zhi-hua , SU Hong , ZHOU Quan-bo , LIN Qing , WANG Jie , CHEN Ji-sheng

2006, 15(3):4-172. DOI: 10.7659/j.issn.1005-6947.2006.03.004

[Abstract](1159) [HTML](0) [PDF 933.71 K](668)

Abstract:
Abstract:Objective:To explore the relationship of hepatocholangiocarcinoma and hepatolithiasis and to increase the early diagnosis of this disease. Methods:The clinical data of 24 cases of hepatocholangiocacinoma associated with hepatolithiasis were retrospectively analyzed. Results:The occurrence rate of hepatolithiasis concomitant with hepatocholangiocarcinoma was 2.8%(24 of 860 cases)，and all of the tumors were located in the area of the bile duct with hepatolithiasis. Biliary atypical epithelial hyperplasia and cholangiocarcinoma were simultaneously present in some of the pathological sections. In this series, the correct diagnostic rate of hepatolithiasis associated with a space-occupying lesion in the liver before operation by ultrasonograph was 40.9%,by CT was 53.8% and by MRI/MRCP was 66.7%. 17 cases(70.8%) were resected, and the radical resection rate was 33.3%(8/24). Palliative resection was done in 37.5%of cases(9/24). The 1- and 3- year survival rate was 62.5%,and 25.0% respectively,in the group of radical resection; was 33.3% and 11.1% respectively,in the group with palliative resection; and 0% in the pathological biopsy group. Conclusions:Long-term recurrent hepatolithiasis is an important cause for the development of hepatocholangiocarcinoma.The misdiagnostic rate of the disease was high, and the treatment results and prognosis were poor. It is important to pay more attention to the reasons for delaying the diagnosis of hepatolithiasis-related cholangiocarcinoma and take the appropriate preventative measures to assist in its early diagnosis.

3 An analysis of factors in perioperative mortality of cholangiocarcinoma

HUANG Hai , LIU Sheng-li

2006, 15(3):5-176. DOI: 10.7659/j.issn.1005-6947.2006.03.005

[Abstract](765) [HTML](0) [PDF 942.68 K](632)

Abstract:
Abstract:Objective:To investigate the risk factors that affect the perioperative mortality in cholangiocarcinoma. Methods:The clinical data of sixty two patients with cholangiocarcinoma who underwent operation were reviewed retrospectively. Logistic regression test was used in the perioperative mortality study. Before multivariate analysis, each parameter was evaluated with univariate analysis to define whether it was of statistical significance (P<0.1) or not. Then the parameters with statistical significance were entered for further multivariate analysis. Results:Univariate analysis showed 7 factors that might influence the perioperative mortality, included age, preoperative total bilirubin, γ-GT, albumin, tumour stage, liver function classification, and preoperative concomitant diseases.In multivariate analysis, results showed that 3 factors significantly influenced the perioperative mortality, which in order of significance were age, tumour stage, and γ-GT. Conclusions:Aging, high γ-GT and late tumour stage are the risk factors, which can increase the perioperative mortality in cholangiocarcinoma.

4 Establishment and characteristics of metastatic tumor model of hilar cholangiocarcinoma

ZHOU Jin-sheng , ， WU Xiao-peng

2006, 15(3):6-180. DOI: 10.7659/j.issn.1005-6947.2006.03.006

[Abstract](648) [HTML](0) [PDF 935.81 K](589)

Abstract:
Abstract:Objective:To establish a novel liver and lung metastatic tumor model in nude mice by splenic inoculation of hilar cholangiocarcinoma cell line. Methods:Human hilar cholangiocarcinoma cell line(FPH-0201 cells) was established and cultured with a fresh human hilar cholangiocarcinoma specimen. The spleen of 7 nude mice was injected with 0.1ml of hilar cholangiocarcinoma cell suspension (1.5×107 cell) .The tumor appearing time, tumor local and metastatic formation rate, histological,morphological and ultrastructure of metastatic tumor cell were observed. The sub-cell line was obtained by cutture of metastatic specimen, and sub-cell line cells were again injected into the lower pole of the spleen and metastatic tumor formation rate was observed again. Results:The overall local tumor formation rate in spleen was 100%, and metastatic tumor formation rate was 14.3%. The sub-cell line cells that were re-inoculated in mice spleen, had a metastatic tumor formation rate of 100%. Morphological observation of metastatic tumor showed the common features of cholangiocarcinoma. Chromosome number showed a variation of 18~44. Conclusions:The hilar cholagiocarcinoma metastatic tumor model that was established in this laboratomy had characteristics compatible with malignant tumor and had all the biological characteristics of human hilar cholagiocarcinoma.

