Abstract:Objective: To determine the feasibility, safety and effectiveness of total laparoscopic left hepatic pedicle occlusion and left hepatectomy in treatment of intra-and extrahepatic bile duct stones. Methods: The clinical data of 32 patients with intra- and extrahepatic bile duct stones undergoing surgical treatment (procedures compromised left hepatectomy, cholecystectomy, choledochotomy, choledochoscopic stone extraction and T-tube drainage) from September 2010 to December 2015 were retrospectively analyzed. Of the patients, 18 cases underwent total laparoscopic surgery with left hepatic pedicle occlusion (laparoscopic group) and 14 cases underwent traditional open surgery (laparotomy group). The relevant clinical variables between the two groups of patients were compared. Results: The preoperative data between the two groups of patients were comparable. All patients were operated successfully, and no conversion was required in laparoscopic group. In laparoscopic group compared with laparotomy group, the operative time was prolonged (273.0 min vs. 214.0 min, P<0.05) and the cost for surgery was increased (5 550.0 yuan vs. 3 962.0 yuan, P<0.05), but significant difference was noted in postoperative alanine aminotransferase level (postoperative day 1: 158.2 U/L vs. 291.5 U/L, postoperative day 7: 33.3 U/L vs. 52.2 U/L), time for pain relief (3.2 h vs. 5.0 h), time to first passage of gas (23.3 h vs. 45.5 h), and length of postoperative hospital stay (12.0 d vs. 15.7 d) (all P<0.05). There was no statistical significance in intraoperative blood loss (226.7 mL vs. 189.3 mL), total hospitalization costs (41 304.4 yuan vs. 41 399.8 yuan) and overall incidence of postoperative complications (11.2% vs. 21.3%) between the two groups (all P>0.05). No residual stone was seen in any of the patients in the two groups. Conclusion: Total laparoscopic left hepatic pedicle occlusion and left hepatectomy is simple, safe and effective in treatment of intra-and extrahepatic bile duct stones. Although the operative time is somewhat prolonged, it has the advantages of less trauma and pain, as well as fast recovery and short hospitalization, so it deserves to be used in clinical practice.

Abstract:Objective: To investigate the application value of using “three lines and one plane” as landmarks for extrahepatic bile ducts in laparoscopic surgery for bile duct stones. Methods: From January 2014 to December 2015, 445 cases of laparoscopic cholecystectomy and 70 cases of laparoscopic common bile duct exploration consecutively performed in the First Department of General Surgery of the Second Affiliated Hospital of Anhui Medical University. “Three lines and one plane” which refers to the upper curve of the duodenal bulb, the arc incisure curve of the hepatic pedicle of the right posterior lobe, the middle line between the common hepatic duct and the common bile duct and the plane of the hilar plate, were used as anatomical landmarks for extrahepatic bile ducts during operation in all patients. Results: No bile duct injury or surgical death occurred in any of the entire group of patients. No open surgical conversion was needed in patients undergoing laparoscopic cholecystectomy, while in those undergoing laparoscopic common bile duct exploration, one case (1.4%) was converted to open operation and 2 cases (2.9%) developed postoperative bile leakage that was cured by conservative treatment. All patients recovered uneventfully. Conclusion: Using “three lines and one plane” as guidance for dissection of the extrahepatic bile ducts can avoid bile duct and vascular injury during laparoscopic surgery for bile duct stones. So, it is recommended to be used.

