Abstract:

Objective: To evaluate the value of endoscopic  treatment of bile duct lithiasis after BillrothⅡ gastrectomy.
 Methods: ERCP was used in 137 patients with bile duct lithiasis after BillrothⅡ gastrectomy. Of the 137 patients, 34 received EST and 4 EPBD.
 Results: ERCP was successfully performed in 109  of the 137 cases (79.6%), and falled in 28 (20.4%). Among 34 patients who had EST and 4 patients who had EPBD, stone extrection was successful in 35 cases (92.1%), and complicated by GI bleeding in 4 cases. There were no cases of GI perforation or death.
 Conclusions: The successful rate of EST is high in patients with bile duct lithiasis after BillrothⅡ gastrectomy, and endoscopic treatment has good therapeutic effects.

Abstract:

Objective: To discuss the clinical value of modified laparoscopic lithotomy of common bile duct.
 Methods: Clinical data of 78 patients over the age of 60 with gallstone and choledocholithiasis who underwent modified laparoscopic lithotomy of common bile duct in the past four years were analysed.
 Results: All operations were successful. Ttubes were withdrawn 4 weeks after operation. Of the 78 cases, 77 cases hat no complications and only one case had a small incision infection. All patients recovered without complications after with drawal of Ttube.
 Conclusions: Modified laparoscopic lithotomy of common bile duct can allow incision and suture of common bile duct and placement of Ttube under direct vision, and achieves excellent therapeatic results in the treatment of common duct stones, especially in elderly patients who cannot tolerate a long period of pneumoperitoneum.

Abstract:

Objective: To evaluate the therapeutic effect of choledocholithiasis treated by laparoscopy combined with choledochoscopy.
 Methods: The operative time, blood loss, time to passage of flatus, hospital stay, and rates of postoperative pain and complications were compared between the laparoscopic surgery group (n=50) and open surgery group (n=50).
 Results: In laparoscopic surgery group, the operative time was longer than that in open surgery group(P＜0.01), whereas the blood loss, time to passage of flatus, hospital stay, rates of postoperative pain and wound infection were obviously lower than those in open surgery group(P＜0.01). There was no significant difference of the rates of bile leakage and residual stone between the two groups(P＞0.05).
 Conclusions: The combined application of laparoscopy and choledochoscopy in the treatment of choledocholithiasis is safe and effective, and with the advantage of less trauma and quick recovery.

Abstract:

Objective: To compare the effect of combined endoscopic sphincterotomy (EST) and laparoscopic cholecystectomy (LC) with combined  laparoscopic choledocholithotomyTtube drainage (LCHTD) and LC for the treatment of cholecystolithiasis and choledochothiasis.
 Methods: We retrospectively analyed the clinical data of patients with cholecystolithiasis and choledocholithiasis  treated by EST combined with LC（468 cases）,and by LCHTD combined with LC（268 cases）. The stoneclearance rates,complication rate, conversion rate of open operation and hospital length of stay in the two groups were compared.
 Results: The stoneclearance rate was 97.2%(455/468) in the EST+LC group compared with 97.4%(261/268) in the LCHTD+LC group, and difference was no statistical (P>0.05).But the complication rate was 6.4% in the EST+LC group compared with 1.5% in the LCHTD+LC group, and  difference  was obvious (P<0.01). Hospital length of stay was a median of 15 days in the EST+LC group,and 10 days in the LCHTD+LC group. The longterm effect of LCHTD+LC group (96.6%) was better than that of EST+LC group(90.6%)(P<0.01).
 Conclusions: EST combined with LC is technically easier, however LCHTD is much harder to handle,but the effect of LCHTD combined with LC is superior to that of EST with LC. For patients with cholecystolithiasis and choledochliothiasis, the treatment method of choice must be individualized.