5 Investigation of the inhibition of the cell growth and down-regulation of mTOR in the cholangiocarcinoma QBC939 cells transfected with plasmid PTEN in vitro

LIU Min-feng , XU Li-ning , ZUO Shi , LUO Jian , GUO wei , DONG Jing-qing , ZOU Shen-quan

2006, 15(3):7-184. DOI: 10.7659/j.issn.1005-6947.2006.03.007

[Abstract](1225) [HTML](0) [PDF 939.31 K](630)

Abstract:
Abstract:Objective:To investigate the effects of the tumor suppressor gene PTEN in growing inhibition and down-regulating mTOR in cholangiocarcinoma QBC939 cells in vitro. Methods:QBC939 cells were transfected with plasmids wild-type PTEN and C124S-PTEN in vitro. After transfection, the expression of the PTEN and phosphorylation of AKT and mTOR was detected by Western blot. Flow cytometry was used to analyze apoptosis and cell cycle of the transfected cells. Results:Compared with the control, the expression of phosphorylation AKT was decreased and mTOR were down-regulated respectively when transfected with the wild-type PTEN. However, after transfection with mutation-type PTEN, the level of PTEN in the cells by increased, but phosphorylation AKT level and mTOR expression had no significant change.Conclusions:PTEN can be actived by phosphorylated AKT. Actived AKT decreased the mTOR which led to tumor cells apoptosis and regulation of the tumor cell cycle. In the pathway of signal transmission of PI3K/AKT/PTEN/mTOR, PTEN and mTOR are closely related through phosphorylation of AKT.

6 Study of the expression and correlation of PTTG and VEGF in human extrahepatic cholangiocarcinoma

CHEN Ling , TANG Hui-huan , FEN Chao

2006, 15(3):8-189. DOI: 10.7659/j.issn.1005-6947.2006.03.008

[Abstract](830) [HTML](0) [PDF 947.15 K](619)

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Abstract:Objective:To investigate the correlation of the expressions of PTTG and VEGF proteins in extrahepatic cholangiocarcinoma, and study its role in the development of extrahepatic cholangiocarcinoma. Methods:Expression of PTTG and VEGF proteins was detected by SABC immunohistochemical technique in 36 cases of extrahepatic cholangiocarcinoma, 30 cases of adjacent histologically noncancerous bile duct tissues and 12 cases of benign bile duct lesions. Results:The positive rates of PTTG and VEGF proteins were 72.2%(26/36) and 83.3%(30/36) respectively,in extrahepatic cholangiocarcinoma; and 63.3%(19/30) and 76.7%(23/30) in adjacent histologically noncancerous bile duct tissues. The expression of PTTG protein was significantly positively correlated with that of VEGF protein (P<0.05) in cholangiocarcinoma. In contrast,no expression of PTTG and VEGF proteins was detectable in 12 cases of benign bile duct lesions (P<0.01). The expression of PTTG and VEGF was closely related to metastasis of extrahepatic cholangiocarcionoma,but was not related to sex or age of the patients,tumor size or tumor differentiation. Conclusions:There is a significant positive correlation between high expressions of PTTG and VEGF proteins in cholangiocarcinoma. The high expressions of PTTG and VEGF proteins may be related to the metastasis of extrahepatic cholangiocarcinoma.

7 Effect of down-regulating DNMT3b expression by transfection with antisense gene on the growth of human cholangiocarcinoma cell line QBC939

ZUO Shi , ZOU Sheng-quan , CHEN Yong-jun , CHEN Bo , TANG Qi-bin

2006, 15(3):9-194. DOI: 10.7659/j.issn.1005-6947.2006.03.009

[Abstract](986) [HTML](0) [PDF 952.05 K](628)

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Abstract:Objective:To study the effect of transfection with antisense DNMT3b gene eukaryotic expression plasmid on the growth of human cholangiocarcinoma cell line QBC939, and to explore the role of DNMT3b in the cholangiocarcinoma tumorigenesis. Methods:The constructed antisense DNMT3b gene eukaryotic expression plasmid was transfected into QBC939 cells using liposome. The expression level of DNMT3b protein was detected by Western blot after stable transfection. The growth curves of transfected cells and un-transfected cells were observed by MTT method respectively. The cell proliferation ability was also observed by the test of colony formation in soft agar. The alterations of the cell cycle and the apoptosis rate were detected by FCM. Results:Following the transfection, the protein level of DNMT3b decreased significantly; transfection with antisense DNMT3b gene eukaryotic expression plasmid did not affect the cell growth curve of QBC939, and did not decrease the cell colony formation rate (P＝0.717); transfection with antisense DNMT3b gene also did not result in cell cycle alterations or induce cell apoptosis (P＝0.089). Conclusions:Transfection with antisense DNMT3b gene eukaryotic expression plasmid can down-regulate the expression level of DNMT3b in QBC939. It can not affect the growth and proliferation of human cholangiocarcinoma cell line QBC939, nor alter the cell cycle and induce cell apoptosis.