Abstract:Objective: To investigate the clinical efficacy of the combined use of duodenoscopy and laparoscopy in treatment of gallbladder stones with concomitant extrahepatic bile duct stones in elderly patients. Methods: One-hundred and twenty elderly patients with gallbladder stones and concomitant extrahepatic bile duct stones admitted from January 2011 to June 2015 were selected. According to surgical approaches, the patients were divided into control group and observational group, with 60 cases in each group. Patients in control group underwent traditional open cholecystectomy, common bile duct exploration, and T tube drainage, and those in observational group underwent minimally invasive operation of duodenoscopic sphincterotomy combined with laparoscopic cholecystectomy. The relevant clinical variables and therapeutic results of the two groups of patients were compared. Results: In observational group compared with control group, the intraoperative blood loss (60.74mL vs. 98.42 mL) and length of hospital stay (10.8 d vs. 12.3 d) were significantly decreased, the operative time (3.12 h vs. 2.06 h) and hospitalization costs (18 047.53 yuan vs. 12 054.88 yuan) were significantly increased (all P<0.05), the pain score (3.8 vs. 4.9) was significantly decreased, time to intestinal function recovery (1.8 d vs. 3.5 d) and peritoneal drainage time (1.7 d vs. 3.3 d) were significantly shortened, and incidence of gastrointestinal adverse reactions (10.0% vs. 25.0%) were significantly reduced (all P<0.05). The overall incidence of postoperative complications (20.0% vs. 41.7%) was significantly decreased, but incidence of acute pancreatitis (16.7% vs. 3.3%) was increased (all P<0.05). During follow-up, in observational group, the incidence of reflux cholangitis was significantly higher than that in control group (13.3% vs.1.7%), but postoperative satisfaction rate (93.5% vs. 78.2%) and time to restore normal activities (25.8 d vs. 48.7 d) were all better than those in control group (all P<0.05), while the stone recurrence rate of observational group and control group (3.3% vs. 6.7%) had no statistical difference (P>0.05). Conclusion: Therapeutic combined use of duodenoscopy and laparoscopy for elderly patients with gallbladder stones and concomitant extrahepatic bile duct stones has the advantages of quick recovery, reduced complications, short length of hospital stay and favorable long-term efficacy, and fully reflects the superiorities of minimally invasive surgery.

Abstract:Objective: To investigate the clinical efficacy of T-tube-free approach in treatment of patients with gallbladder stones and concomitant common bile duct (CBD) stones. Methods: The clinical data of 100 patients with gallbladder stones and CBD stones treated during September 2013 to September 2014 were retrospectively studied. Of the patients, 45 cases underwent laparoscopic cholecystectomy (LC), common bile duct exploration and primary suture (primary closure group), and 55 cases were subjected to LC and endoscopic sphincterotomy (sphincterotomy group). All patients were followed-up for 12–24 months. The relevant clinical variables between the two groups were compared and analyzed. Results: There was no statistical difference in gender, age, bilirubin and transaminase levels and mean diameter of the CBD stones between the two groups (all P>0.05), but the mean diameter of the dilated CBD in primary closure group was significantly larger than that in sphincterotomy group (P<0.05). All the 100 patients successfully underwent operation and were discharged after recovery. In all patients, ambulation was resumed on postoperative day one, and no statistical difference was noted in operative time, total length of hospital stay and remnant stones (all P>0.05), but the intraoperative blood loss, time to postoperative food and water consumption, length of postoperative stay and hospitalization costs were all reduced in primary closure group compared with sphincterotomy group (all P<0.05). As for complications, postoperative bile leakage occurred in 5 cases in primary closure group, and postoperative acute pancreatitis occurred in 6 cases in sphincterotomy group, and both differences had statistical significance (both P<0.05). Conclusion: Laparoscopic common bile duct exploration and primary suture without T-tube drainage can preserve the function of sphincter of Oddi and avoid long-term T-tube placement, which shows the benefits of the minimally invasive techniques, and it is an effective and feasible approach worthy of clinical use.