Abstract:

Objective: To investigate the value of laparoscopy combined with choledochoscopy in treatment of cholecystolithiasis complicated with choledocholithiasis.
 Methods: Clinical data of 168 patients with  cholecystolithiasis and choledocholithiasis treated in our haspital from June 2005 to June 2009 were analysed. Ninety patients were randomly selected and treated by laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage (group A), the other 78 patients, as control group, underwent routine cholecystectomy and choledocholithotomy plus T-tube drainage by laparotomy (group B).
 Results: The hospital stay and the mean time to passage of flatus in group A was much shorter than that in group B (P<0.05); and the postoperative complication rate in group A was obviously lower than that in group B(P＜0.05); while  the mean operative time and cost of hospitalization between the two groups had no statistical difference（P>0.05）.
 Conclusions: Laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage for cholecystolithiasis and choledocholithiasis is a microtrauma management with advantages of quick recovery and shorter hospital stay, that makes it superior to the open operation.

Abstract:

Objective: To evaluate therapeutic effects of hepatectomy for hepatolithiasis.
 Methods: Retrospective analysis of the clinical data，including stones distribution, operative modality, postoperative complications, and therapeutic effect of hepatectomy for hepatolithiasis in 107cases admitted  in our hospital from June 2000-July 2007 was undertaken.
 Results: Among the 107 patients, left lateral lobectomy was performed in 80 cases, left hepatectomy  in 14 cases,  right hepatectomy in one case and selective combined segmentectomy in 12 cases.The postoperative residual stone rate was 10.3% (11/107 cases), but the final residual stone rate was 3.7% (4 /107 cases) after stone extraction by subsequent T-tube route or endoscopic sphincterotomy (EST). Postoperative complication rate was 29.9%（32  /107 cases）, while in left lateral lobectomy, left hepatectomy, right hepatectomy and selective combined segmentectomy complications were 23.7% (19/80 cases), 42.8% (6/14 cases) and 53.8% (7/13 cases), respectively. The latter 2 procedures had a higher rate of complications than the former 2 procedures (P<0.05).
 Conclusions: Liver resection for intrahepatic bile duct stones has a relatively low rate of residual stones and stone recurrence, it is safe and effective.

Abstract:

Objective: To explore the correlation and mechanism between serum adiponectin and estrogen level in female patients with gallstones.
 Methods: A total of 62 female gallstone patients were analyzed, of which 33 cases were premenopausal and 29 cases were postmenopausal. Sixty age-matched normal physical examination cases were selected as controls. Gallbladder stones were diagnosed by B-Ultrasound. Height and weight of the patients were measured to calculate body mass index (BMI). Blood glucose was determined by Glucose Oxidase method. Lipids were determined by turbidimetry method in automatic biochemical analyzer. Serum adiponectin and estrogen were determined by radioimmunoassay.
 Results: Compate with control group, serum adiponectin level was significantly decreased, and estrogen level was significantly ncreased in premenopausal and postmenopausal patients with gallbladder stones. There was a positive correlation between serum adiponectin and HDL-C and ApoA1 level.
 Conclusions: Low serum adiponectin level may be a predisposing factor of gallstone that is initiated by estrogen, and independent of obesity and diabetes.

Abstract:

Objective: To investigate the expression and significance of fragile histidine triad(FHIT) gene in the cholangiocarcinoma cell line QBC939.
 Methods: The eukaryotic expression vector was transfected into QBC939, real-time RT-PCR was used to detect the change of FHIT expression, and direct counting method under microscope was used to detect the change in the biological behavior of cells.
 Results: After transfection, the expression of FHIT mRNA increased by 2.53-fold, but the cell clones were significantly less ［(11.2±1.3) vs.(10.5±1.1) vs.(6.3±1.0)，P＜0.05］.
 Conclusions: The expression of FHIT gene in QBC939 is attenuated, but after its expression is regained it can inhibit the formation of cell clones.

Abstract:

Objective: To study the effect of CO2 pneumoperitoneum on the anti-apoptotic capability of gallbladder carcinoma cell line (GBC-SD).
 Methods: The CO2 pneumoperitoneum was established in vitro. After GBC-SD cells were exposed to CO2 pneumoperitoneum at 12 mmHg for 1, 2, 3, 4 h, the expressions of survivin mRNA was examined by RT-PCR. The untreated GBC-SD cells served as control.
 Results: Under a pressure of 12 mmHg, the expressions of survivn had an increasing tendency with the exposure time.
 Conclusions: Under certain pressure and within certain exposure time, CO2 pneumoperitoneum could improve anti-apoptotic capability of GBC-SD cells, which may be one of the mechanisms of the promoting effect of carbon dioxide pneumoperitoneum on malignant cell growth.

