Objective To discuss the effective surgical treatment of intrahepatic lithiasis combined with high hepatic duct strictures. MethodsTwo hundreds and sixteen cases of intrahepatic lithiasis and high hepatic duct strictures treated in this hospital from January 1993 to October 2002 were analysed retrospectively.ResultsOne hundred and eightythree cases underwent different selective operation by selected time; 33 cases complicated with acute obstructive suppurative cholangitis underwent emergency were performed single biliary drainage, in which 30 cases were reoperated. The operative procedure were: hepatic lobectomy,high cholangiotomy and plastic repair,exposure of hepatic duct of the 2nd and the 3rd order,and plastic repair with own patch and choledochojejunostomy.Two hundreds and six cases were cured,the curative rate was 95.4%; 8 cases improved (3.7%), and 2 cases died (0.9%).Conclusion The best effective surgical treatment of intrahpatic lithiasis is hepatic lobectomy. Exposure of hepatic duct of the 2nd and the 3rd order is a satisfactory to release the hepatic duct strictures and to clear the intrahepatic lithiasis. For patients with normal extrahepatic bile duct and Oddi’s function, plastic repair of bile duct with own patch is possible to keep the normal form and function. Cholangioscopy may play an important role in the treatment of intrahepatic tract lithiasis during operation.
ObjectiveTo study the clinical manifestations, pathologic characteristics, imaging features, diagnosis and treatment of adenomas of extrahepatic bile duct.MethodsTwo cases of adenomas of extrahepatic bile duct in our hospital and 14 cases reported in the literatures were analyzed retrospectively.ResultsThe patients’(male 5, female 11) mean age was 58.4 years (range 21-85). The main manifestations included jaundice (n=11), abdominal pain (n=8),fever (n=6),dyspepsia (n=4),body weight loss (n=3) and claycolored stool (n=1). The locations of tumors were in the left hepatic duct (n=1), right hepatic duct (n=3), hepatic common bile duct(n=3）,the junction of cystic duct and common bile duct (n=1），distal common bile duct (n=8). The pathologic types were tubular adenomas (n=5), papillary (villous) adenomas (n=10),and mucous adenoma (n=1). All the patients underwent surgical therapy. The tumors were identified by postoperative histopathologic examination.ConclusionIt is difficult to correctly diagnose adenomas of extrahepatic bile duct before operation, because the clinical manifestations are usually atypical. The definite diagnosis should depend on histopathologic examination. It is the key to completely resect the tumors. Postoperative followup should be done on regular basis.
To study bacterial changes of bile, to detect relationship between formation of core of gallstones and bacterial infection. Floras of bacteria in bile were studied in patients with gallstones by using aerobic, anaerobic and Lforms (X, Y,L) culturing system.Results: Bacterial growth positive was found in 88 of 98 patients in which single bacterial growth accounted for 54 cases, multiple growth 34 including type X 83, type L 23 and type Y 5. The results show that some alteration of bacteria flora exists during biliary infection and S. Liguefaoiens and E. Coli are the most frequent bacteria present. Formation of the core of gallstone might be related with bacterial infection.
Objective To observe the expression and distribution of transforming growth factor-β1 (TGF-β1) in the healing process of bile duct and discuss its function and significance in the process of benign biliary stricture formation. Methods An injury to bile duct of dog was made and then repaired. The expression and distribution of TGF-β1 in the tissue at different time of the healing process were studied after operation with immunohistochemical SP staining. Results TGF-β1 staining was observed in the granulation tissue, fibroblasts and endothelial cells of blood vessels. High expression of TGF-β1 was observed in the healing process lasting for a long time. Conclusion The high expression of TGF-β1 is related closely with the fibroblast proliferating activity, extracellular matrix overdeposition and scar proliferation in the healing process of bile duct.
Objective To observe the influence of connexin 43 (Cx43) on bystander effects induced by cytosine deaminase (CD) and herpes simplex virus thymidine kinase (HSV-tk) coexpression suicide genes system in human cholangiocarcinoma QBC939 cells and transplantation tumors in nude mice. Methods In vitro, the CD+tk+ and CD+tk+Cx+ cells were respectively treated with 5-fluorocytosine (5-FC) and ganciclovir (GCV). The cytotoxic efficacy was evaluated by microculture tetrajolium test (MTT) method. In order to investigate the influence of Cx43 on bystander effects, the volumes of transplantation tumors of the CD+tk+ and CD+tk+Cx+ cells were measured before and after application of 5-FC and GCV. Results CD and tk gene were stably expressed in transfected QBC939 cells. Increasing expression of Cx43 was determined by testing for the presence of Cx43 mRNA by RT-PCR and the presence of Cx43 protein by Western blot in CD+tk+Cx+ cells. The killing effect of 5-FC and GCV on CD+tk+Cx+ cells was more effective than that on CD+tk+ cells both in vitro and in vivo. Conclusion Double suicide genes system CD/5-FC+tk/GCV could induce remarkable killing effect on cholangiocarcinoma cells in vitro and transplantation tumors in vivo. The cotransfection of Cx43 gene is able to enhance the bystander effects and the inhibition of carcinoma cells.
