• Volume 24,Issue 8,2015 Table of Contents
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    • >胆石症专题研究
    • Laparoscopic versus open left lateral hepatic lobectomy plus choledochoscopic stone extraction for left lobe hepatolithiasis

      2015, 24(8):1070-1076. DOI: 10.3978/j.issn.1005-6947.2015.08.003

      Abstract (1109) HTML (0) PDF 1.75 M (16540) Comment (0) Favorites

      Abstract:Objective: To compare the efficacy of laparoscopic and open left lateral hepatic lobectomy combined with choledochoscopic stone extraction for left hepatolithiasis. Methods: The clinical data of 45 patients with left intrahepatic duct stones treated from September 2010 to September 2013 were retrospective analyzed. Of the patients, 23 cases received laparoscopic left lateral hepatic lobectomy plus choledochoscopic stone extraction (laparoscopic group), and 22 cases were subjected to open left lateral hepatic lobectomy plus choledochoscopic stone removal (laparotomy group). Results: Laparoscopic group was superior to laparotomy group in the variables of time to regain ambulation, intestinal function recovery and food intake, length of postoperative stay and postoperative pain (all P<0.05), while the operative time, intraoperative blood loss, live function parameters and hospitalization costs between the two groups showed no significant difference (all P>0.05). After operation, no residual stone was noted in either of both groups of patients; bile leakage occurred in one case in laparoscopic group and biliary collection on the hepatic resection surface occurred in one case in laparotomy group respectively, which were all resolved by conservative treatment. Forty-three cases were followed up, in whom no stone recurrence, abdominal pain, jaundice or abnormal liver function was noted. Conclusion: Laparoscopic left lateral hepatic lobectomy plus choledochoscopic stone extraction has similar efficacy as open approach in treatment of left intrahepatic duct stones, but it allows a quick postoperative recovery, so it is recommended as the first therapeutic option for this condition.

    • Clinical efficacy of simple resection of affected bile ducts for right-sided regional hepatolithiasis

      2015, 24(8):1077-1082. DOI: 10.3978/j.issn.1005-6947.2015.08.004

      Abstract (136) HTML (0) PDF 2.06 M (558) Comment (0) Favorites

      Abstract:Objective: To investigate the clinical efficacy of simple resection of the affected bile ducts for right-sided regional hepatolithiasis. Methods: The clinical data of 19 patients with right-sided regional hepatolithiasis undergoing simple resection of the affected bile ducts from November 2008 to November 2014 were retrospectively analyzed. Results: Of the 19 patients, 8 cases were males and 11 cases were females; 9 cases had a history of biliary surgery, and stones in all cases were locally distributed in the third-order or more proximal bile ducts of the hepatic segment V, VI or VII. All patients underwent simple resection of the affected bile ducts, namely, excision of the affected bile ducts along with the surroundings impaired hepatic tissues after determination of the location of the root of the affected bile ducts and range of the stones according to preoperative imaging data and intraoperative ultrasound examination, without routine cholecystectomy and biliary drainage. The intraoperative blood loss was 100-500 mL, operative time was 2–4.5 h, and time of total hepatic inflow occlusion was 10–20 min. Bile leakage occurred in three cases, and pleural effusion, subphrenic abscess and residual stones were found in one case each after operation; no death occurred during hospitalization. Seventeen patients were followed up for 3–72 months, two patients had suspicious stone recurrence found by CT and MRI examination, but no clinical symptoms or stone recurrence was noted in the remaining patients, and the rate of excellent quality of life was 88.2%. Conclusion: Simple resection of the affected bile ducts may have a good effect in patients with stones locally distributed in the third-order or more proximal bile ducts of the hepatic segment V, VI or VII.

    • Surgical management of complicated bile duct stones around second porta hepatis

      2015, 24(8):1083-1087. DOI: 10.3978/j.issn.1005-6947.2015.08.005

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      Abstract:Objective: To investigate the clinical efficacy of lithotomy through incision of the second portal region parenchyma for complicated bile duct stones around the second porta hepatis. Methods: The clinical data of 28 patients with complicated bile duct stones around the second porta hepatis admitted during January 2008 to January 2014 were retrospectively analyzed. Results: In these patients, the stones were largely located in segment II, IV and VIII; lithotomy through incision of the second portal region parenchyma was the main surgical procedure performed, in addition with choledocholithotomy or partial hepatectomy. Death during hospitalization occurred in one case, and the incidence of postoperative complications was 14.8%. Twenty-five patients were followed up for one year to 4 years, postoperative stone clearance rate was 81.5% and final clearance rate was 92.6% after postoperative choledochoscopic lithotripsy, and the stone recurrence rate was 11.1%. Conclusion: Lithotomy through incision of the second portal region parenchyma offers certain efficacy for patients with complicated bile duct stones around the second porta hepatis, especially those unable to tolerate multisegmentectomy.

