Abstract:

Objective: To investigate the clinical efficacy of precise hepatectomy for complicated hepatolithiasis. Methods: The clinical data of 60 patients with complicated hepatolithiasis undergoing precise hepatectomy within the last two years were retrospectively analyzed. Results: The operations were performed successfully in all patients. The average operative time was (358.60±45.6) min, intraoperative blood loss was (598.2±95.6) mL and length of postoperative hospital stay was (12.5±2.7) d. Postoperative complications occurred in 11 cases (18.3%) and included 5 cases (8.3%) of wound infection, 1 case (1.7%) of bile leakage, 3 cases (5.0%) of right pleural effusion, and 2 cases (3.3%) of lung infection. During the follow-up period of 2 months to 2 years, residual stones were found in 3 patients (5.0%), which were removed by choledochofiberscope through T-tube sinus tract, and recurrence occurred in 2 patients (3.3%) who were treated again by endoscpic sphincterotomy (EST) to extract stones. Conclusion: Precise hepatectomy is effective for treatment of complicated hepatolithiasis, which can reduce the rate of residual and recurrent stones and reoperation.

Abstract:

Objective: To determine therapeutic efficacy in patients with intra- and extrahepatic stones by observation of the imaging evolution of the affected bile ducts before and after operation. Methods: The clinical records of 62 patients with intra- and extrahepatic calculi who met the criteria between 2006 to 2009 were selected, and then the patients were followed up and reexamined with MRI and magnetic resonance cholangiopancreatography (MRCP). The patients were divided, according to the types of surgery performed, into group A (8 cases, undergoing choledocholithotomy, T-tube drainage and partial liver resection), group B (16 cases, undergoing choledocholithotomy, T-tube drainage, partial liver resection, and choledochoscopic lithotomy via T-tube sinus tract) and group C (38 cases, undergoing choledocholithotomy, T-tube drainage, and choledochoscopic lithotomy via T-tube sinus tract). The imaging evolutions of each group were observed. The disease characteristic factors were assigned weighted values, according to which the scores of each group before and after operation were calculated to assess the therapeutic effects. Results: In the entire group, the pre- and postoperative rate of intrahepatic bile duct dilatation, extrahepatic bile duct dilatation and intrahepatic bile duct stricture was 98.4% vs. 79.0%, 90.3% vs. 67.7%, and 40.3% vs. 29.0% respectively, and recurrence rate was 9.7%. By comparison of the results before and after operation, the maximal diameters of the common bile duct in the three groups were all significantly reduced (all P<0.05), and the maximal diameters of the intrahepatic bile duct in group B and group C were markedly decreased (both P<0.05), and except in group A, it did not reach statistical significance (P>0.05). The postoperative scores in the three groups were all significantly decreased (all P<0.05), and the results of the pairwised comparison showed that the difference-value between pre- and postoperative scores in group B was significantly higher than that in group C (P<0.05). Conclusion: Most of the affected intra- and extrahepatic bile ducts do not recover into their normal state after operation and choledochoscopic lithotomy. Partial hepatectomy is an ideal procedure for intra- and extrahepatic stones.

Abstract:

Objective: To compare the effects of primary closure and T-tube drainage following laparoscopic common bile duct exploration (LCBDE). Methods: The clinical data of 71 patients who underwent LCBDE for stone extraction from January 2011 to August 2012 were retrospectively analyzed. Of the 71 patients, 39 cases underwent primary closure (suture group) and 32 cases received T-tube drainage (drainage group) after LCBDE. The intra- and postoperative conditions between the two groups were compared. Results: There were no significant differences between the two groups in the operative time, length of postoperative hospital stay and time to liquid intake (all P>0.05), but abdominal drainage time and hospital costs in suture group were significantly lower than those of drainage group (both P<0.05). The incidences of postoperative complications such as bile leakage, cholangitis and retained stones between the two groups showed no statistical difference (P>0.05). No bile duct stricture or death occurred in either group. Conclusion: Primary closure has reduced duration of postoperative drainage and hospital cost compared with T-tube drainage following LCBDE, and thus, it could be proposed as the method of first choice under appropriate indications.