8 Study on clinical significance of expression of p16,nm23 and PTEN gene in malignant tumors of biliary system

CUI Ping , PU Pin , ZHAO Xiao-xia , WU Tao , YANG Shi-kun , HU Zhu-pei

2006, 15(3):10-197. DOI: 10.7659/j.issn.1005-6947.2006.03.010

[Abstract](816) [HTML](0) [PDF 934.58 K](605)

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Abstract:Objective:To study the clinical significance of the gene protein expression of p16,nm23 and PTEN in bile duct carcinoma. Methods:The expression of p16,PTEN and nm23 gene protein in tissues of 63 cases of malignant tumors of biliary system(33 cases of bile duct carcinoma,30 cases of carcinoma of gallbladder) and 20 cases of benign bile duct lesion were studied by SP immunohistochemical technique and analyzed together with clinicopathologic data.Results:The positive expression of p16,PTEN and nm23 in bile duct carcinoma tissue was low to medium,their expression rate was 36.5%,38.1% and 23.8%,respectively,and was significantly lower than that of bile duct benign lesions(P<0.05). In the well-differentrated bile duct carcinoma and gallbladder carcinoma group,the expression of PTEN was significantly different(P<0.05),but p16,PTEN and nm23 expression was not significantly different. Conclusions:Mutation or deletion of the above 3 genes is present in malignant tumors of biliary system.PTEN and p16 gene mutation can loss control of the cell cycle and thus promote tumor development.PTEN and nm23 gene mutation can lower the controlability of invasiveness and metastasis of tumors of biliary system.

9 Study on reversal of mutidrug resistance of GBC-SD cell lines by grape seed polyphenols

YANG Feng-hui , WANG Zhan-min , WU Xin-lin

2006, 15(3):12-205. DOI: 10.7659/j.issn.1005-6947.2006.03.011

[Abstract](777) [HTML](0) [PDF 939.44 K](581)

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Abstract:Objective:To explore the mechanism of reversal of mutidrug resistance of GBC-SD cell lines by grape seed polyphenols（GSP）. Methods:GBC-SD cell lines were used to determine the effect of GSP. MTT assay was adopted to evaluate the cytotoxity(IC50), RT-PCR were used to determine MDR1 mRNA, P- gp,bcl-2 and cellular adriamycin was measured by flow cytometry. Results:In non-toxic(3μg/mL) and low toxic(6μg/mL) comcentration of GSP treated group(P<0.05), the IC50 of chemotherapeutic agents was reduced the expression of P-gp,bcl-2 and MDR1 mRNA inhibited(P<0.05), and cellular accumulation of adriamycin increased(P<0.05). Conclusions:GSP could reverse mutidrug resistance of GBC-SD cell lines, and the suggested mechanism is that GSP decreased the expression of P-gp,bcl-2 and MDR1 mRNA.

10 Investigation of expression of c-erbB-2 and DPC4 in tissues of colonic schistosomiasis and colorectal carcinoma

WANG Kuang-song , WEN Ji-fang , SHEN Ming

2006, 15(3):13-209. DOI: 10.7659/j.issn.1005-6947.2006.03.012

[Abstract](1055) [HTML](0) [PDF 1000.10 K](653)

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Abstract:Objective:To determine the relationship between chronic colonic schistosomiasis and colorectal carcinoma. Methods:Expression levels of c-erbB-2 and DPC4 were detected by two-step and SP immunohistochemical method respectively in normal colonic mucosa of 15 cases, in colonic mucosa of 15 cases with simple schistosomiasis, 20 cases of colorectal carcinoma with schistosomiasis and 20 cases of colorectal carcinoma without schistosomiasis. Results:c-erbB-2 was expressed in each group with different levels, but the level in colonic mucosa with schistosomiasis was the highest compared to other groups, which had statistical significance (P<0.05). DPC4 was also expressed in each group with different levels, but the level in normal colonic mucosa was the highest compared to other groups, which had statistical significance(P<0.05).Conclusions:There is a high correlation between chronic schistosomiasis japonica in colon and colorectal carcinoma. Alteration of expression levels of c-erbB-2 and DPC4 may be an early stage molecular event during the course of malignant change of mucosal epithelium caused by chronic colonic schistosomiasis.