    • Clinical comparative study of laparoscopic common bile duct exploration versus endoscopic sphincterotomy for choledocholithiasis

      2015, 24(8):1088-1092. DOI: 10.3978/j.issn.1005-6947.2015.08.006

      Abstract (182) HTML (0) PDF 1.11 M (608) Comment (0) Favorites

      Abstract:Objective: To compare the clinical effects between laparoscopic common bile duct exploration (LCBDE) and endoscopic sphincterotomy (EST) for common bile duct stones. Methods: The data of 210 patients with common bile duct stones treated between November 2012 and March 2014 were retrospectively analyzed. The patients were divided into LCBDE group (n=116) and EST group (n=94) according to the procedure they received, and the main clinical variables between the two groups were compared. Results: The surgical success rate had no significant difference between the two groups (99.1% vs. 95.74, P=0.175), but the one-stage cure rate in LCBDE group was significantly higher than that in EST group (97.4% vs. 90.4%, P=0.038), and there was no significant difference in residual stone rate, and the average length of hospital stay and hospitalization costs between the two groups (all P>0.05), but in EST group, 9 cases underwent second EST, and 6 cases underwent third EST after the first-stage treatment due to residual stones, and the length of hospital stay and medical expenses were markedly increased in these cases with first treatment failure. The incidence of perioperative complications and long-term complications in LCBDE group was significantly lower than that in EST group (both P<0.05), due to the relatively high incidence of the EST-related complications of the latter. Conclusion: For common bile duct stones, the one-stage cure rate of LCBDE is higher than that of EST, with less incidence of complications and preservation of the function of the sphincter of Oddi. In addition, laparoscopic cholecystectomy can be simultaneously performed to solve the gallbladder problems during LCBDE. Thus, it should be considered as the first choice of option in most cases.

    • Clinical efficacy of laparoscopic cholecystectomy and common bile duct exploration for elderly patients with gallbladder disease and concomitant choledocholithiasis

      2015, 24(8):1093-1096. DOI: 10.3978/j.issn.1005-6947.2015.08.007

      Abstract (151) HTML (0) PDF 1.08 M (628) Comment (0) Favorites

      Abstract:Objective: To investigate the clinical effect and safety of laparoscopic cholecystectomy and common bile duct exploration (LCBDE) in the treatment of elderly patients with gallbladder disease and concomitant common bile duct stones. Methods: The clinical data of elderly patients (≥60 years of age) with gallbladder disease and common bile duct stones undergoing LCBDE treatment (LCBDE group, n=60) or endoscopic sphincterotomy (EST) plus laparoscopic cholecystectomy (LC) (LC-EST group, n=60) were retrospectively analyzed. Results: The preoperative data between the two groups of patients were comparable. The operative time, length of postoperative hospital stay and incidence of operative complications in LCBDE group were significantly decreased compared with LC-EST group (all P<0.05), while there was no significant difference between the two groups with regard to intraoperative blood loss, time to first postoperative flatus, and the rate of surgical success, open conversion and one-session stone clearance (all P>0.05). Conclusion: LCEST has similar therapeutic effect with LC plus EST in treatment of elderly patients with gallbladder disease and common bile duct stones, but it also has the advantages of short operative time, quick recovery and low incidence of complications.

    • Efficacy of gallbladder-preserving cholecystolithotomy for patients with gallstones and low functioning gallbladder: a report of 69 cases

      2015, 24(8):1097-1101. DOI: 10.3978/j.issn.1005-6947.2015.08.008

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      Abstract:Objective: To observe the changes in gallbladder function in patients with gallstones and low functioning gallbladder (gallbladder contraction rate less than 30% measured by ultrasound) after gallbladder-preserving cholecystolithotomy, so as to comprehensively assess the efficacy of this procedure in such patients. Methods: The clinical data of 71 patients with gallstones and low functioning gallbladder undergoing gallbladder-preserving cholecystolithotomy in Department of General Surgery of Tangdu Hospital during December 2009 to May 2015 were retrospectively analyzed. Results: All the 69 patients underwent laparoscopy assisted minimally invasive gallbladder-preserving cholecystolithotomy. At postoperative follow-up conducted for one year to four years, the treatment results in all patients, excepted one case of recurrence, were satisfactory, and the postoperative gallbladder contraction rate of the 69 cases was significantly increased compared with preoperative level [(42.48±8.70) % vs. (14.46±9.78) %], and further grouping analysis also showed this effect regardless of the number or location of stones of the patients (all P<0.05). Conclusion: Gallbladder-preserving cholecystolithotomy can achieve satisfactory efficacy in patients with gallstone and low functioning gallbladder.

