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Objective To investigate clinical efficacy and prognostic factors of hilar cholangiocarcinoma.Methods The retrospective case-control study was conducted.The clinicopathological data of 322 patients with hilar cholangiocarcinoma who were admitted to the Xiangya Hospital of Central South University between December 2005 and November 2015 were collected.Preoperative staging and classification of tumor and treatment planning were carried out according to the results of laboratory and imaging examinations.Observation indexes:(1) clinical features and results of assisted examinations;(2) treatments and results of pathological examination;(3) followup and survival;(4) prognostic factors analysis:gender,age,preoperative highest total bilirubin (TBil),preoperative carcinoembryonic antigen (CEA),preoperative CA19-9,preoperative CA242,preoperative CA125,treatment methods and TNM staging.The follow-up of outpatient examination and telephone interview was perfornmed to detect patients' survival up to November 2016.Survival curve was drawn using the Kaplan-Meier method.Survival and univariate analyses were done using the Log-rank test,and multivariate analysis was done using the Cox proportional hazard model.Results (1) Clinical features and results of assisted examinations:among the 322 patients,there were 301 patients with a chief complaint of jaundice.Of the 322 patients,the preoperative highest levels of TBil,DBil,ALT and AST in 322 patients were 3.9-785.2 μmol/L,1.6-410.2 μ mol/L,14.8-484.5 U/L and 21.4-539.8 U/L,respectively.Levels of ALP and GGT in 272 patients were 93.8-1 890.0 U/L and 2.0-1 832.8 U/L,respectively.Seventy-seven of 292 patients had an elevated CEA level,272 of 298 patients had an elevated CA19-9 level,153 of 260 patients had an elevated CA242 level and 86 of 260 patients had an elevated CA125 level.According to Bismuth-Corlette type,24 patients were detected in type Ⅰ,115 in type Ⅱ,55 in type Ⅲa,63 in type Ⅲb and 65 in type Ⅳ.(2) Treatments and results of pathological examination:Of the 322 patients,104 patients underwent radical resection,including 79 with hilar bile duct resection (9 combined with vascular resection and reconstruction) and 25 with extended hepatic lobectomy (16 combined with caudate lobectomy),and 218 patients underwent palliative treatments,including 134 with external biliary drainage and 84 with internal biliary drainage.Five patients were dead in the perioperative period,of which 2 died of acute liver failure,1 died of systemic infection and multiple organ failure,1 died of acute renal failure and 1 died of acute suppurative cholangitis,septic shock and disseminated intravascular coagulation.Of 263 patients receiving pathological examination,adenocarcinoma was detected in 253 patients (12 with high-differentiated adenocarcinoma,85 with moderate-differentiated adenocarcinoma,33 with low-differentiated adenocarcinoma and 123 with indefinite differentiation),mucinous adenocarcinoma in 5 patients,cholangiocarcinoma in 3 patients and neuroendocrine carcinoma in 2 patients.TNM staging of 322 patients:stage Ⅰ was detected in 8 patients,stage Ⅱ in 53 patients,stage Ⅲ in 132 patients,stage Ⅳ in 96 patients and indefinite stage in 33 patients.(3) Follow up and survival:among the 322 patients,296 were followed up for 12-132 months,with a median follow-up time of 65 months,including 94 with radical resection and 202 with palliative treatments.Among the 296 patients,the median survival time and 1-,3-,5-year survival rates were 10 months,47.1％,20.2％ and 9.5％,respectively.0f296 patients with follow-up,median survival time and 1-,3-,5-year survival rates were 31 months,84.0％,46.2％,25.0％ in 94 patients receiving radical resection and 7 months,29.9％,8.1％ and 2.3％ in 202 patients receiving palliative treatment,respectively,with a statistically significant difference between the 2 groups (x2=78.777,P＜ 0.05).Among the 94 patients receiving follow-up and radical resection,the median survival time and 1-,3-,5-year survival rates were 31 months,82.1％,45.1％,25.7％ in 73 patients undergoing hilar bile duct resection and 35 months,90.5％,49.8％,22.1％ in 21 patients undergoing hepatic lobectomy,respectively,with no statistically significant difference (x2=0.186,P＞0.05).Among the 73 patients undergoing hilar bile duct resection,median survival time and 1-,3-,5-year survival rates were 16 months,57.1％,0,0 in 7 patients combined with vascular resection and reconstruction and 34 months,84.6％,49.5％,27.5％ in 66 patients undergoing simplex hilar bile duct resection,respectively,showing a statistically significant difference (x2 =11.977,P＜ 0.05).