Abstract:

Objective: To investigate the value and operative approach of liver resection for intrahepatic bile duct stones. Methods: The operative approaches and outcomes in 442 patients with hepatolithiasis, 410 of whom had concomitant extrahepatic cholangiolithiasis, admitted during the past 3 years, were retrospectively analyzed. Results: Of the 442 patients, 206 cases underwent hepatic lobectomy (group A), and the other 236 cases received choledocholithotomy only (group B). One patient in each group died after operation. The incidence of complications related to surgery was 8.8% (18/205) in group A and 11.1% (26/235) in group B respectively, and the difference between them had no statistical significance (χ2=0.634, P=0.263). The rate of retained stones was 16.1% (33/205) in group A and 46.8% (96/235) in group B respectively, and the difference between the two groups had statistical significance (χ2=32.4, P<0.001). In group A, the rate of residual stones was associated with the distribution of stones in the intrahepatic bile ducts (χ2=14.0, P=0.001), but irrelevant to whether anatomical lobectomy was performed or not (χ2=0.892, P=0.451). Seven cases in group A were found to have intrahepatic cholangiocarcinoma, and successfully underwent surgical resection of the tumors. In group B, 4 cases were found to have liver tumors after a follow-up of 2 years, and 2 of them underwent surgical resection. The total number of cases of recurrent cholangiolithiasis, biliary obstruction or infection after follow-up of more than 2 years was 16 (8.1%) in group A and 62 (26.8%) group B respectively, and the difference had statistical significance (χ2=25.2, P<0.001); of the 16 cases in group A, only one case was from those undergoing anatomical lobectomy and the other 15 cases were from those receiving partial hepatectomy, which showed significant difference (P=0.043). Conclusion: Hepatic lobectomy can reduce the rate of postoperative residual stones in patients with hepatolithiasis. Further, the anatomical hepatolobectomy can apportunely resect latent malignant lesions, and also effectively decrease the long-term chance of recurrence of biliary stones, obstruction and infection.

Abstract:Objective: To compare the clinical efficacy between anatomical segmentectomy/lobectomy and non-anatomical segmentectomy/lobectomy in treatment of intrahepatic bile duct stones. Methods: Ninety-six patients with intrahepatic bile duct stones were randomly divided into observation group and control group with 48 cases in each group. Patients in observation group underwent anatomical segmentectomy/lobectomy, while those in control group received non-anatomical segmentectomy/lobectomy. The operative time, intraoperative blood loss, incidence of postoperative complications and rates of residual and recurrent stones and reoperation of the two groups were compared. Results: Operations were performed successfully in all patients, and all of them experienced a smooth perioperative period. No death occurred. The operative times between the two groups showed no statistical difference (P>0.05), but the intraoperative blood loss, incidence of postoperative complications, rates of residual and recurrent stones and reoperation in observation group were all significantly lower than those in control group (all P<0.05). Conclusion: Partial liver resection is effective for intrahepatic bile duct stones and anatomical segmentectomy/lobectomy is the preferred procedure.