    • >基础研究
    • Effects of epidermal growth factor receptor inhibitor plus 5-fluorouracil on proliferation, migration and invasiveness of cholangiocarcinoma cells

      2015, 24(8):1102-1106. DOI: 10.3978/j.issn.1005-6947.2015.08.009

      Abstract (193) HTML (0) PDF 1.57 M (760) Comment (0) Favorites

      Abstract:Objective: To investigate the effects of epidermal growth factor receptor (EGFR) inhibitor AG1478 in combination with 5-fluorouracil (5-FU) on proliferation, migration and invasiveness of cholangiocarcinoma cells in vitro. Methods: Human cholangiocarcinoma QBC939 cells were cultured in vitro and exposed to AG1478 (10 μmol/L) and 5-FU (100 mg/L) alone or in combination for 24 h. The cell proliferation, migration and invasiveness were measured by CCK-8 assay, wound-scratch assay and Matrigel invasion chamber assay, respectively. Results: The abilities of proliferation, migration and invasion of QBC939 cells were significantly decreased after either lone AG1478 or 5-FU treatment (all P<0.05), and above effects were further enhanced by the combined treatment compared with either lone drug treatment (all P<0.05). Conclusion: Combination use of EGFR inhibitor and 5-FU may be an effective method for inhibiting the growth, migration and invasiveness of cholangiocarcinoma cells.

    • MMP-2 and MMP-9 expressions in intrahepatic cholangiocarcinoma tissue and the significance

      2015, 24(8):1107-1111. DOI: 10.3978/j.issn.1005-6947.2015.08.010

      Abstract (222) HTML (0) PDF 1.55 M (706) Comment (0) Favorites

      Abstract:Objective: To investigate the expression of matrix metalloproteinase 2 (MMP-2) and 9 (MMP-9) in intrahepatic cholangiocarcinoma (ICC) and their relations with the clinicopathologic features and prognosis of ICC patients. Methods: The surgical specimens including tumor and tumor-adjacent tissue from 50 ICC patients treated between January 2011 and December 2014 were collected. The MMP-2 and MMP-9 expressions in these tissues were detected by immunohistochemical staining and RT-PCR method, and the relations of MMP-2 and MMP-9 expressions with clinicopathologic variables and postoperative survival of ICC patients were analyzed. Results: Results of immunohistochemical staining showed that the positive expression rate of MMP-2 and MMP-9 in ICC tissue was 34.0% and 32.0% respectively, but neither was positive in tumor-adjacent tissue; results of RT-PCR showed that both relative expression levels of MMP-2 and MMP-9 in ICC tissue were significantly higher than those in tumor-adjacent tissue (both P<0.05). Both MMP-2 and MMP-9 expressions were significantly associated with the presence or absence of lymph node metastasis and degree of tumor differentiation of ICC patients (all P<0.05), but were irrelevant to the gender, age and tumor stage of ICC patients (all P>0.05); the survival rate in patients with positive MMP-2 or MMP-9 expression was significantly lower than that in patients with negative MMP-2 or MMP-9 expression, and those with both MMP-2 and MMP-9 positive expressions had lowest survival rate (all P<0.05). Conclusion: MMP-2 and MMP-9 expressions are increased in ICC tissue, and both expressions are closely related to the malignant clinicopathologic profiles and poor prognosis of ICC patients.

    • Alteration of leptin, soluble leptin receptor and blood lipid levels and their relations in patients with chronic cholecystitis

      2015, 24(8):1112-1115. DOI: 10.3978/j.issn.1005-6947.2015.08.011

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      Abstract:Objective: To investigate the changes of serum leptin (Lep) and soluble leptin receptor (sLR) levels as well as blood lipid profile and their reciprocal relationship in patients with chronic cholecystitis. Methods: One hundred and three patients with chronic cholecystitis were enrolled, and 91 individuals undergoing health maintenance examinations served as control. In all subjects, the fasting serum levels of Lep and sLR and blood lipid indicators that included total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were measured, and the relations of serum Lep and sLR levels with blood lipid parameters in chronic cholecystitis patients were also analyzed. Results: Compared with control group, the levels of Lep, TC and LDL in chronic cholecystitis patients were increased, while the sLR level was decreased significantly (all P<0.05). In chronic cholecystitis patients, univariate analysis showed significantly positive correlation of Lep level with either TC, TG or HDL level (all P<0.05), while sLR level had no significant correlation with any of the blood lipid indicators (all P>0.05); multivariate regression analysis revealed that there was a significantly positive correlation between Lep level and TC level (P<0.05). Conclusion: There are increased Lep level and decreased sLR level as were as lipid metabolism disorders in patients with chronic cholecystitis, in which the abnormal lipid metabolism caused by increased Lep level may play a causal role.

