Objective: To investigate the expression of FIG-ROS fusion gene in intrahepatic cholangiocarcinoma (ICC) cells and the effects of its intervention on biological behavior of ICC cells. Methods: ROS protein expression in 4 different specimens of ICC tissue and 3 types of ICC cell line (HUCCT1, REB and QBC939) was determined by Western blot analysis; the ROS positive cell line was selected for use and after transfection with a series of plasmids containing different sequences of ROS-shRNAs or FIG-shRNAs respectively, the protein expressions of ROS and FIG in the cells were measured by Western blot analysis. The sequences of ROS-shRNA and FIG-shRNA with highest inhibitory effect on ROS and FIG expression were chosen, which were alone or in combination transfected into the above cells, and after that, the cell proliferation, apoptosis, cell cycle and colony formation were observed. Results: Two specimens of ICC tissue and one ICC cell line (HUCCT1) showed positive ROS expression. Transfection of ROS1-6290 shRNA and FIG-363 shRNA had the most remarkable inhibitory effect on ROS and FIG expression, respectively. Compared with the HUCCT1 cells without any transfection, lone FIG-363 shRNA transfection had no obvious effect on proliferation, apoptosis or cell cycle phase (all P>0.05), but significantly reduced the colony formation of the cells (P<0.05); either ROS1-6290 shRNA transfection alone or in combination with FIG-363 shRNA showed significant effects of suppression of proliferation, induction of apoptosis and cell cycle arrest and inhibition of colony formation, and these effects were more remarkable in cells with combined transfection (all P<0.05). Conclusion: Some kinds of ICC have FIG-ROS fusion gene expression, and the combined inhibition of the two genes may probably provide a hopeful targeted treatment approach for these ICC.

Objective: To observe the changes of myoelectric activity and pressure in sphincter function of Oddi (SO) after short-term partial bile duct obstruction in guinea pigs. Methods: Sixteen English short-hair guinea pigs were equally randomized into sham operation group and model group, and underwent sham operation and establishment of partial obstruction of the common bile duct (CBD) respectively, during which, the CBD diameters were measured. At one week after operation, the CBD diameters were measured again, and the liver function parameters, as well as the electrical activity and dynamic variables of SO were determined. Results: After operation, the CBD diameter in sham operation group showed no significant change (P>0.05), but it was significantly enlarged in model group (P<0.05). In model group compared with sham operation group, the serum levels of bilirubin and liver enzymes were significantly increased (all P<0.05); the voltage amplitudes of both rapid and slow waves of SO were significantly decreased (both P<0.05), while the frequencies of them had no significant difference (both P>0.05); the basal SO pressure was increased but peak SO pressure was decreased significantly (both P<0.05), while the SO contraction frequency showed no obvious difference (P>0.05). Conclusion: Partial CBD obstruction can cause decrease of voltage amplitudes of rapid and slow waves, basal pressure increase and peak pressure decrease in SO, and these changes may be one of the important mechanisms responsible for being prone to acute biliary pancreatitis in partial CBD obstruction.

Objective: To investigate and discuss the surgical practice and technical improvement of totally laparoscopic Roux-en-Y hepaticojejunostomy. Methods: The clinical data of 25 patients undergoing modified totally laparoscopic Roux-en-Y hepaticojejunostomy between October 2011 and October 2014 were retrospectively analyzed. Of the patients, 10 cases were congenital choledochal cysts (type I), 2 cases were common bile duct stone with distal inflammatory stricture, 6 cases were cancer in the head of the pancreas, 5 cases were distal bile duct cancer, and 2 cases were periampullary cancer. Results: Operation was successfully completed in all patients, with no need for open conversion. The operative time for choledochal cysts was (194.5±20) min and for obstructive jaundice caused by inflammatory stricture or tumors was (120±23.5) min; the time for hepaticojejunal anastomosis was (18.4±3.3) min and for jejunojejunal anastomosis was (17.4±2.3) min; the intraoperative blood loss was (38.8±35.8) mL, time to ambulation was (2.0±0.9) d and to first flatus was (2.48±0.7) d, and the length of postoperative hospital stay was (7.96±1.9) d, respectively. Minor bile leakage occurred in one patient after operation, which ceased after prolonged drainage. Follow-up was obtained in 24 patients (96%) for 1-36 months, postoperative reflux cholangitis occurred in one patient, which was resolved by anti-infective treatment, and no relapse of jaundice was noted in any of the cases. Conclusion: Totally laparoscopic Roux-en-Y hepaticojejunostomy is safe, effective, and feasible, and technical improvement can reduce the surgical difficulty, simplify the surgical procedure and shorten the operative time.

Objective: To investigate the causes and treatment strategy of recurrent intrahepatic stones after choledochojejunostomy for biliary drainage. Methods: The clinical data of 28 patients with recurrent hepatolithiasis after biliary-enteric drainage treated during January 2006 to June 2013 were retrospectively analyzed. Results: According to whether or not the continuity of the extrahepatic bile duct was preserved in former surgery, the 28 patients were divided into preservation group and non-preservation group, respectively. Of the 16 patients in preservation group, in 8 cases with normal function of Oddi’s sphincter, the original biliary-enteric anastomosis was taken down, and after the bile duct was repaired, a T-tube was inserted for external drainage; 7 cases with Oddi’s sphincter dysfunction underwent resection and reconstruction of the biliary-enteric anastomosis, and then standard Roux-en-Y choledochojejunostomy was performed; and one case underwent choledocholithotomy only due to unresectable bile duct tumor. Of the 12 patients in non-preservation group, 7 cases with anastomotic stricture underwent anastomosic repair and reconstruction, and 5 cases underwent stone removal by incision of the anastomosis and then its reconstruction. Among the two groups, postoperative complications occurred in 11 patients (39.3%) which included biliary fistula in 3 cases, wound infection in 6 cases, and intra-abdominal bleeding in two cases, and were all resolved. No perioperative death occurred. The immediate stone clearance rate and final stone clearance rate in preservation group was 68.8% and 87.5%, in non-preservation group was 66.7% and 83.3% respectively, and the good rate of living condition during follow-up was 85.7% in preservation group and 90% in non-preservation group. All differences between the two groups showed no statistical significance (all P>0.05). Conclusion: For patients with recurrent intrahepatic stones after choledochojejunostomy, the former surgical procedure and cause of stone recurrence should be ascertained, stones should be removed as completely as possible, and method of biliary drainage should be chosen according to the function of Oddi’s sphincter.