Abstract:Objective: To investigate the effects of different biliary drainage methods on the intestinal mucosal barrier function in rats with obstructive jaundice (OJ) and the mechanisms. Methods: Sixty SD rats were used to establish OJ models by common bile duct ligation. One week after operation, the rats were equally randomized into non-drainage group (underwent no biliary drainage), internal drainage group (underwent internal biliary drainage) and external drainage group (underwent external biliary drainage), and the drainage time was one week. Twenty SD undergoing sham operation served as control group and the total experiment time was two weeks. At the end of the experiment, the serum endotoxin level and protein expression of occludin and zona occludens 1 (ZO-1) in the tissues of small intestinal mucosa of each group were determined by ELISA assay and Western blot analysis respectively, and the histomorphological changes in small intestinal mucosa were also observed. Results: Rats presented overt symptoms after OJ model creation, while the general conditions of rats of internal drainage group were better than those of non-drainage group and external group after the second operation. The serum endotoxin levels in OJ rats of non-drainage group and external drainage group were increased markedly, and their differences versus control group reached statistical significance (both P<0.01), but no significant difference was observed between the two drainage groups (P>0.05); the serum endotoxin level in OJ rats of internal drainage group was significantly lower than that in OJ rats of non-drainage group or external drainage group (both P<0.01), and showed no significant difference versus control group (P>0.05). Compared with control group, the protein expressions of occludin and ZO-1 in small intestinal mucosa in rats of non-drainage group and external drainage group were significantly decreased (all P<0.01), and the degree of decrease in external group was more evident than that in non-drainage group (both P<0.01); the expression levels of the two proteins in internal drainage group were significantly higher than those in non-drainage group or external drainage group (all P<0.01), and were similar to those in control group (both P>0.05). As seen at the pathological examination, the intestinal mucosal integrity was damaged in OJ rats of both non-drainage group and external group with large or moderate amounts of inflammatory cell infiltration, while the intestinal mucosal integrity was maintained intact with less inflammation in OJ rats of internal drainage group. Conclusion: Internal biliary drainage has protective effect on the intestinal mucosal barrier in OJ rats, and the mechanism is probably due to the maintaining effect of bile on tight junction-related protein expression in intestinal epithelial cells.

Abstract:

Objective: To construct the lentiviral vector containing tumor suppressor gene WTX (Wilms tumor gene on the X chromosome) and the colon cancer cell line stably transduced with this WTX-containing vector (Lovo/WTX-EGFP), so as to provide a useful tool for studying the role of WTX in colon cancer. Methods: The lentiviral vector pLV.Ex3d.null-EF1A>WTX>IRES/EGFP was constructed by Gateway technology, which was screened and identified by colony PCR. After that, it was co-transfected into the 293FT cells with three helper plasmids that were PLV/helper-SL3, PLV/helper-SL4 and PLV/helper-SL5 to package lentivirus and then the viral titer was determined under fluorescence microscope. Finally, the human colon cancer Lovo cells were transduced with the WTX-containing lentiviral vector to obtain the Lovo/WTX-EGFP cell line with stable expression of WTX gene through several subcultures by repeated colony picking. Results: The lentiviral vector pLV.Ex3d.null-EF1A>WTX>IRES/EGFP constructed by Gateway technology was completely and correctly identified. The distinct green fluorescence was seen under fluorescence microscope 48 h after virus packaging and the virus titer was 5×107 TU/mL. The vector was successfully transduced into Lovo cells as evidenced by the significantly increased WTX expression level determined by both qPCR and Western blot was obviously higher than cells without transducting. The Lovo/WTX-EGFP colon cancer cell line with stable transduction of WTX containing vector was established by repeated colony picking and subcultures. Conclusion: Through Gateway technology, the WTX-containing lentiviral vector can be successfully constructed and colon cancer Lovo/WTX-EGFP cell line can be stably transduced by this WTX-containing lentiviral vector. It may provide an experimental basis for studying the role of WTX in colon cancer.

Abstract:

Objective: To investigate the alterations of interstitial cells of Cajal (ICC) and gap junction protein connexin 43 (Cx43) in the stomach of hemorrhagic shock rats before and after resuscitation. Methods: SD rats were equally randomized into control group and experimental group. Rats in control group underwent sham operation, while rats in experimental group were subjected to hemorrhagic shock by means of exsanguination, and the shock state was maintained for 1 h before fluid resuscitation. At 1 h after shock induction and 3, 6, 12 and 24 h after resuscitation treatment respectively, the gastric tissues were excised from the rats, and their ICC ultrastructure was observed by transmission electron microscope and Cx43 expression was detected by both immunofluorescence staining and Western blot analysis. Results: Under electron microscope, the gastric ICC presented severe edema, nuclear shrinkage and basal membrane rupture at 1 h after shock, which showed little or no recovery at 3 and 6 h after resuscitation treatment, but began to recover gradually at 12 h and returned to the appearance of control group at 24 h after resuscitation treatment. Immunofluorescence staining showed that the Cx43 fluorescence intensity in experimental group was markedly reduced at 1 h after shock, but gradually increased after resuscitation and approximately reached the control level at 24 h after resuscitation. The results of Western blot analysis for the expression level profiles of Cx43 protein were consistent with those of immunofluorescence staining. Conclusion: Hemorrhagic shock can cause both ICC injury and Cx43 expression reduction, and the intercellular communication defect resulting from both changes may be one of the important reasons for gastrointestinal dynamic disturbance during hemorrhagic shock.