    • Comparison of electroporation and chemical agent transfection in gastric cancer cells with multidrug resistance

      2015, 24(8):1116-1120. DOI: 10.3978/j.issn.1005-6947.2015.08.012

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      Abstract:

      Objective: To compare the transfection efficiency of electroporation and chemical transfection agents in multidrug-resistant (MDR) gastric cancer cells.
      Methods: MDR gastric cancer SGC7901/VCR cells were transfected with plasmids bearing tumor suppressor gene WTX through electroporation method and two chemical agents (Lipofectamine2000 and Attractene), respectively. Then, the expression of enhanced green fluorescent protein (eGFP) and the WTX mRNA in the cells after transfection were examined.
      Results: Results of eGFP analysis showed that in SGC7901/VCR cells compared with the parental non-drug-resistant SGC7901 cells, the transection efficiencies of both chemical methods were significantly decreased (both P<0.05), but the transfection efficiency of electroporation exhibited no significant decrease (P>0.05), which was significantly higher than that of either chemical agent (both P<0.05). Results of RT-PCR showed that the WTX mRNA expression level in SGC7901/VCR cells undergoing electroporation transfection was significantly higher than that in those transfected by the two chemical agents (both P<0.05).
      Conclusion: In MDR gastric cancer cells, electroporation transfection will not be influenced easily by their cell membrane components, and can maintain its transfection efficiency.

    • >临床研究
    • Clinical value of laparoscopic meticulous dissection of Calot’s triangle via cystic artery approach

      2015, 24(8):1121-1124. DOI: 10.3978/j.issn.1005-6947.2015.08.013

      Abstract (211) HTML (0) PDF 1.46 M (679) Comment (0) Favorites

      Abstract:

      Objective: To evaluate the clinic value of using the technique of “laparoscopic meticulous dissection of Calot’s triangle via cystic artery approach” for preventing bile duct injury during laparoscopic cholecystectomy (LC). Methods: The clinical data of 2 200 patients undergoing LC with this technique from June 2010 to June 2014 were analyzed retrospectively. The essential feature of the technique was namely “cystic artery first”, and full exposure of the relationship of the three biliary ducts after meticulously dissecting out the contents of Calot’s triangle. Results: LC procedure was successfully completed in 2 152 patients, without bile duct injury occurring in any of them, and the other 48 patients (2.18%) were converted to open surgery due to Mirizzi’s syndrome, cholecystoduodenal fistula or gallbladder cancer The operative time was 20 to 55 min, with an average of 35.5 minutes, the intraoperative blood loss was 5 to 50 mL, with an average of 15.5 mL, and the length of postoperative hospital stay was 3 to 5 d, with an average of 3.5 d, respectively. Follow-up performed for 3 to 12 months, and no complications such as biliary stricture, bile leakage or intraperitoneal abscess occurred. Conclusion: Using the technique of “laparoscopic meticulous dissection of Calot’s triangle via cystic artery approach” can effectively prevent bile duct injury during LC, and it can be recommended as a standard procedure.

    • Clinical feasibility of transumbilical single-port laparoscopic cholecystectomy

      2015, 24(8):1125-1129. DOI: 10.3978/j.issn.1005-6947.2015.08.014

      Abstract (197) HTML (0) PDF 1.74 M (737) Comment (0) Favorites

      Abstract:Objective: To assess the clinical feasibility of transumbilical single port laparoscopic cholecystectomy. Methods: The clinical data of 85 patients with gallstones or gallbladder polyps undergoing laparoscopic cholecystectomy between August 2012 and October 2013 were retrospectively analyzed. Of the patients, 41 cases underwent transumbilical single port laparoscopic cholecystectomy (single-port group), and 44 cases underwent traditional three-port laparoscopic cholecystectomy (three-port group). The relevant clinical variables between the two groups were compared. Results: All laparoscopic procedures were successfully conducted, without any open conversion. The operative time in single-port group was significantly longer than that in three-port group [(31.73±4.22) min vs. (15.43± 1.81) min, P=0.000], and intraoperative blood loss, length of postoperative hospital stay, hospitalization costs and incidence of wound infection showed no statistical difference between the two groups (all P>0.05), while the ratio of patients receiving analgesics in single-port group was significantly reduced compared with three-port group (7.31% vs. 34.09%, P=0.003). No postoperative biliary fistula or other serious complications occurred in any of the two groups. Conclusion: Single-port laparoscopic cholecystectomy has the same therapeutic effect as traditional three-port laparoscopic cholecystectomy, but it has evident superiority in minimal invasiveness.