(4) Prognostic factors analysis:results of univariate analysis showed that preoperative highest TBil,preoperative CEA,preoperative CA242,preoperative CA125,treatment methods and TNM staging were related factors affecting prognosis of patients with hilar cholangiocarcinoma (x2=25.009,18.671,9.359,33.628,94.729,77.136,P＜0.05).Multivariate analysis showed that preoperative highest TBil ≥ 342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ and Ⅳ were the independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma (HR =2.270,2.147,3.166,2.351,95％ confidence interval:1.587-3.247,1.446-3.188,2.117-4.734,1.489-3.712,P＜0.05).Conclusions Prognosis of hilar cholangiocarcinoma is still unsatisfactory.The R0 resection is the key in radical surgery.Preoperative highest TBil≥342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ-Ⅳ are independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma.
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Objective To determine the possible mechanism for chronic pancreatitis causing pancreatic duct stones. Methods A total of 172 patients with chronic pancreatitis (n=67) , pan-creatic duct stones (n=62) , and pancreatic injury (n=43) , admitted to from August 2000 to October 2008, preoperatively diagnosed by endoscopic retrograde cholangiopancreatograpby (ERCP) or computed tomography (CT) , and intraoperatively confirmed by exploration and biopsy, were divid-ed into 3 groups. Pancreatic fluid was drawn to test the concentrations of pancreatic stone protein (PSP), lactoferrin (LF) and Ca2+. Results The chronic pancreatitis (the CP group) presented hard consistency, shrinkage and nodular fibrosis of the pancreas; besides the above symptoms, the pancreatic duct stones (the PS group) presented dilatation of the pancreatic ductal system with vari-ous stones ; pancreatic injury (the PI group) presented broken pancreas of different grades with fluid or blood. Compared with that of the PI group, PSP concentration of both the PS group and the CP group was elevated (P<0.05), and was more apparent in the CP group. Concentrations of LF and Ca2+ were also elevated (P<0.05) , which were more obvious in the PS group. Conclusion De-creased concentrations of PSP and increased concentrations of LF and Ca2+ may play very important roles in chronic pancreatitis causing pancreatic stones.
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Objective To investigate the indication and value of metallic stent in the management of patients with malignant obstructive jaundice(OJ). Method The clinical data of 15 patients with malignant OJ treated in our hospital were analysed retrospectively. All the 15 patients were treated with metallic stent including cholangiocarcinoma in 8 cases, carcinoma of gallbladder in 3 cases, pancreatic carcinoma in 2 cases, porta hepatis metastasis of gastric carcinoma after radical gastrectomy in 2 cases. Result All the patients' jaundice disappeared 11-38 days after the stent placement. No severe complications or death occurred in this series. One patient had cholimia 5 days after the stent placement, which was cured by non-operative method. All cases were followed up periodically, the survival time was 30-384 days(averag 180.5 days). Conclusions Installing stent of Titanium-Nickel metallic alloy for the patient with unresectable malignant OJ is an ideal palliative therapy which is simple and less discomfortable.and less complications.The effect of reducing jaundice is satisfactory. This method may offer a new alternative method in the management of malignant OJ.