11 Study of therapeutic effects of surgical treatment of intrahepatic cholelithiasis

YANG Zhong-yi , MIAO Xiong-ying , LIU Hong-cheng , HU Xiong

2006, 15(3):14-213. DOI: 10.7659/j.issn.1005-6947.2006.03.013

[Abstract](758) [HTML](0) [PDF 973.45 K](739)

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Abstract:Objective:To evaluate retrospectively the methods and outcomes of surgical treatment of patients with intrahepatic cholelithiasis and biliary stricture. Methods:The data of the surgical therapy of 165 cases of cholelithiasis and biliary stricture admitted between January 1995 and January 2003 were analyzed. Group A included 85 cases managed by various types of hepatectomy or hepatic segmental resection(HSR). In group A, 40 patients underwent simultaneous cholangiojejunostomy, in 10 patients the dilated bile duct on resected surface of liver and bile duct of hepatic hilum were separately anastomosed to the jejunum by double stoma anostomosis, T-tube drainage was done in 21 cases and U-tube drainage in 14 cases. Group B patients(n=80) were treated by operation without HSR, included 23 cases with choledochotomy and stone removal plus T-tube drainage, 15 cases with choledochotomy and stone removal plus U-tube drainage, 42 cases with choledochotomy and stone removal plus biliary-enteric anastomosis; in group B, plastic operation of the hepatic duct stricture was proforemed in 46 cases. Results:In Group A, no operative death occurred. The cases were followed up after operation from 2 to 7 years, and showed residual calculus rate was 4.71%, and symptoms recurrence rate 3.53%. No patient was operated again. In Group B, no operative death occurred. The cases were followed up from 2 to 7 years after operation, and residual stones were found in 12 cases, a residual calculus rate of 15.00%. After operation, 10 cases complained of upper abdominal pain and fever, with a symptoms recurrence rate of 12.5%. The residual stones of 5 cases were removed by fiber biliary endoscopy, while 3 cases of the other 6 cases received hepatectomy. Conclusions:The combined hepatic resection and other operation is an ideal and effective surgical method to treat hepatolithiasis.

12 Prevention and treatment of accessory hepatic duct injury during biliary operation:a report of 26 cases

KONG Fan-min , LI Hang-yu , LI Yu-ji , ZHOU Jian-ping , DONG Ming , GUO Ke-jian , GUO Ren-xuan , TIAN Yu-lin

2006, 15(3):15-217. DOI: 10.7659/j.issn.1005-6947.2006.03.014

[Abstract](627) [HTML](0) [PDF 943.18 K](633)

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Abstract:Objective:To summarize our experience in the prevention and treatment of accessory hepatic duct injury during operation on biliary tract. Methods:The clinical data of 26 cases with accessory hepatic duct were retrospectively reviewed. Results:Of 26 cases, the accessory hepatic duct were type I in 38.5%(10/26), and no complications including bile leakage, biliary infection and obstructive jaundice developed after division and ligation of the accessory hepatic duct; 26.9% (7/26) were type II, among which, the accessory hepatic duct were injured in 3 cases, but no case developecl complications after relevant treatment; 23.0% (6/26) were type III, among which, injury of accessory bile duct occurred in 2 cases. Of them, 1 case developed bile leakage and was cured by re-operation. 7.7%(2/26) were type IV and 3.9% (1/26) was type V. The cases of type IV and V were not damaged. Conclusions:To prevent injury of accessory hepatic duct, pre-and intra-operation identification of the condition is very important, and especially by intraoperative cholangiography. Different types of accessory hepatic duct injury should be treated by different approaches. Accessory hepatic duct of type I might be cut and ligated. Type II accessory bile duct which enters the cystic duct and should be protected, but, if damaged, different methods of treatment are used,depending on the caliber of accessory hepatic duct. Type III and IV also should be protected, but, when damaged, the accessory hepatic duct should be repaired or performed an internal draining.

13 The diagnosis and treatment of obstructive jaundice caused by peripapillary duodenal diverticulum

HU Guo-huang , DUAN Lian , ZHOU Jun , TANG Hui-huan

2006, 15(3):16-220. DOI: 10.7659/j.issn.1005-6947.2006.03.015

[Abstract](653) [HTML](0) [PDF 929.44 K](676)

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Abstract:Objective:To investigate the relationship between peripapillary duodenal diverticulum and obstructive jaundice, and the diagnosis and treatment for this clinical entity. Methods:The clinical data of 25 cases of obstructive jaundice caused by peripapillary diverticulum were retrospectively reviewed. Results:All cases were diagnosed definitively by endoscopic retrograde cholangiopancreatography(ERCP). 20 cases underwent choledochostomy with T-tube drainage and subtotal gastrectomy (Billroth II) and recovered, and 5 cases were cured by nonoperative therapy and discharged asymptomatically, but followup showed they had recurrent attacks of symptoms. Conclusions:Obstructive jaundice caused by peripapillary diverticulum can be definitively diagnosed by ERCP, and should be treated by choledochostomy, T tube drainage and subtotal gastrectomy(Billroth II), which is a simple, rational, safe and effective surgical procedure.

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Volume 15,Issue 3,2006 Table of Contents

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