Abstract:Objective: To evaluate the clinical efficacy of percutaneous transhepatic stone disintegration and extraction in treatment of hepatolithiasis under B ultrasound positioning and X-ray guidance. Methods: Patients with intrahepatic stones admitted from June 2015 to February 2016 were selected, and then were randomly designated to observational group and control group, with 30 cases in each group. Patients in observational group underwent percutaneous transhepatic stone disintegration and extraction under B ultrasound positioning and X-ray guidance, and those in control group underwent percutaneous transhepatic stone disintegration and extraction under X-ray guidance alone. The relevant clinical variables and the quality of life between the two groups at 6 months after operation were compared. Results: In observational group compared with control group, the length of hospital stay and time to bowel function recovery showed no significant difference (both P>0.05), but operative time (69.46 min vs. 158.67 min), intraoperative blood loss (35.15 mL vs. 102.76 mL) were significantly reduced, the number of cases with surgical success (30 vs. 25) was significantly increased, the number of cases with residual stones (0 vs. 6) and early recurrence (0 vs. 4) were significantly decreased, the incidence of postoperative acute pancreatitis, acute cholangitis, bile leakage and hemorrhage were all significantly decreased, and the scores for all parameters of the SF-36 at 6 months after operation were all significantly elevated (all P<0.05). Conclusion: Percutaneous transhepatic stone disintegration and extraction under B ultrasound positioning and X-ray guidance is a safe, effective and convenient method of treatment for hepatolithiasis. It also has advantages of accurate location, high stone clearance rate, short operative time and fewer complications.

Abstract:Objective: To investigate the effects of different surgical methods on the long-term prognosis of patients with stage IV gallbladder carcinoma. Methods: The clinical and follow-up data of 134 patients with stage IV gallbladder carcinoma undergoing surgical treatment were retrospectively analyzed. Of the patients, 44 cases underwent palliative resection (palliative surgery group), 56 cases received radical or extended radical treatment for gallbladder carcinoma (radical surgery group), and 34 cases only had internal and external biliary drainage (drainage group). The long-term results among the three groups of patients were compared. Results: For patients with stage IVa gallbladder carcinoma, there was no statistical difference among the three groups in postoperative 1-year survival rate (P>0.05), but the postoperative 3-year survival rate in radical surgery group was significantly higher than that in palliative surgery group or drainage group (17.2% vs. 0.0% vs. 0.0%, both P<0.05). The median postoperative survival time in radical surgery group was 18 months, which was significantly longer than that in palliative surgery group (14 months) and drainage group (12 months) (χ2=12.094; 14.876, both P<0.05). For patients with stage IVb gallbladder carcinoma, both postoperative 1- and 3-year survival rates showed no statistical difference among the three groups (both P>0.05); the median postoperative survival time in radical surgery group was 14 months that was significantly longer than that in palliative surgery group (9 months) and drainage group (9 months) (χ2=8.741; 8.839, both P<0.05). Conclusion: Early radical resection may be helpful for improving the long-term outcomes of patients with stage IV gallbladder carcinoma.

Abstract:Objective: To investigate the natural evolution process of polypoid lesion of the gallbladder, so as to provide a reference for determination of its indications for surgery. Methods: Two-hundred patients with polypoid lesions of the gallbladder who had consecutive ultrasonographic data within 3 years were collected. The ultrasonic characteristics of the changes in size and number of their lesions were analyzed. Results: Among the 200 patients with polypoid lesion, 79 cases (39.5%) had single lesion, and 121 cases (60.5%) multiple lesions. The diameter of lesion in 113 cases (56.5%, that included 45 cases with single lesion) was ≥5 mm, in 87 cases (43.5%) was <5 mm, and in none of them was >1 cm. During 3 years of follow-up, the lesions were found to be reduced in size in 8 cases, disappeared in 10 cases and unchanged in 161 cases, which accounted for 89.5% (179/200) of the whole group. The lesions were found to be enlarged in only 21 cases (10.5%), but no lesion was greater than 1 cm. Conclusion: The majority of polypoid lesions of the gallbladder grow very slowly and are benign lesions, and can be managed by regular follow-up with no need of surgical treatment.