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Objecctive To study the expression and significance of CD44V6 and E-Cd in gallbladder carcinoma. Methods The expression of CD44V6 and E-Cd was detected by immunohistochemical technique in 48 cases of gallbladder carcinoma, 29 cases of gallbladder adenomal polypi and 25 cases of chronic calculous cholecytitis. The association of CD44V6 and E-Cd expression with the clinical and pathologic parameters was analyzed. Results E-Cd expressed in 21 of 48 cases of gallbladder carcinoma(43 75%), 21 of 29 cases of gallbladder adenomal polypi(72 42%) and 24 of 25 cases of chronic calculous cholecytitis(96 00%), while CD44V6 expressed in 31 of 48 cases of gallbladder carcinoma(64 58%), 9 of 29 cases of gallbladder adenomal polypi(31 03%) and 1 of 25 cases of chronic calculous cholecytitis(4 00%). The expression rates of CD44V6 and E-Cd in the three kinds of tissues were significantly different(P
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Objective To investigate the relationship between the expression of the Smad4,TGF-?_1 and T?R II and the possible mechanisms in the development of cholangiocarcinoma. Methods Immunohistochemical SABC method was used to examine the expression of Smad4,TGF-?_1 and T?R II in 49 cases of cholangiocarcinoma and 8 nomal common bile duct.Results The expression rates of Smad4,TGF-?_1 and T?R II in cholangiocarcinoma were (40.82)%(20/49),71.43%(35/49) and 36.73%(18/49) respectively; in normal common bile duct tissues were 87.50(7/8),12.50%(1/8) and 100%(8/8) respectively. There was a significant relationship between the (expression) of TGF-?_1 and clinical stage, and tumor metastasis (P
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Objective To evaluate the therapeutic effect of segmental hepatectomy for intrahepatic bile duct stones.Methods In this study, 414 patients suffering from intrahepatic bile duct stones underwent hepatectomy from Jan 1981 to Dec 2001. Stones distribution, operation modality,postoperative complication and therapeutic effect were evaluated. Results Postoperative complications occurred in 72 cases(17.4%), mortality was 0.7%. A follow up of 2 to 22 years was achieved in 305 patients (73.7%), with excellent or good result in 88.9%, residual stone in 15.7%,and stone recurrence in 4.6%.Conclusion Appropriate use of hepatectomy is effective for the treatment of intrahepatic bile duct stones.
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Objective To investigate the expressions of phosphatase and tensin homolog deleted on chromosome 10(PTEN) and P53 protein in cholangiocarcinoma and evaluate their possible relationship and clinical significance. Methods The expressions of PTEN and P53 in 36 cases of cholangiocarcinoma, eight cases of normal biliary duct and 30 cases of para-neoplastic tissue were detected by S-P immunohistochemistry method. Results The positive rate of PTEN protein expression was 63.89%(23/36) in cholangiocarcinoma, which was significantly lower than that in normal biliary duct (100%,8/8) and that in para-neoplastic tissue(100%,30/30), and which had no relationship with tumor locus, but was significantly correlated with the degree of differentiation and metastasis. The positive rate of P53 protein expression was 44.44%(16/36) in cholangiocarcinoma, which was significantly higher than that in normal biliary duct( 0%, 0/8) and that in para-neoplastic tissue (0%, 0/30), and it had no relationship with tumor locus and metastasis,but was significantly correlated with the degree of differentiation. The PTEN protein expression had correlation with the expression of P53. Conclusion The expression of PTEN protein was significantly lower in cholangiocarcinoma and significantly correlated with the degree of differentiation and metastasis other than the locus of tumor. The expression of P53 protein was associated with the degree of differentiation, but not with the tumor locus and metastasis. Moreover, The PTEN protein expression had correlation with the P53 expression.
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Objective To evaluate the diagnostic and therapeutic methods for hilar bile duct carcinoma. Methods The clinical data of 36 patients with hilar bile duct carcinoma from Jan 1998 to Jul 2003 were retrospectively analyzed. Results The misdiagnosis rate(39%) was high. All patients underwent a surgery. The median survival time of 16 patients treated by radical resection was 30 months. The 1,3,5-year survival rate was 93%,50% and 25% respectively. While the median survival time of the rest 20 patients treated by a variety of non-radical operation was 16 months with 1,3,5-year survival rate of 47%,8% and 0 respectively(t=2.585).Conclusions Early diagnosis and radical resection improves long-term survival of patients with hilar bile duct carcinoma.