    • Clinical risk factors for early complications of laparoscopic cholecystectomy

      2015, 24(8):1130-1134. DOI: 10.3978/j.issn.1005-6947.2015.08.015

      Abstract (222) HTML (0) PDF 1.11 M (628) Comment (0) Favorites

      Abstract:Objective: To determine the risk factors for early complications (during or in early period after operation) of laparoscopic cholecystectomy (LC), so as to provide warning signs for preventing such incidents. Methods: The records of 16 032 LC cases from July 2000 to August 2014 were reviewed. The general clinical variables and incidence of early complications were analyzed, and the suspicious factors for early complications were screened by univariate analysis and then verified by multivariate analysis. Results: Of the 16 032 patients, the average age was (56.7±21.3) years, male-to-female ratio was 1:1.87, 14 101 cases (88.0%) underwent elective LC and 1 931 (12.0%) cases underwent emergency LC and early complications occurred in 1 420 cases (8.9%). Univariate analysis suggested that sex, inflammatory status of the gallbladder, obesity, history of upper abdominal surgery, emergency LC, operative duration, and number of LC operations the surgeon had performed were possible risk factors associated with the occurrence of early complications of LC (P<0.05); Multivariable analysis revealed that male gender (OR=10.012, P=0.002), acute cholecystitis (OR=2.510, P=0.010), BMI≥25 kg/m2 (OR= 3.105, P=0.023), history of upper abdominal surgery (OR=7.882, P=0.030) and operative duration ≥60 min (OR=8.634, P=0.001) were independent risk factors for occurrence of early complications of LC. Conclusion: Males, acute cholecystitis, obesity, history of upper abdominal surgery, and long operative time are independent risk factors for early complications of LC, and for patients with these factors, adequate pre- and postoperative measures should be taken to prevent the occurrence of these events.

    • Primary closure versus T-tube drainage following laparoscopic common bile duct exploration for choledocholithiasis

      2015, 24(8):1135-1139. DOI: 10.3978/j.issn.1005-6947.2015.08.016

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      Abstract:

      Objective: To compare the clinical efficacy of primary closure versus T-tube drainage after laparoscopic common bile duct exploration (LCBDE) for common bile duct stones. Methods: The clinical data of 142 patients with common bile duct stones undergoing LCBDE from January 2012 to December 2014 were retrospectively analyzed. Of the patients, 75 cases received primary closure of the common bile duct and 67 patients were subjected to T-tube drainage after choledochotomy. The relevant clinical variables between the two procedures were compared, and the risk factors for postoperative complications were also analyzed. Results: Between patients undergoing the two different procedures, all preoperative variables, except the gender ratio that was of a statistical difference (P=0.028), exhibited no significant difference (all P>0.05); the operative time, and incidence of postoperative complications, surgical death and stone recurrence also showed no significant difference (all P>0.05), but the length of postoperative hospital stay in patients undergoing primary closure was significantly shorter than that in patients undergoing T-tube drainage (P<0.05). Biliary fistula was the main postoperative complication for either procedure, which occurred in 7 cases (9.3%) in patients undergoing primary closure and in 8 cases (11.9%) in those undergoing T-tube drainage, respectively. No risk factors for postoperative biliary fistula was detected by comparison of the relevant variables between patients with and without postoperative biliary fistula (all P>0.05). Conclusion: LCBDE with primary closure of the common bile duct is an effective and safe procedure for common bile duct stones, and it has similar clinical efficacy but reduced length of postoperative hospital stay compared with post-LCBDE T-tube drainage. The determination of risk factors for biliary fistula still requires big data analyses and further randomized controlled trials.

    • Is routine pathological examination of gallbladder necessary after laparoscopic cholecystectomy?