Abstract:Objective: To evaluate the clinical efficacy of ultrasound guided percutaneous puncture and drainage of the gallbladder (PPDG) in treatment of acute calculous cholecystitis during middle and late pregnancy. Methods: The clinical data of 47 women with acute calculous cholecystitis during middle or late pregnancy undergoing ultrasound guided PPDG from September 2010 to October 2015 were retrospectively analyzed. Results: PPDG was successfully performed in all the 47 patients. After treatment, the symptoms such as abdominal pain and fever were relieved quickly, no complications such as hemorrhage or biliary fistula occurred, and the laboratory parameters that included white blood cell count, and transaminase, total bilirubin and procalcitonin levels were statistically improved compared with preoperative findings (all P<0.05). Except in one patient whose tube fell out at 7 days after tube placement, all the remaining patients underwent regular tube removal or had tube removal during elective surgery after delivery. Of the 47 patients, 28 cases had spontaneous labor, and 19 had caesarean section, and all the neonates were physically normal at birth. Conclusion: Ultrasound guided PPDG is an effective, safe and convenient method of treatment for acute calculous cholecystitis during middle and late pregnancy, and it is recommended to be used in clinical practice.

Abstract:Objective: To investigate the clinical characteristics of cholecystocolonic fistula. Methods: The clinical, pathological and follow-up data of 14 patients with cholecystocolonic fistula, who were discovered among 8 235 patients admitted for gallbladder stones over the past 15 years in Xiangya hospital, were retrospectively analyzed. Results: The incidence of cholecystocolonic fistula in cholelithiasis patients was 0.17% (14/8235). Of the 14 patients, 2 cases (14.28%) were correctly diagnosed before operation, the other cases were found during operation; one case had internal fistula formation between the residual gallbladder and the transverse colon, 2 cases had internal fistula formation between the body of gallbladder and the transverse colon, the fistulous opening of the gallbladder in one case was uncertain due to atrophy of gallbladder, and in the other 10 cases, the fistulous tracts were all located between the fundus of the gallbladder and the transverse colon. All 14 patients underwent cholecystectomy, 12 patients had primary repair of colonic fistula and 2 patients received partial colectomy and anastomosis. Postoperative infection occurred in 2 patients (7.14%), of which one was wound infection and the other was subphrenic infection. Conclusion: In patients with a high suspicion of cholecystocolonic fistula, using ERCP and other examinations may help improve its preoperative detection rate.

Abstract:Objective: To investigate the clinical efficacy of postoperative chemotherapy with tegafur/gimeracil/oteracil (S-1) in patients with cholangiocarcinoma. Methods: Eighty-seven patients with cholangiocarcinoma after radical resection were selected as study subjects. According to patients’ preferences, 42 cases received postoperative S-1 chemotherapy (chemotherapy group), and 45 cases did not receive any postoperative chemotherapy (non-chemotherapy group). The short-term effects and long-term results between the two groups of patients were compared. Results: The serum levels of KL-6 protein, CA19-9 and CA125 after chemotherapy were significantly reduced in chemotherapy group compared with those in non- chemotherapy group (all P<0.05). The main toxic and side effects during chemotherapy were dyspepsia (35.71%), anemia (14.29%) and pigmentation (14.29%), all of which were minor degrees of severity. The 1-year disease-free survival and overall survival rates showed no statistical difference between the two groups (both P>0.05), but the 3-year disease-free survival and overall survival rates in chemotherapy group were significantly higher than those in non-chemotherapy group (28.57% vs. 11.11%; 42.86% vs. 22.22%, both P<0.05). The median disease-free survival time and overall survival time was 13.7 and 21.5 months respectively, and both were significantly longer than those in non-chemotherapy group (9.8 and 16.4 months) (both P<0.05). Conclusion: In cholangiocarcinoma patients, postoperative S-1 chemotherapy has beneficial effects on reducing tumor marker levels and prolonging survival time.