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Objective To summarize our experience in the prevention and treatment of iatrogenic vascular(trauma).Methods The clinical data of 24 different types of iatrogenic vascular trauma committed from 2003 to 2006 were retrospectively analyzed.Results The 24 cases included 7 cases of superior mesenteric(arteriovenous) trauma,3 cases of portal venous trauma,4 cases of carotid arterial trauma,6 cases of iliac and femoral arterial trauma,and each one of trauma of popliteal artery,axillary artery,renal artery,left gastric artery,respectively.Treated method: Six cases underwent vascular repair,5 cases had vascular anastomosis,2 cases had vascular replacement,3 cases had vascular ligation,2 cases had covered stent implantation under intervention,and other methods included thrombectomy,thrombolysis and packing.Among the 24 cases,22 were cured completely,one patient died from massive hemorrhage 24 hours after operation,and the other died 5 days after operation.Conclusions Iatrogenic vascular trauma can be prevented and its incidence reduced by increased vigilance,clear identification of the anatomy,and accurate and careful operation.Once iatrogenic vascular trauma has occurred,its cause must be determined and then different treatment methods can be(chosen),based on the cicumstaces. When effective treatment technique is not at hand,one should promptly seek outside support or transfer the patient to an advanced hostipal.
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Objective To investigate the effect of expression of pituitary tumor transforming gene(PTTG) on the expression of inhibitory of vascular endothelial growth factor(VEGF).Methods The constructed(recomibinant) vector,pcDNA3.1-PTTGas that contained full-length antisense PTTG,was transfected into the cholangiocarcinoma cell line QBC939 in different quantity.After 48h incubation,the variation of expressions of PTTG and VEGF mRNAs and proteins were observed by RT-PCP and Western-blot method.Results(After) successful transfecting the recomibinant vector into QBC939,the mRNAs and proteins of PTTG and VEGF were all inhibited.Linear correlation analysis showed positive correlation between descendent extents of PTTG and VEGF(P
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Objective To investigate the diagnosis and treatment of hashimoto′s disease(HD) complicated with thyroid adenomas(TA).Methods Clinical data of 50 cases of HD complicated with TA were analysed retrospectively. Results 8 patients were diagnosed before operation ,misdiagnosis rate was 84.0%.Intra operation frozen section diagnosis rate was 81.4% (35/43).All patients were diagnosed as HD complicated with TA by pathology after operation.Various extension thyroidectomies were performed according to the patients conditions. After operation,27 cases were given small dosage of thyroxine and 2 cases were given small dosage of prednisone. All the 50 patients were followed up for 3 months to 1 year, none presented hypothyroidism.Conclusions Complete serum immunologic examinations,ultrasonography and fine needle aspiration biopsy are helpful for the diagnosis of HD with TA. HD with TA should be treated surgically,and the intraoperation frozen section for the diagnosis is important.The operation procedures,extension of excision and medication after operation should be individulization to avoid the occurrence of postoperative hypothyroidism as possible.
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Objective To investigate the possible mechanism of pancreaticobiliary maljunction(PBM) on development of congenital choledochal cyst(CCC).Methods Tweenty-one patients with choledochal cysts initially diagnosed by ultrasonography,then underwent ERCP.The concentrations of amylase(AMS) and C-reactive protein(CRP) in bile removed through selective biliary catheterization was analyzed.Results Each of 21 cases of PBM(including 13 cases of C-P type and 8 cases of P-C type) had significantly higher concentrations of AMS and CRP compared with control group(P
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Objective To detect the effect of exogenous IL-6 on the proliferation of cholangiocarcinoma cell line QBC939.Methods MTT was used to observe the proliferation of cell line QBC939 treated with exogenous IL-6.Following the annexin V/FITC and PI staining,FCM was used to detect the apoptosis of QBC939 treated with exogenous IL-6.Results The proliferation of cell line QBC939 was increased after treatment with IL-6 and was positively related with the concentration of IL-6(P
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Objective To analyze the outcome of patients with acute obstruction of left colorectal cancer treated by modified antegrade colonic lavage with primary tumor resection and anastomosis.Methods From April 2002 to April 2007,112 patients with acute obstruction of left colorectal cancer underwent surgery.During the operation the left colon was exteriorized and placed into a sterilized plastic bag to protect the surgical field from contamination,then a catheter was inserted via the appendix,and after antegrade colonic lavage,primary resection and anastomosis was performed.Results Tumor resection and primary anastomosis was successfully done in the 112 cases.Postoperatively,1 case had anastomotic leak which healed after reoperation with proximal colostomy,and one patient died.Conclusions Modified antegrade colonic lavage is a simple procedure,the bowel can be rapidly decompressed with essentially no contamination,and has a high level of bowel cleansing.It is possible to safely perform primary resection and anastomosis for left colon cancer after the modified antegrade lavage.