Abstract:

Objective: To investigate the association of Arg261Gln polymorphism in the coding region of 12-lipoxygenase (LOX12) gene with the risk of developing stomach cancer. Methods: The LOX12 genotypes in 148 patients with gastric cancer and 148 cancer-free controls were determined by using PCR-restriction fragment length polymorphism (PCR-RFLP). The association between the genotypes and risk of developing gastric cancer was estimated by logistic regression model. Results: The allele frequency for LOX12 Arg261Gln in gastric cancer patients (0.544) was higher than that of the normal controls (0.443). Compared with the Arg/Arg genotype carriers, the risk of developing gastric cancer was increased in Gln/Gln genotype carriers (OR=2.26, 95%CI=1.15–4.46, P=0.018), while those with the heterozygous genotype Arg/Gln showed no increased risk of developing gastric cancer (OR=1.37, 95%CI=0.77–2.44, P=0.284). Conclusion: The inherited polymorphisms of Arg261Gln in LOX12 gene encoding region may confer genetic susceptibility to development of stomach cancer.

Abstract:

Objective: To evaluate the efficiency and safety of single-incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC). Methods: The literature of randomized controlled trials (RCTs) concerning SILC versus CLC was retrieved by searching the electronic databases from their inception date to November 2012. Methodological quality of the included trials was assessed using the Cochrane Reviewers’ Handbook criteria, and data were extracted and combined into a Meta-analysis by using RevMan 5.1 analysis software. Results: Seventeen studies were finally selected after screening, with a total of 1 267 patients, of whom, 654 cases underwent SILC and 613 cases underwent CLC. Meta-analysis results demonstrated that the operative time in SILC group was longer than that in CLC group (WMD=13.02, 95%CI=7.95–18.09, P<0.001); the scores for the postoperative appearance of incision and patient-satisfaction in SILC group were higher than those in CLC group (WMD=1.21, 95%CI=0.70–1.72, P<0.001; WMD=0.76, 95%CI=0.53–1.00, P<0.001); the postoperative complications, postoperative pain scores and lengths of hospital stay between the two group showed no statistical difference (RR=1.13, 95%CI=0.87–1.48, P=0.35; WMD=0.03, 95%CI=–0.82–0.88, P=0.95; WMD=–0.06, 95%CI=–0.40–0.28, P=0.73). Conclusion: For uncomplicated cases of benign gallbladder disease, SILC is a safe and effective surgical procedure with the advantages of a good cosmetic incision and high patient satisfaction.

Abstract:

Objective: To compare the effects exerted by endoscopic gallbladder-preserving cholecystolithotomy (EGPCL) with those by cholecystectomy on the postoperative defecation function in patients with gallstones. Methods: Questionnaire follow-up investigation was conducted in 330 patients (more than one year after operation), who were selected, by stratified random sampling, from the gallstone patients treated between 2001 and 2011 in our hospital. The incidences of postoperative diarrhea and constipation of the patients were analyzed. Results: In total, 298 valid questionnaires were returned. Of the patients, 28 cases underwent laparoscopic cholecystectomy (LC), 108 cases underwent open cholecystectomy (OC) and 162 cases underwent EGPCL. In LC, OC and EGPCL group, the incidence of postoperative diarrhea was 3.57% (1/28), 6.48% (7/108) and 0.62% (1/162), incidence of postoperative constipation was 10.71% (3/28), 9.26% (10/108) and 2.47% (4/162), and incidence of alternating diarrhea and constipation was 35.18% (38/108), 21.43% (6/28) and 16.67% (27/162), respectively. The incidences of above three conditions in EGPCL group were all significantly lower than those in cholecystectomy (LC+OC) group (all P<0.01). Both diarrhea and constipation were not associated with the age of the patients undergoing either cholecystectomy or EGPCL (all P>0.05). Conclusion: Gallbladder removal may cause diarrhea and/or constipation. Gallbladder function preservation-oriented operation is recommended for those with preoperative abnormal defecation dynamics.