Abstract:Objective: To investigate the levels of mitosis regulatory enzyme polo-like kinase 1 (PLK1) and Aurora A in tumor tissues and serum in patients with extrahepatic cholangiocarcinoma, and their clinical significance. Methods: The expressions of PLK1 and Aurora A in 54 tumor specimens of extrahepatic cholangiocarcinoma and 20 specimens of tumor adjacent bile duct tissue were determined by immunohistochemical staining, and the serum concentrations of PLK1 and Aurora A in 25 patients with extrahepatic cholangiocarcinoma and 15 healthy subjects were measured by ELISA assay. The relations of their expressions with clincopathologic factors of the patients and the changes in their serum levels in the patients before and after operation were analyzed. Results: In patients with extrahepatic cholangiocarcinoma, the positive expression rates of both PLK1 and Aurora A were significantly higher than those in tumor adjacent bile duct tissue (66.7% vs. 25.0%; 63.0% vs. 15.0%, both P<0.05), and their expressions were all significantly associated with degree of tumor differentiation, TNM stage and lymph node metastasis (all P<0.05). The preoperative serum concentrations of both PLK1 and Aurora A were significantly higher than those in healthy control population (434.85 pg/mL vs. 256.00 pg/mL; 644.64 pg/mL vs. 375.73 pg/mL, both P<0.05), which were significantly declined after operation (all P<0.05). The expression levels of PLK1 and Aurora A in tumor tissue and their serum concentrations had significant consistency (r=0.55; r=0.64, both P<0.05), and either in tumor tissue or serum, there was a significantly positive correlation between the levels of PLK1 and Aurora (tumor tissue: r=0.47, P<0.01; serum: r=0.71, P<0.01). Conclusion: The levels of both PLK1 and Aurora A are increased in either tumor tissue or peripheral blood in patients with extrahepatic cholangiocarcinoma, their elevations are closely related to the malignant progression of extrahepatic cholangiocarcinom and their combined detection may have certain value for early diagnosis and estimating therapeutic effect and prognosis of extrahepatic cholangiocarcinoma.

Abstract:Objective: To investigate the effect of inducible nitric oxide synthase (iNOS) inhibitor on the biological behaviors of cholangiocarcinoma cells. Methods: Human cholangiocarcinoma QBC939 cells were cultured in different concentrations of iNOS inhibitor 1400W for 24 h, and then, the NO contents and proliferation status of each group of cells were determined by nitrate reductase assay and MTT assay respectively, and the half-inhibitory concentration (IC50) was also calculated. After that, QBC939 cells were exposed to an appropriate concentration of 1400W, according to the IC50 value, for 24 h, and then, the cell migration and invasion were detected by wound healing assay and Transwell invasion assay, respectively. QBC939 cells cultured with the medium without 1400W were used as blank control for all experiments. Results: Compared with blank control group, the NO content and proliferation in each 1400W treatment group were significantly reduced, with a concentration-dependent trend, and the IC50 was 51.24 μmol/L. In QBC939 after exposure to 50 μmol/L 1400W, the healing rate of the scratch wound (61.7% vs. 92.3%) and number of invaded cells (72.7 vs. 128.0) were all significantly lower than those in blank control group (both P<0.05). Conclusion: iNOS inhibitor 1400W can suppress the growth, migration and invasion of cholangiocarcinoma cells, the mechanism may be associated with the changes in NO downstream signaling molecules.