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Objective To investigate a new microcapsular system for culture of primary generation hepatocytes in vitro. Methods A novel microcapsular system was used for in vitro culture of primary generation rat hepatocytes .The various characteristics of the microcapsular system were examined. The survival rate of hepatocytes and the functions of urea and albumin synthesis were observed.Results The microcapsule had good permeability,a certain degree of mechanical stability and favorable immunological protective ability. Hepatocytes within the microcapsule maintained a high degree of viability and function, and the synthesis of urea and albumin was 1~3 times higher than that of controls.Conclusions This microcapsule has excellent biological and mechanical properties.This system can be of great benefit for use in bioartificial liver and cell transplantation.
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Objective To investigate the principles of treatment for severe acute pancreatitis(SAP). Methods A retrospective analysis of the data of 217 cases of SAP with regards to clinical features,mortality rate and conversion to surgical operation.In this group,66 cases received early operation and 24 cases were converted to operation after initial conservative treatment.Results The overall cure rate was 80.2%(174/217). Among them,90 cases underwent operative treatment,with a cure rate of 72.2%(65/90),and 127 cases underwent conservative treatment with a cure rate of 85.8%(109/127).Conclusions The initial treatment of SAP should be conservative. Operation should be performed if there is a specific indication for early surgical intervention,or for conversion to operation.
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This paper reported nine cases of pancreatic lithiasis. Pancreatolithotomy and pancreaticojejunostomy was performed in 4 cases; Pancreatoduodenectomy in 1 case; Laparotomy and biopsy in 1 case complicated with pancreatic carcinoma and hepatic metastasis; And nonoperative treatment in 3 cases. Our data showed that pancreatic fluid stasis caused by stenosis of pancreatic duct and/or the distal segment of bile duct maybe one of the important factors of pancreatic stone formation. The diagnosis and principles of surgical treatment of pancreatic lithiasis were discussed.
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Objective To study the significance of expression of VEGF in the hepatocellular carcinoma tissue(HCT) and the expression of AFPmRNA in the peripheral vein blood in hepatocellular carcinoma patients(HCC) with metastasis. Methods AFPmRNA was detected in peripheral blood before operation and the expression of VEGF in HCC tissue was analyzed by immunohistochemistry after operation in 20 patients. The relations between the expression of VEGF protein and AFPmRNA with clinicpathological parameters were analyzed statistically. Results (1)Among the 20 patients with HCC, 10 were positive expression of VEGF protein, which had no relation with the clinicopathological parameters. (2)Of the 20 patients, positive expression of AFPmRNA were detected in the peripheral blood in 15 patients, and AFP≥200?g/L were found in 13 patients.(3) AFPmRNA in the peripheral blood vein was detected in 9 of 10 patients with VEGF positive expression. Conclusions (1)Either VEGF protein expressed in HCC tissue or AFPmRNA detected in the peripheral blood could be as a guide line to judge the tendency of the metastasis of HCC,however former is simpler and the later is more sensitive . (2)The detection of AFPmRNA in the peripheral blood is more sensitive than the detection of serum AFP lever for surveillance of the high risk patients and postoperative follow up of the patients with HCC.
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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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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