Abstract:Objective: To compare the clinical efficacies between endoscopic minimally invasive polypectomy with gallbladder preservation and laparoscopic cholecystectomy in treatment of gallbladder polyps. Methods: One hundred and ninety-six patients with gallbladder polyps who met our criteria were designated to undergo either endoscopic minimally invasive gallbladder preserving polypectomy (gallbladder preservation group, 103 cases) or laparoscopic cholecystectomy (cholecystectomy group, 93 cases) depending on the their own willingness. The intra- and postoperative conditions of the patients between the two groups were compared. Results: There were no significant differences between the two groups with regard to age, sex and comorbidities (all P>0.05), so they were comparable. Two patients in gallbladder preservation group were converted to perform cholecystectomy due to gallbladder wall hemorrhage after polypectomy. Compared with cholecystectomy group, in gallbladder preservation group, the average operative time and intraoperative blood loss were reduced [(50.3±12.9) min vs. (61.2±16.7) min; (10.2±2.7) mL vs. (15.1±3.9) mL]; the incidences of postoperative pain and gastrointestinal adverse reactions were decreased, and time to the first intestinal gas passage was shortened [16.83% vs. 32.26%; 18.81% vs. 3.33%; (18.5±4.1) h vs. (26.2±5.3) h]; the incidence of long-term complications were also decreased (10.89% vs. 22.58%) (all P<0.05). Conclusion: The minimally invasive endoscopic gallbladder preserving polypectomy has the advantages of less pain, fast recovery and fewer complications compared with laparoscopic cholecystectomy, and so it is a safe and effective treatment method for patients with suitable indications.

Abstract:Objective: To investigate the causes, management and prevention measures of iatrogenic bile duct injury (IBDI). Methods: The clinical data of 56 patients with IBDI after operation from January 2004 to September 2010 were retrospectively analyzed. Results: Among the 56 patients, IBDI of 36 (64.3%) cases resulted from laparoscopic cholecystectomy, 12 (21.4%) cases from open cholecystectomy, 5 (8.9%) cases from common bile duct exploration and 3 (5.4%) cases from radical gastrectomy; 33 cases were discovered during operation and the other 23 cases were found after operation. Surgical treatments for IBDI included primary bile duct repair or reconstruction, bilioenteric anastomosis and biliary stenting. Postoperative follow-up showed that 50 (89.3%) patients obtained a favorable outcome, while 6 patients had poor results, 3 of whom developed postoperative biliary stricture or intrahepatic bile duct stones, and the other 3 cases died due to liver failure or septic shock. Conclusion: The causes of IBDI are associated with the local anatomic variations in bile ducts of the patients, pathological factors and surgical skills of the surgeon. IBDI requires individualized treatment depending on a number of factors such as the causes, detection time, severity and location of injury, as well as the extent of biliary stricture and general conditions of the patients.

Abstract:Objective: To compare the short-term clinical efficacy of hand-assisted laparoscopic (HAL) and open modified Sugiura procedure on patients suffering from portal hypertension. Methods: From January 2011 to March 2012, 56 patients with portal hypertension scheduled for a Sugiura procedure were randomly designated to HAL group or open surgery group, with 28 cases in each group. The intra- and postoperative variables between the two groups were compared. Results: Operations were performed successfully in all the patients in the two groups, and no complications developed during the procedures. The differences in operative time and incidence of postoperative complications between the two groups showed no statistical difference (both P>0.05). However, HALS group was better than open surgery group in terms of incision length, intraoperative blood loss, time to have flatus passage, volume of abdominal drainage, and postoperative hospital stay, and all the differences between them had statistical significance (all P<0.05). The patients were followed up for 1 to 13 months, with an average of 7.32 months. The rate of varicose veins occlusion achieved 100% in both groups, and no relapsing bleeding occurred in any of the patients. Conclusion: The HAL modified Sugiura procedure has not only the same clinical efficacy as the open procedure, but also has the minimally invasive advantages of the laparoscopic procedure.