Abstract:Objective: To investigate the expression of metastasis suppressor 1 (MTSS1) in cholangiocarcinoma tissues and its clinical significance. Methods: Eighty-nine patients with cholangiocarcinoma admitted from January 2012 to January 2014 were prospectively enrolled as study subjects, and meanwhile, 89 cases undergoing cholecystectomy due to cholecystolithiasis were collected as a control group. The difference in MTSS1 expression in the pathological tissues between the two groups of patients was compared, and the relations of MTSS1 expression with the clinicopathologic variables and prognosis of the patients with cholangiocarcinoma were analyzed. Results: Compared with control group, the positive rate of MTSS1 expression in study group was significantly decreased (20.22% vs. 58.43%, P=0.000), and the percentage of MTSS1 positive cells was also significantly reduced (9.47% vs. 43.95%, P=0.000). In patients with MTSS1 negative cholangiocarcinoma compared with those with MTSS1 positive cholangiocarcinoma, the tumor size was significantly increased (3.84 cm vs. 2.46 cm, P=0.000), the proportion of cases with clinical stage III or IV was significantly increased (70.42% vs. 27.78%, P=0.001), lymph node metastasis rate was significantly increased (77.46% vs. 44.44%, P=0.028), the 2-year mortality rate was significantly increased (42.25% vs. 16.67%, P=0.045) and the number of cases with low differentiated tumor cells was significantly increased (P=0.001). Logistic regression analysis showed that the loss of MTSS1 expression was an independent risk factor for death of patients with cholangiocarcinoma (P=0.000), and Wilcoxon test showed that the survival rate in patients with positive MTSS1 expression was significantly higher than that in patients with negative MTSS1 expression (P=0.041). Conclusion: The decrease or loss of MTSS1 expression is closely related to the occurrence and development of cholangiocarcinoma.

Abstract:Objective: To investigate the effect of 18β-glycyrrhetinic acid (GA) on growth of hepatocellular carcinoma cells. Methods: The hepatocellular carcinoma cells (Hepa1-6) and normal hepatic cells (AML-12) were exposed to different concentrations of GA or adriamycin (ADM) for different time periods, after that, the cell growth inhibition and half inhibitory concentration (IC50) were analyzed. Then, after Hepa1-6 cells were treated with GA of an appropriate concentration selected according to IC50 for a certain time period, the cell apoptosis was measured. Results: Low concentrations of GA exerted no obvious inhibitory effects on proliferations of the two types of cells, but had remarkable inhibitory effects on proliferations of them at the concentrations >8 μg/mL, and the effects were increased with the elevation of the GA concentration and time prolongation. All concentrations of ADM showed evident inhibitory effects on proliferations of the two types of cells, and these effects were increased with the rising of the ADM concentration but decreased as time elapsed. The IC50 of GA for Hepa1-6 cells was lower than that for AML-12 cells, and the IC50 difference between them reached a largest value at 48 h treatment, while the IC50 of ADM for Hepa1-6 cells was higher than that for AML-12 cells at any time period of treatment. After treatment with 25 μg/mL GA for 48 h (under this condition, the inhibition rate of proliferation in Hepa1-6 cells was 50%, while in AML-12 cells was only 3.8%), the apoptosis in Hepa1-6 cells was significantly increased, which mainly resulted from early apoptosis (P<0.05). Conclusion: GA can inhibit the growth of hepatocellular carcinoma cells and the mechanism may be related to its inducing cells apoptosis. GA may be safer and has less toxic side effects for treatment of hepatocellular carcinoma.

Abstract:Objective: To investigate the effect of miR-150-5p on migration and invasion in hepatocellular carcinoma (HCC) cells and the mechanism. Methods: The miR-150-5p expression in normal hepatic cells and HCC HepG2 cells was determined by real-time PCR. Then, the HepG2 cells were divided into two groups to transfect with miR-150-5p (miR-150-5p group) or scramble sequences (control group), respectively. After transfection, the cell migration and invasion abilities were measured by wound healing assay and Transwell invasion assay, and the protein expressions of matrix metalloproteinase 2 (MMP2) and 9 (MMP9) were examined by Western blot, respectively. Results: The expression level of miR-150-5p in HepG2 cells was significantly reduced, and was 26% of that in normal hepatic cells (P<0.01). After transfection, the miR-150-5p expression level in miR-150-5p group was significantly increased, which was 9.53 times of that in control group (P<0.001). In miR-150-5p group compared with control group, the healing rate of the scratch wound (54.63% vs. 87.51%, P<0.01) and number of invaded cells (138 vs. 452, P<0.01) were all significantly decreased. The protein expression levels of MMP2 and MMP9 (0.78 vs. 1.75; 0.82 vs. 1.85) were all significantly decreased (both P<0.05). Conclusion: The miR-150-5p expression is decreased in HCC cells, and up-regulation of miR-150-5p expression can inhibit the migration and invasion of HCC cells and the mechanism may be associated with its suppressing MMP2 and MMP9 expressions.