      2015, 24(8):1140-1144. DOI: 10.3978/j.issn.1005-6947.2015.08.017

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      Abstract:Objective: To assess the necessity of routine pathological examination of the gallbladder after laparoscopic cholecystectomy (LC). Methods: All pathological reports of gallbladder over a 5-year period in Department of Pathology of West China Hospital were collected to pick up the cases of incidental gallbladder cancer after LC, and then their clinical data were analyzed. Results: The incidence of incidental gallbladder cancer after LC was 0.28% (36/12 969), among which, 89% (32/36) were adenocarcinoma, and 58.3% carcinoma in situ (Tis) and early gallbladder cancer (T1a and T1b). A suspicious lesion was successfully identified in 34 patients (94.4%) during operation, through intraoperative observation and palpation of the gallbladder specimen combined with preoperative imaging findings, and one Tis case and one T1a case missed identification. Conclusion: A suspicious lesion can be found during operation in a great majority of cases of incidental gallbladder cancer, only a very few cases in very early stages are difficult to be identified, and for these cases, simple cholecystectomy can offer adequate effectiveness. So, the necessity of routine pathological examination of the gallbladder after LC is still questionable.

    • Efficacy analysis of percutaneous transhepatic cholangial drainage plus metal stent placement in palliative treatment of malignant biliary obstruction

      2015, 24(8):1145-1149. DOI: 10.3978/j.issn.1005-6947.2015.08.018

      Abstract (305) HTML (0) PDF 1.17 M (757) Comment (0) Favorites

      Abstract:Objective: To evaluate the efficacy of percutaneous transhepatic cholangial drainage (PTCD) plus biliary metal stent placement in palliative treatment of malignant biliary obstruction. Methods: The clinical data of 94 patients with malignant biliary obstruction admitted between January 2011 and June 2013, who underwent PTCD alone or in combination with biliary metal stent placement after failure of endoscopic retrograde cholangiopancreatography (ERCP) with stent placement, were retrospectively analyzed. Of the patients, 45 cases underwent PTCD treatment alone (PTCD group), and 49 cases underwent PTCD plus biliary metal stent placement (PTCD plus stent group). The degree of jaundice reduction, incidence of postoperative complications and survival between the two groups were compared. Results: The serum bilirubin levels at 5 d after operation showed no significant difference between the two groups (P>0.05), but were significantly lower at 7 and 14 d after operation in PTCD plus stent group than those in PTCD group (P<0.05); There was no significant difference in incidence of postoperative complications between the two groups (P>0.05); the 1-year postoperative survival in PTCD plus stent group was better than that in PTCD group (χ2=6.280, P=0.012). Conclusion: PTCD plus metal biliary stent placement is an effective palliative treatment for malignant biliary obstruction in patients with ERCP failure, moreover, it is superior to PTCD alone treatment.

    • Ultrasound-guided percutaneous transhepatic catheterization and bidirectional drainage for liver abscess after Roux-en-Y hepaticojejunostomy

      2015, 24(8):1150-1154. DOI: 10.3978/j.issn.1005-6947.2015.08.019

      Abstract (173) HTML (0) PDF 1.18 M (594) Comment (0) Favorites

      Abstract:Objective: To evaluate the clinical efficacy of ultrasound-guided percutaneous transhepatic catheterization and bidirectional drainage for liver abscess after Roux-en-Y hepaticojejunostomy. Methods: The clinical data of 20 patients with liver abscess after Roux-en-Y hepaticojejunostomy undergoing ultrasound-guided percutaneous transhepatic catheterization and bidirectional drainage from January 2012 to January 2014 were retrospectively analyzed. Results: In all 20 patients, catheterization was successfully performed, the symptoms of pain were alleviated 24–48 h after catheterization, body temperature returned to normal, and the symptoms of pain and chills disappeared 48–72 h after catheterization; white blood cell levels returned to normal range 72–96 h after catheterization, and no tube blockage or partial blockage occurred during the continuous drainage. The tube retention time ranged from 11 d to one month, with an average of 14 d. No serious complications such as hemorrhage or surrounding organ injuries were noted in any of the 20 patients. Conclusion: Interventional ultrasound-guided percutaneous transhepatic catheterization and bidirectional drainage is a reliable and effective management for liver abscess after Roux-en-Y hepaticojejunostomy.