Abstract:Objective: To assess the clinical value of using the concept of precise liver surgery in the treatment of liver hemangioma. Methods: The clinical data of 52 patients with liver hemangioma undergoing hepatectomy during the past three and a half years were retrospectively analyzed. Of the patients, 23 cases underwent precise hepatectomy, and another 29 cases underwent traditional hepatectomy. Results: The operations were performed successfully in all patients. All of them recovered well with no serious complications during operation and the perioperative period, and no death occurred. In precise hepatectomy group, compared with the traditional hepatectomy group, there was prolonged operative time [(128.0±25.7) min vs. (100.9±20.4) min] (P<0.05), and similar intraoperative blood loss and ratio of blood transfusion requirement (both P>0.05), but reduced length of postoperative hospital stay [(7.0±1.5) d vs. (8.6±1.5) d] (P<0.05), and postoperative peak levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) [(277.5±189.3) U/L vs. (960.0±635.0) U/L; (254.2±191.4) U/L vs. (838.5±677.1) U/L], as well as decreased postoperative complications (8.7% vs. 31.0%) (all P<0.05). Conclusion: Precise liver surgery is safe and effective for liver hemangioma with significant advantages versus traditional hepatectomy.

Abstract:MicroRNAs (miRNAs) are tiny, endogenously expressed noncoding RNAs that act as the posttranscriptional regulators of gene expression, and play very important roles in cell proliferation, differentiation and apoptosis as well as in cancer occurrence and development. In this paper, the authors overview the recent advances of miRNAs involvement in cholangiocarcinoma, focusing on miR-21, miR-370, let-7 family, miR-373, miR-200 family, miR-29b, miR-204 and miR-320.

Abstract:Epithelial mesenchymal transition (EMT) is an important biological process enabling the malignant tumors of epithelial cell origin to acquire migratory and invasive ability. Among the mechanisms contributing to EMT, transforming growth factor β (TGF-β) is considered to play a key role. This paper overviews the relationship between EMT and tumor invasion and metastasis, and mentions the related signaling pathways mediated by TGF-β, which are responsible for EMT.

Abstract:The PARs are G-protein-coupled receptors. Studies have found that the 4 subtypes (PAR-1, PAR-2, PAR-3 and PAR-4) of PARs are closely related to the occurrence and development of digestive tract tumors. The pathophysiological role of PARs in the digestive tract and gastrointestinal tumors was reviewed and summed up in this paper, with emphasis on the expressions and mechanisms of PAR-2 and PAR-4 in digestive tract tumors, as well as the role of PARs in the development of digestive tract tumors.

Abstract:目的：观察腹腔镜胆囊切除术（LC）治疗急性胆囊炎的临床效果，并分析中转开腹手术的原因。 方法：回顾性分析LC治疗急性胆囊炎患者520例的临床资料，总结LC手术成功率及术中中转开腹胆囊切除术（OC）的情况。 结果：520例患者LC成功498例（95.8%），中转开腹22例（4.2%），其中男性14例（63.6%），女性8例（36.4%）；年龄≥60岁者15例（68.2%），发病至就诊时间>72 h者16例(72.7%)；中转原因包括：胆囊周围粘连5例（0.96%），胆囊壁增厚（>6 mm）4例（0.77%），Calot三角解剖不清3例（0.58%），胆囊管近端结石嵌顿3例（0.58%），胆管损伤2例（0.38%），胆囊床出血不止2例（0.38%），胆囊坏疽2例（0.38%），胆囊胆管瘘1例（0.19%）。 结论：术前综合评估、筛选高危因素有助于提高LC成功率、降低中转开腹率，术中发现完成LC有困难时，应及时中转开腹，确保手术安全。