Abstract:Objective: To investigate the value of indocyanine green retention test at 15 minutes (ICG-R15) on postoperative day (POD) 3 in predicting the occurrence of liver dysfunction after hepatectomy for hepatocellular carcinoma (HCC). Methods: The clinical data of 119 HCC patients undergoing hepatectomy from January 2015 to February 2016 were reviewed. The relations of the occurrence of postoperative liver dysfunction with preoperative and POD 3 ICG-R15 were analyzed, and the difference in predicting the occurrence of postoperative liver dysfunction between preoperative and POD 3 ICG-R15 was also compared. Results: Postoperative liver dysfunction occurred in 33 (27.7%) of the 119 patients. In patients with and without liver dysfunction, the average preoperative ICG-R15 was 9.7% and 5.2%, and POD 3 ICG-R15 was 11.8% and 5.3% respectively, and either the preoperative or POD 3 ICG-R15 was significantly different between patients with and without liver dysfunction (both P<0.05). Results of stratified analysis showed that the incidence of postoperative liver dysfunction was increased with the elevation of either preoperative or POD 3 ICG-R15, with statistical difference noted between patients with ICG-R15<10% and >20% (both P<0.05). The area under the curve of ROC of POD 3 ICG-R15 for prediction of preoperative liver dysfunction was larger than that of preoperative ICG-R15, and the cut-off value for the former was 7.75 (sensitivity: 66.7%; specificity: 83.7%) and for the latter was 3.35 (sensitivity: 84.8%; specificity: 46.5%), respectively. Conclusion: POD 3 ICG-R15 can be used for predicting liver dysfunction after hepatectomy for HCC similar to that of preoperative ICG-R15, and may even be superior to the latter.

Abstract:Objective: To investigate the clinical efficacy of postoperative chemotherapy combined with cytokine-induced killer cell (CIK) therapy in rectal cancer patients. Methods: The clinical data of 45 rectal cancer patients undergoing postoperative chemotherapy with FOLFOX4 regimen in combination with CIK therapy (CIK plus chemotherapy group) during June 2011 to May 2013 were retrospectively analyzed, and another 45 rectal cancer patients undergoing postoperative chemotherapy alone (chemotherapy alone group) with the same regimen during the same period served as control. The quality of life, short-term results, survival rate and adverse reactions between the two groups were compared, and the influential factors for prognosis of rectal cancer patients were also analyzed. Results: In CIK plus chemotherapy group compared with chemotherapy alone group, the improvement rate in quality of life was significantly increased (82.2% vs. 33.3%, P<0.05), the overall response rate had no significant difference (31.1% vs. 22.2%, P>0.05), but the disease control rate was significantly increased (77.8 % vs. 51.1%, P<0.05). The 1- and 2-year overall survival rate showed no significant difference (100.0% vs. 97.8%; 93.3% vs. 80%, both P>0.05), but the 1- and 2-year progression-free survival rate was significantly increased (86.7% vs. 62.2%; 62.2% vs. 40%, both P<0.05) and the overall incidence of adverse reactions showed no significant difference (46.7% vs. 53.3%, P>0.05). Univariate analysis showed that degree of tumor differentiation, lymph node metastasis, TNM stage and surgical procedure were associated with the prognosis of rectal cancer patients (all P<0.05), and multivariate analysis identified that degree of tumor differentiation and pathological stage were independent prognostic factors (both P<0.05). Conclusion: Postoperative chemotherapy in combination with CIK immunotherapy can significantly improve the quality of life, increase the overall efficacy, and prolong the progression-free survival rate of rectal cancer patients. The degree of tumor differentiation and pathological stage are independent postoperative prognostic factors for rectal cancer patients.