    • Diagnosis and treatment of gallbladder adenomyomatosis: a report of 205 cases

      2015, 24(8):1155-1158. DOI: 10.3978/j.issn.1005-6947.2015.08.020

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      Abstract:Objective: To discuss the diagnosis and treatment of adenomyomatosis of the gallbladder. Methods: The data of patients undergoing gallbladder surgery from January 2003 to December 2013 were retrieved from the medical record database in Peking University People’s Hospital to pick up the pathologically confirmed cases of gallbladder adenomyomatosis, and then, the correct diagnostic rate of different imaging examinations, surgical procedures and results were retrospectively analyzed. Results: Among 6 336 patients undergoing gallbladder surgery, 205 cases (3.2%) were pathologically diagnosed as adenomyomatosis of the gallbladder, of whom 195 cases (95.1%) were accompanied with cholecystitis and 150 cases (73.2%) were complicated with gallbladder stones. The correct diagnostic rate of ultrasonography, CT and MRI was 16.2%, 26.5% and 43.8%, respectively. Of the lesions, the localized type accounted for the majority, which was found in 164 cases (80.0%), and the diffuse and segmental types were relatively infrequent, which was seen 16 (7.8%) and 25 cases (12.2%), respectively. Of the patients, 178 cases underwent laparoscopic cholecystectomy and 24 cases were subjected to open cholecystectomy, and no complications such as bile duct injury occurred; 3 cases received partial cholecystectomy. At follow-up one year after operation, no residual lesion or recurrence was noted. Conclusion: Gallbladder adenomyomatosis is often combined with cholecystitis and gallbladder stones, and is likely to be undiagnosed. For cases with localized lesion in the base of the gallbladder, laparoscopic partial cholecystectomy can be considered as a treatment option.

    • Diagnosis and treatment of splenic inflammatory myofibroblastic tumor: a report of 72 cases and literature review

      2015, 24(8):1159-1165. DOI: 10.3978/j.issn.1005-6947.2015.08.021

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      Abstract:Objective: Objective: To review the clinicopathologic characteristics, diagnosis and treatment of splenic inflammatory myofibroblastic tumor (SIMT). Methods: Clinical data of SIMT patients including 4 cases admitted in Guangzhou General Hospital of Guangzhou Military Command and 68 cases extracted from literature reports were collected. The main clinical manifestations, imaging features, pathological diagnosis, treatment and results of the patients were analyzed and summarized. Results: The majority of the patients were male adults, left upper abdominal pain was the initial and main symptom, which was often accompanied with other systemic symptoms such as fever, fatigue, weight loss and anemia, and most of the tumors were solitary and localized with clear margins as shown by imaging examinations. B-ultrasonography showed heterogeneous echogenic masses in the spleen, with absent or barely visible color Doppler flow; CT scan showed homogeneous or heterogeneous low-density lesions in the spleen, some of which had no obvious enhancement in any contrast-enhanced phase, and most of which had slight enhancement in the arterial phase, and continuously increased enhancement in the venous and delayed phase, with the density lower than or similar to that of the spleen, and more evident change in the rims; lesions typically showed low signal on both the T1WI and T2WI in MRI imaging, most of which demonstrated no enhancement during enhanced scanning, some of which had slight enhancement in arterial phase, and continuously increased enhancement in venous and delayed phase. Hyperplastic spindle cells, chronic inflammatory cell infiltration, and collagen fibril formation were seen under microscope; immunohistochemical staining was positive for vimentin, SMA, Desmin and CD68. All the 72 patients underwent splenectomy, and followed-up ranged from 4 months to 14 years; recurrence occurred in one case 2 years after operation, and hepatic metastases occurred in one case 4 years after operation. Conclusion: SIMT is a rare borderline mesenchymal tumor, with no clinical characteristics, and can be easily misdiagnosed as malignant tumor, for which, imaging examinations have certain diagnostic significance, and diagnosis relies on immunohistochemical and pathological examination; splenectomy is the effective treatment method and prognosis is favorable, but long-term postoperative follow-up is necessary.

    • Clinical diagnostic value of serum procalcitonin and C-reactive protein in reflux cholangitis

      2015, 24(8):1166-1169. DOI: 10.3978/j.issn.1005-6947.2015.08.022

      Abstract (194) HTML (0) PDF 1.08 M (634) Comment (0) Favorites

      Abstract:Objective: To investigate the clinical diagnostic value of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in reflux cholangitis. Methods: The clinical data of 40 patients with reflux cholangitis treated during January 2010 to June 2014 were retrospectively analyzed. In all patients, blood culture and bile bacterial culture were performed before treatment, and the serum PCT and CRP as well as white blood cells (WBC) were measured before and 4 d after therapy. The difference in positive detection rate among all parameters before treatment, and the pre- and post-treatment changes in levels of PCT, CRP and WBC were compared; patients were grouped according to whether their infection was controlled or not, and then the relations of whether the infection controlled or not with the post- to pretreatment ratios of PCT, CRP and WBC were determined by using receiver operating characteristic curve (ROC) analysis. Results: Before treatment, the positive detection rate of PCT, CRP, WBC, blood culture and bile bacterial culture was 92.5%, 87.5%, 57.5%, 25.0% and 100.0% respectively, and the positive detection rates of PCT and CRP had no significant difference (P=0.709), but both were significantly higher than that of WBC or blood culture (all P<0.05). Compared with pretreatment value, either PCT or CRP level was significantly reduced (both P<0.05), but the WBC had no significant change (P>0.05), the area under ROC in estimating infection control or not for PCT ratio was 0.827 (95% CI=0.724–0.929, P<0.001), with a sensitivity of 87.5% and specificity of 77.5%, and for CRP ratio was 0.764 (95% CI=0.644–0.883, P<0.001), with a sensitivity of 92.5% and specificity of 60.5%, but which for WBC ratio showed no significant difference (P>0.05). Conclusion: Serum PCT and CRP levels are sensitive indicators for diagnosis of reflux cholangitis, and their alterations have an important reference value for estimating whether the infection is controlled or uncontrolled.