Abstract:

Objective: To study the expressive levels of ubiquitin and cul-1 in benign and malignant lesions of gallbladder, and detect their clinicopathological significance.
 Methods: EnVisonTM immunohistochemistry was used to assay the expressive levels of ubiquitin and cul-1 in the convetional paraffin-embedded specimens of adenocarcinoma (n=108), peritumoral tissues(n=46), adenomatous polyp (n=15) and chronic cholecystitis (n=35).
 Results: The positive rates of ubiquitin and cul-1 were significantly higher in adenocarcinoma (51.9%, 48.1%)  than those in peritumoral tissues(21.7%, 15.2%)，adenomatous polyp(13.3%, 6.7%)  and chronic cholecystitis(2.9%,0.0%)(all P＜0.01). The positive cases of ubquitin and/or cul-1 expreesion in the benign lesions showed atypical hyperplasia of epithelia. The positive rates of ubiquitin were significantly lower in the well-differentiated adenocarcinoma and non-metastasic  lymph node than those in the moderately-or poor-differentiated adenocarcinoma and metastasis of lymph node(P＜0.05). And also the positive rates of Cul-1 were significantly lower in the well-differentiated adenocarcinoma, the maximal diameter of mass <2cm,non-metastasis of lymph node and non-invasiness of regional tissues than those in the moderately-or poorly-differentiated adenocarcinoma, maximal tumor diameter ≥2cm, metastasis of lymph node and invasiveness of regional tissues  (P＜0.05 or P＜0.01). High possitive correlation was found between the expressive levels of ubiquitin and cul-1 in gallbladder adenocarcinoma（P＜0.01）.
 Conclusions: The expressive levels of ubiquitin and/or cul-1 might be closely related to the carcinogenesis, progression, clinical biological behaviors and prognosis of gallbladder  adenocarcinoma.

Abstract:

Objective: To explore the effects of glucagon-like peptide-2（GLP-2） on intestinal mucosa epithelium myosin light chain kinase（MLCK）of the rat with obstructive jaundice.
 Methods: The obstructive jaundice models of rats were set up. At postoperative 10 d,the control group rats were subcutaneously injected with 0.5 mL PBS; experiment group A with 250g/(kg·d) GLP-2 (0.5 mL),and experiment group B with 125 g/(kg·d) GLP-2 (0.5 mL), b.i.d×7 d,then all the rats were killed The villus height,mucosa thickness and crypt depth of the terminal ileum mucosa were detected. Immunohistochemistry and Western-blot were used to examine the distribution and expression of MLCK. Image analytical system and statistics software were used to analyze the results quantitately.
 Results: The intestinal villi of the  distal ileum mucosa were short and sparse in control group.Compared with control group, the average intestinal villus height,mucosa thickness and crypt depth were increased 27.8%,21.7% and 25.4%(all P＜0. 01) in experiment group A. And the MLCK stainings appeared  discontinuous and vague in control group, but they recovered somewhat in experiment group A. The values of strong positive expression were obviously higher in experiment group A than those in control group (8/10 vs. 2/10, P＜0.05) and experiment group B(8/10 vs. 4/10,P＞0.05). The same outcomes were obtained by quantitative analysing Western blot images. The degression of intestinal villus height and absorbance of MLCK images presented direct correlation.
 Conclusions: The intestinal mucous membrane shows obvious atrophy in obstructive jaundice.Exogenous supplemented GLP-2 can enhance the quantity and distribution of MLCK in intestinal mucosa in obstructive jaurdice, and can restore the morphology of intestinal mucosa epithelium.