Objective To study the clinical feasibility of invasive mechanical ventilation with bilevel positive airway pressure（BiPAP） non-invasive ventilator in the stable patients needing prolonged mechanical ventilation.Methods Eleven patients with respiratory failure admitted in intensive care unit（ICU）of our department，who needed prolonged mechanical ventilation，between Jun 2004 and Nov 2007 were enrolled in the study and followed until death or Jan 2008.The arterial blood gas analysis data，length of stay(LOS)，LOS after changing to BiPAP non-invasive ventilator（Synchrony，Harmony，RESPIRONICS，VPAP III ST-A，RESMED），survival time after discharge(or fulfilled the discharge standards) were reviewed retrospectively.Results The settings of inspiratory pressure，expiratory pressure and respiratory rate of non-invasive ventilation were 21.3 (16-26) cm H2O，4 cm H2O，and 16 min-1，respectively.The LOS (or up to the discharge standard) was (91.5±50.2) days.The LOS (or up to the discharge standard) after changing to BiPAP ventilator was (23.5±12.2) days.The mean survival time after discharge (or up to the discharge standard) was (353.1±296.5) days.Four patients were still alive up to the end of the study.The arterial pH，PaCO2，PaO2，and SaO2 were not significant different before and after changing to BiPAP ventilator.Conclusion The mechanical ventilation with BiPAP non-invasive ventilator via tracheotomy tube is an alternative choice for stable patients needing prolonged mechanical ventilation.
The structure of 39 specimens of hepatobiliary duct stones with strictures were studied histologically. The elastic and collagenous fibers were studied by quantitative analysis. The results show that the epithelium of the sttnotic bile duct are intact but with proliferation. The mitochondrions are degenerated and broken, the endoplasmic reticulum are dilated, suggesting the functional impediment of these epithelium. The mucous glands are markedly proliferated fibrosis are found near the glands which are destroyed .Some of the elastic fibers are destroyed and arranged disorderly . Hyaline degeneration was observed in collagenous fibers with remarkable increase of the volume density.
Objective To investigate the effect of cholecystectomy on the induction of large intestine cancer and its mechanism. Methods After cholecystectomy, the large intestine neoplasm in mice was induced with dimethylhydrazine(DMH).The histogenesis and growth pattern of large intestine cancer were observed.The Sphase fraction (SPF) of epithelium cells in large intestine mucosa was determined using flow cytometry. Before and after operation, the feces of mice were collected to determine the cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA) and lithocholic acid (LCA) concentration by highperformance liquid chromatography. Results The average number of large intestine neoplasms per mouse,percentage of large intestine adenomas in examined mice and SPF of experimental group were significantly higher than those of control group (P＜0.05). The fecal LCA concentration in postcholecystectomy was significantly higher than that in precholecystectomy and in sham operation group (P=0.00). Conclusion The large intestine neoplasm of mice induced by DMH is increased and the proliferation of epithelium cell in large intestine mucosa is increased after cholecystectomy. This suggests that cholecystectomy has promoting effect on induction of large intestine neoplasm in mice. The gut may deal with the increased secondary bile acid(LCA) concentration postcholecystectomy.
Objective To study the distribution and concentration of meropenem in rabbit bile. Methods The rabbits were cannulated with a silicone tube in the common bile duct and the blank bile was collected. The rabbits were then administered intravenously with meropenem. Multiple bile samples (1.5 ml) were collected at different phases after the administrations. According to requirement of the high performance liquid chromatography (HPLC), the specificity test was undertook. The blank bile was then mixed with meropenem and mobile phase, respectively, in order to obtain a series of bile samples at different concentrations ranging from 0.5 to 500 μg/ml. The samples were analyzed with HPLC and the chromatographic peak area of meropenem contents were quantitated through external reference method. The linear regression equation was used to analyzed the relationship between the drug concentrations and the chromatographic peak areas. The bile samples that were collected after drug administrations were pretreated and the chromatographic peak areas were assayed by the liquid chromatograph. The bile concentrations were then calculated according to the regression equation, and the concentration-time distribution of meropenem in the bile was obtained ultimately. Results The specificity test indicated the bile dopant peak and the meropenem chromatographic peak were well-separated under chromatographic condition of the mobile phase. The standard curve regression equation was S=2 209.10C-1 251.34, r=0.999 9, and minimum quantitation limit of meropenem was 0.5 μg/ml. After a single i.v. administration of 75 mg/kg of meropenem in each rabbit, drug concentrations reached (38.36±14.17) μg/ml immediately in bile， which significantly exceeded the minimum inhibitory concentrations (MIC90) for most gram negatives, which range from 0.031 to 2 μg/ml. The bile concentration of meropenem decreased quickly over time, and meropenem was eliminated completely in rabbit bile 3 hours after intravenous injection. Conclusion Meropenem could achieve adequate bile concentration for the treatment of biliary tract infection due to susceptible bacteria. However, because of its rapid biliary elimination, meropenem should be used in shorter interval time.
Objective To investigate the prevention and treatment strategy of bile duct injury (BDI) in laparoscopic cholecystectomy (LC). MethodsLatest progress was reviewed based on recent documents and the experience on BDI in LC in our department. ResultsWith the popularity of LC, BDI in LC is increasing. The reasons include illegibility and variability of local anatomy in gallbladder trigone,injury caused by galvanothermy, as well as operator’s overconfidence. In order to prevent BDI, we should apply more blunt dissection, not to use electrocogulation if possible and to study local anatomy and its variance clearly. The common bile duct and common hepatic duct should be clearly identified. Intraoperative cholangiography, laparoscopic ultrasonography and hepatobiliary scintigraphy are selections as necessary.The treatment of BDI depends on the type of BDI and its site and local condition.The treatment includes end to end anastomosis, repairing the defect, choledochoduodenostomy, RouxenY choledochojejunostomy and so on. T tube should be maintained in place for more than half a year after operation.Conclusion The key to improve the prognosis of BDI is prevention and treatment in proper time and in correct way.