    • Predictive significance of preoperative serum CEA and CA19-9 determination in early recurrence/metastasis of colon cancer after operation

      2015, 24(8):1170-1174. DOI: 10.3978/j.issn.1005-6947.2015.08.023

      Abstract (176) HTML (0) PDF 1.09 M (966) Comment (0) Favorites

      Abstract:Objective: To investigate the value of serum CEA and CA19-9 in predicting early recurrence/metastasis of colon cancer after radical surgery. Methods: The clinical data of 129 patients with postoperative recurrence and metastasis of colon cancer and treated from January 2012 to January 2015 were collected. The relations of preoperative CEA and CA19-9 levels with early postoperative recurrence/metastasis and other clinicopathologic variables were analyzed. Results: Of the 129 patients, early recurrence/metastasis (within 12 months after surgery) occurred in 82 cases and another 47 cases had late recurrence/metastasis (over 12 months after surgery); early recurrence/metastasis occurred in 56 of the 74 patients with positive preoperative CEA and 51 of the 68 patients with positive preoperative CA19-9. Statistical analyses showed that there was a close relationship between early postoperative recurrence/metastasis of colon cancer and preoperative CEA or CA19-9 level; the ratios of cases with advanced T or TNM stage, lymph node metastasis or vascular invasion was increased in patients with positive preoperative CEA or CA19-9. The rate of early postoperative recurrence/metastasis in patients with positive preoperative CEA or CA19-9 was significantly higher than that in corresponding negative ones, and in patients with both positive CEA and CA19-9 was significantly higher than that in either single positive or double negative ones, and all differences had statistical significance (all P<0.05). Conclusion: Preoperative determination of serum CEA and CA19-9 levels has important significance in predicting early postoperative recurrence/metastasis of colon cancer, and patients with both positive CEA and CA19-9 may face a poor prognosis.

    • >文献综述
    • Notch signaling pathway in cholangiocarcinoma: recent progress

      2015, 24(8):1175-1180. DOI: 10.3978/j.issn.1005-6947.2015.08.024

      Abstract (223) HTML (0) PDF 1.09 M (713) Comment (0) Favorites

      Abstract:The Notch pathway plays an important role in cancer occurrence, development, migration and metastasis as well as angiogenesis, and is also responsible for the maintenance of the properties of tumor stem cells, and regulating their tumorigenesis and differentiation. In this paper, the authors present the latest progress concerning Notch signaling pathway in cholangiocarcinoma.

    • Perioperative nutritional support in surgical liver diseases: recent advances

      2015, 24(8):1181-1186. DOI: 10.3978/j.issn.1005-6947.2015.08.025

      Abstract (166) HTML (0) PDF 1.13 M (711) Comment (0) Favorites

      Abstract:The importance of perioperative nutritional supportive treatment in surgical liver disease has been increasingly recognized. The prevalence of using nutritional support for patients with diseases of the digestive system is significantly higher than that for those with diseases of other systems, due to the restraint of nutrient intake, digestion, absorption and metabolism. Because the liver is the hub for metabolism and nutrient metabolism is closely associated with liver function status, the nutritional support mode for patients with surgical liver diseases is distinct from those with gastrointestinal tract diseases, and irrational or excessive nutritional support may not improve the patient's condition, but result in metabolic disorder, and thereby affect the recovery of patients. In this paper, the authors present the research progress in perioperative nutritional supportive treatment for surgical liver diseases.

Governing authority:

Ministry of Education People's Republic of China

Sponsor:

Central South University Xiangya Hospital

Editor in chief:

WANG Zhiming

Inauguration:

1992-03

International standard number:

ISSN 1005-6947(Print) 2096-9252(Online)

Unified domestic issue:

CN 43-1213R

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