Abstract:

Objective: To constuct and identify a specific siRNA targeting mucins (MUC1) expression vector.
 Methods: A pair of oligonucleotide completing and coding hairpin MUC1-siRNA synthesized were inserted into pGC silencerTM U6/Neo/RNAi vector. Double enzyme digestion, PCR test and DNA sequencing were used to identify the recombinant plasmid. Then, special MUC1-siRNA was transfected into cholangiocarcinoma cells with Lipofectamine TM 2000. In vitro, MUC1 mRNA and protein expression was tested by RT-PCR and Western Blot respectively.
 Results: Double enzyme digestion, PCR test and DNA sequencing confirmed that the MUC1 specific siRNA expression vector was constructed successfully. After transfection, the expression of MUC1 mRNA and protein  in QBC939 (experimental group) decreased significantly (P＜0.05).
 Conclusions: The results indicate that the MUC1-siRNA expression vector was successfully constructed, and the siRNA can significantly inhibit the expression level of MUC1. This study can provide an experimental basis for further research of MUC1-siRNA vector.

Abstract:

Objective: To investigate the effects of angiotensin Ⅱ (Ang Ⅱ) on the expression of vascular endothelial growth factor (VEGF) in human hepatic cancer cell line Hep G2.
 Methods: Cultured Hep G2 cells were treated by AngⅡ with various concentrations and were collected at different time points. Then total RNA was extracted. The expression of VEGF mRNA in cultured Hep G2 was determined by relative quantitative reverse transcription polymerase chain reaction(RT-PCR),and the proliferation was detected by methyl thiazolyl tetrazolium (MTT).
 Results: AngⅡ stimulated the proliferation of HepG2 cells, and enhanced the expression of VEGF mRNA (P＜0.05), which was dose-and time-dependent. When the concentration of AngⅡ was 10-7 mol/L and the time was 60 h, the effect reached the maximum, and  which could be suppressed by Angiotensin II type 1 receptor (AT1R) antagonist.
 Conclusions: The expression of VEGF mRNA can be induced by AngⅡin human hepatic cancer cell line Hep G2 through AT1R, which may play a definite role in tumor growth and metastasis.

Abstract:

Objective: To investigate the effects and mechanisms of extraction centipede extraction (CE) on grafting hepatocellular carcinoma (HCC) in nude mice.
 Methods: We set up model of  Bel-7404 cells heterotopic grafting HCC in nude mice, and  observed the tumor growth and metastasis after intragastric administration of CE (treatment group).  Immunohistochemical methods were used to detect X-chromosome linked inhibitor of apoptosis protein（XIAP）,bax gene,vascular endothelial growth factor(VEGF) and angiopoietin-2(Ang-2) in tumor tissue.
 Results:  There was distinctive inhibitive effect of CE on in Bel-7404 cells heterotopic grafting HCC in nude mice. The staining cells population，staining intensity and the optical density（OD）of XIAP,VEGF and Ang-2 in the control group were higher than those in treatment group, but those of BAX were lower than that in treatment group, and there was significant difference between the 2 groups（P＜0.05）.
 Conclusions: CE can inhibit the growth of heterotopic grafting HCC in nude mice, and the mechanisms may be related to inhibition of tumor angiogenesis  and promotion of apoptosis of HCC.

Abstract:

Objective: To investigate the diagnosis and treatment of secondary sclerosing cholangitis after billary tract operation.
 Methods: The clinical clata of 7 cases with secondary sclerosing cholangitis after billary tract operation treated in our hospital from January 2000 to June 2008 were retrospectively analyzed.
 Results: Recurrent episodes of bacterial cholangitis were present in all patients, and they all had history of biliary tract operation. After definite diagnosis, 2 cases underwent operation and 5 cases underwent conservative treatment. Among the latter, 1 case underwent endoscopic sphincterotomy and 1 case had liver transplantation. Of all the patients, 2 cases recovered(2/7), 2 cases died(2/7) and 3 cases are still undergoing treatment.
 Conclusions: The prognosis of secondary sclerosing cholangitis after billary tract operation is relatively poor. The key measure is prevention, and early diagnosis together with rational treatment can have certain therapeutic effect.