Abstract:Objective: To investigate the clinicopathologic characteristics and prognostic factors of patients with stage IA breast cancer. Methods: The clinicopathologic data of 156 patients with IA stage (T1N0M0) breast cancer treated in Cancer Hospital of Tianjin Medical University from January 2004 to December 2009were retrospectively analyzed. Results: Of the 156 patients, all cases were female; infiltrate ductal carcinoma accounted for the majority of the pathological types (115 cases, 73.7%), the primary tumor sizes were mostly classified as T1c (77 cases, 49.4%) and histological grades were mainly grade II (79 cases, 50.6%) and III (58 cases, 37.2%). The 5-year progress-free survival (PFS) was 93.3% and overall survival (OS) was 99.1%, respectively. Univariate analysis showed that histological grade, Ki-67 expression and lymphvascular invasion were significantly related to the PFS of the patients (all P<0.05). Multivariate analysis identified that histological grade and Ki-67 expression were independent prognostic factors for PFS of the patients (both P<0.05). Conclusion: Although the overall prognosis of stage IA breast cancer patients is favorable, patients in some subgroups still have great risk of recurrence and metastases, and they have a poor prognosis.

Abstract:Intrahepatic cholangiocarcinoma (ICC) arising from the epithelial cells of the second order bile ducts and their branches, is one of the liver cancers with high degree of malignancy and poor prognosis. Lymph node metastasis is the most important factor affecting the prognosis of ICC patients. Recently, many studies indicated that hepatitis B virus (HBV) is an independent risk factor for ICC, and the clinical manifestations in patients with HBV-associated ICC are similar to those with hepatocellular carcinoma. Further, the latest studies demonstrated that the prognosis in HBV-positive ICC patients is better than that in HBV-negative patients, and HBV-positive ICC patients have a relatively low rate of lymph node metastasis. Thus, further insight into the actions of HBV on the pathogenesis and outcomes of ICC is of great clinical significance.

Abstract:Cholangiocarcinoma (CC) is a malignant tumor originating from the epithelial cells of the bile ducts with high degree of malignancy and poor prognosis. Current treatment methods mainly include radical resection, palliative surgery, chemotherapy, and radiotherapy, but all these methods exert little impact on patients’ survival. 125I seed implantation is a recently emerging technique for cancer therapy. It has better safety and efficacy, and can effectively improve the survival of CC patients in combination with other treatment methods, but still has some disadvantages. Here, the authors present the progress of 125I seed implantation in CC treatment.

Abstract:Acute cholangitis of severe type (ACST) is caused by suppurative infection following acute biliary obstruction, characterized by sudden onset, rapid change of morbid condition, and high mortality rates. Non-surgical treatment should be initiated aggressively as soon as ACST is suspected or confirmed, and then selection of appropriate surgical procedure can be decided according to the conditions of the patients. With the development of minimally invasive technology and the improvement of medical science, reports on one-session surgical removal of cause of obstruction on the premise of unobstructed drainage have been available. In this paper, the authors present the current status of treatment of common bile duct stones complicated with ACST by minimally invasive techniques that mainly include endoscopic, percutaneous transhepatic biliary drainage and laparoscopic techniques.

Abstract:With the development of laparoscopic and choledochoscopic techniques, laparoscopic choledochotomy with primary closure of the common bile duct has become an ideal surgical procedure for choledocholithiasis. The authors, in this article, address its scope of application (indications, and contraindications), intraoperative procedures, and complications and their preventions, so as to provide a theoretical basis for clinical work.