RESUMEN
Objective: To compare the clinical efficacy and safety of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography in the treatment of bile duct stones, and to analyze the related factors influencing postoperative acute pancreatitis. Methods: From March 2017 to June 2021, we recruited patients with bile duct stones to our study: 175 patients undergoing endoscopic retrograde cholangiopancreato-graphy and 147 patients undergoing laparoscopic common bile duct exploration. The operative time, intraoperative blood loss, conversion to laparotomy, postoperative exhaust time, hospitalization time, liver function before and after the operation, and the incidence of adverse events were compared. Logistic regression analysis was used to analyze the related factors influencing postoperative acute pancreatitis. Results: All patients were operated on successfully, with no conversion to laparotomy. Operative time, postoperative exhaust time, and hospitalization time were shorter, intraoperative blood loss was lower, and aspartate aminotransferase and alanine aminotransferase were higher in the endoscopic retrograde cholangiopancreato-graphy group compared with the laparoscopic common bile duct exploration group (P < .05). The endoscopic retrograde cholangiopancreatography group had a higher incidence of adverse events than the laparoscopic common bile duct exploration group (P < .05). After logistic regression analysis, white blood cell concentration, operative time, intraoperative blood loss, previous history of pancreatic disease, and endoscopic retrograde cholangiopancreatography operation all independently influenced the occurrence of acute pancreatitis. Conclusion: Laparoscopic common bile duct exploration is our first choice for patients with bile duct stones who have no history of abdominal surgery, cardiac or pulmonary valve insufficiency, bile duct stenosis, and poor duodenal papilla function, as it can reduce the occurrence of postoperative complications and shorten rehabilitation. Further investigation of the factors that independently caused postoperative acute pancreatitis after stone removal is warranted.
RESUMEN
Inhibitors for histone deacetylases (HDACs) have been identified as epigenetic drug targets to treat a variety of malignancies through several molecular mechanisms. The present study is aimed at investigating the mechanism underlying the possible antitumor effect of the HDAC inhibitor chidamide (CDM) on cholangiocarcinoma (CCA). Microarray-based gene expression profiling was conducted to predict the expression of HDACs in CCA, which was validated in clinical tissue samples from CCA patients. Next, the proliferation, migration, invasion, autophagy, and apoptosis of human CCA QBC939 and SNU308 cells were measured following treatment with CDM at different concentrations. The acetylation level of FOXO1 in the nucleus and cytoplasm of QBC939 and SNU308 cells was determined after overexpression and suppression of HDAC3. A QBC939-implanted xenograft nude mouse model was established for further exploration of CDM roles in vitro. HDAC3 was prominently expressed in CCA tissues and indicated a poor prognosis for patients with CCA. CDM significantly inhibited cell proliferation, migration, and invasion of QBC939 and SNU308 cells, while inducing their autophagy and apoptosis by reducing the expression of HDAC3. CDM promoted FOXO1 acetylation by inhibiting HDAC3, thereby inducing cell autophagy. Additionally, CDM inhibited tumor growth in vivo via HDAC3 downregulation and FOXO1 acetylation induction. Overall, this study reveals that CDM can exhibit antitumor effects against CCA by promoting HDAC3-mediated FOXO1 acetylation, thus identifying a new therapeutic avenue for the treatment of CCA.