Abstract:

Objective: To evaluate the safety and feasibility of laparoscopic cholecystectomy（LC） in patients with cirrhosis, and compare the value of model for end-stage liver disease (MELD) score and Child-Pugh classification in predicting prognosis.
 Methods: We reviewed the records of 55 laparoscopic cholecystectomies in cirrhotic patients in our department in the recent 11 years. Indications included symptomatic gallbladder disease, cholecystitis, cystic polyps and cystic adenoma. MELD score and Child-Pugh class were preoperatively calculated and associated with postoperative results. Data regarding patients and surgical outcome were retrospectively analyzed.
 Results: No perioperative death occurred. Total cholecystectomy was employed in 53 patients and subtotal cholecystectomy in 2 patients. Median operative time was（77±5.1）min. Median intraoperative blood loss was(51.0±3.33)mL. Median hospital stay was（5.0±1.3）days. Postoperative complications occurred in 9.09% of the patients, including hemorrhage, intra-abdominal collections and wound complications, which were all controlled conservatively. The incidence of postoperative complications in Child A patients was 7.27%, in Child B was 10.0%; in MELD score below 14 was 2.44%, and in MELD score above 14 was 28.57%. The difference between rates of postoperative complications in patients with preoperative MELD score above 14 and below 14 was significant(P＜0.05), while that between Child-Pugh A and B was not significant (P＞0.05).
 Conclusions: Laparoscopic cholecystectomy is a safe procedure for selected cirrhotic patients, and with controllable complications. MELD score appears to predict morbidity more accurately than Child-Pugh classification system.

Abstract:

Objective: To investigate the diagnostic and predictive value of measuring peritoneal inflammatory cytokines  in predicting biliary fistulas in patients undergoing biliary surgery.
 Methods: Peritoneal samples and serum samples of 3227 biliary surgery patients were collected on the first, third, fifth postoperative day, and IL-6, IL-8, IL-10, TNF-α and CRP of the samples were measured. Patients were divided into two groups: those with clinical evidence of biliary fistulas and those without any evidence of biliary fistulas.The age, sex, operative method and operative time between the two groups were compared.
 Results: There was a negative correlation between biliary fistulas and age, sex and operation mode; but blood loss, operation time and common bile duct diameter had positive correlation with biliary fistulas. Peritoneal cytokine levels were significantly higher in patients with biliary fistulas as compared to those without biliary fistulas.
 Conclusions: The peritoneal cytokine level is a sensitive parameter of peritoneal inflammation and can be as an additional diagnostic tool for the early prediction of biliary fistulas after biliary surgery.

Abstract:

Objective: To explore the clinical effects of unilateral placement of plastic stents by ERCP for nonresectable Bismuth type IV hilar cholangiocarcinoma.
 Methods: A prospective study  was conducted in 42 patients with nonresectable Bismuth type IV hilar cholangiocarcinoma, who had unilateral insertion of plastic stents in the recent 4 years, All of the patients had successful insertion of single plastic stent by ERCP manipulation. Early results (less than 30 days) of procedure-related complications, mortality, long-term results (greater than 30 days)  and survival were observed.
 Results: All of the 42 patients had successful drainage. Mean total bilirubin value decreased from （332.3±163.4）μmol/L to （30.6±18.5）μmol/L, and complete resolution of jaundice was achieved in 61.9% （26/42）of the patients. Early comlications included papilla bleeding due to EST in 4 of 42 patients (9.5%) and acute cholangitis in 10 of 42 patients (23.8%). No procedure-related death occurred. All of the patients needed to have their stents replaced periodically, and the median duration up to the first stent replacement was 65 d, and without significant differences between the two groups in stent insertion to the left and right hepatic duct. Median duration of stent patency was 5.15 months, and median patient survival was 6.5 months,but also no significant differences were found between the two groups.
 Conclusions: Unilateral plastic stent insertion is safe and feasible, can achieve adequate drainage for relatively long time, and can improve life quality and survival for patients with nonresectable hilar cholangiocarcinoma.