A acute partial obstructive hepatocholangitis model by selective ligation and injection of E coli into left hepatic bile duct was successfully founded in rat. Using parameters including mortality, mitochondrial glutamic oxalacetic transaminase and ornithine carbamoytransferase activity, pathological observation and blood culture of bacteria, we evaluated the model. The authors emphasize that this models is superior to the wole-bile-duct-challenged cholangitis model, which is characterized by liver injury.
Objective To explore the indications for liver transplantation among patients with hepatolithiasis. Methods Data from 1431 consecutive patients with hepatolithiasis who underwent surgical treatment from January 2000 to December 2006 were retrospectively collected for analysis. Surgical procedures included T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones, hepatectomy, cholangiojejunostomy, and liver transplantation. Results Nine hundred and sixty-one patients who had a stone located in the left or right intrahepatic duct underwent hepatectomy or T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones. The rate of residual stones was 7.5% (72/961). Four hundred and seventy patients who had a stone located in the bilateral intrahepatic ducts underwent surgical procedures other than liver transplantation; the rate of residual stones was 21.7% (102/470). Only 15 patients with hepatolithiasis underwent liver transplantation; they all survived. According to the degree of biliary cirrhosis, recipients were divided into 2 groups: a group with biliary decompensated cirrhosis (n=7), or group with biliary compensated cirrhosis or noncirrhosis group (n=8). There were significant differences in operative times, transfusion volumes and blood losses between 2 groups (P＜0.05). In the first group, 6 of 7 patients experienced surgical complications, and in the second, 8 recipients recovered smoothly with no complications. Health status, disability and psychological wellness of all recipients (n=15) were significantly improved in 1 year after transplantation as compared with pretransplantation (P＜0.05). Conclusion Liver transplantation is a possible method to address hepatolithiasis and secondary decompensated biliary cirrhosis or difficult to remove, diffusely distributed intrahepatic duct stones unavailable by hepatectomy, cholangiojejunostomy, and choledochoscopy.
Twenty five children with congenital biliary dilatation were treated with hepatico-jejuno-duodenostomy following excision of choledochal cysts between 1983 and 1985. The age ranged from two months to eleven years. The last follow-up ranged from 6-9 years (mean 7.5 years). All patients were free of jaundice with normal growth and development and none had peptic ulcer. The results from the last follow-up was better than that of the first one. This procedure was safe, effective and physiologically appealing.
Objective To evaluate the linkage between the proxmal as well as long term outcome and choice of therapeutical modality for benign hilar stricture of bile duct prospectively. Methods 25 patients have been catergorized into 4 groups according to different pathogen and the proxmal as well as long term outcome after pathogen based management have been studied prospectively. Results The hepatic portal cholangio-jejunostomy applied for iatrogenic hilar stricture of bile duct has been proved to be effective and the incidence of refulux cholangitis is only 10%(1/10). Hepatic hilar plasty procedures keep the physiological entitity of bile duct and the vital, sufficient autologous repair materials as well as reliable operation design are needed. Resection of atrophic right liver lobe bearing hepatolithiasis combined hepatic hilar plasty has reached both elimination of liver focus and maintaining the physiological entitity of bile duct. The ballon dilation for mild ring-like hilar stricture of bile duct is valide but not for hilar tubular stricture of secondary sclerosing cholangitis.Conclusion The strategy of individualized management (pathogen based management) for benign hilar stricture of bile duct has proved to be reliable and effective.
Objective To explore the feasibility and safety of laparoscopic cyst resection and Roux-en-Y hepatojejunostomy in treatment for adult congenital cholangiectasis and to compare the therapeutic effects of laparoscopic procedure with conventional open procedure. Methods The clinical data of 33 adult patients with congenital cholangiectasis from May 2008 to September 2011 in the department of general surgery of Shengjing Hospital of China Medical University were retrospectively analyzed. Fourteen patients received laparoscopic procedure （laparoscopic group），whereas the other 19 patients received conventional open procedure （conventional group）. Results All the operations were carried out successfully through laparoscopic procedure. The mean time of operation in the laparoscopic group was significantly longer than that in the conventional group （195min versus 130min，P＜0.01）. The average intraoperative blood loss in the laparoscopic group was significantly less than that in the conventional group （80ml versus 270ml，P＜0.01）. In contrast，the mean time of bowel peristalsis recovery and postoperative hospital stay in the laparoscopic group were significantly shorter than those in the conventional group （time of bowel motion recovery：76h versus 104 h，P＜0.01；hospital stay：6.1 d versus 9.6 d，P＜0.01）. There were no differences in the early complications between two groups （P＞0.05）. Conclusions Totally laparoscopic treatment for congenital cholangiectasis in adult is feasible and safe. It is worth to be generally applied because of its minimal invasion and fast postoperative recovery.
胆囊作为贮存和浓缩胆汁的器官，其内的胆汁易于析出、凝集而形成结石。胆囊最常见的疾病多与结石相关，如胆石症、急慢性胆囊炎、胆囊癌等； 其他影响胆囊的病理状态还包括胆道动力障碍、术后改变等。超声对胆囊结石及胆囊炎的诊断有较高的敏感性及特异性，还可通过摄取高脂食物前后对比评价胆囊功能，是胆囊疾病的传统影像检查手段，但对肥胖患者其图像质量及解剖细节显示较差。目前，常规MRI已经成为重要的胆囊成像方法之一，并可引入经胆道排泄的造影剂进一步清晰显示其解剖及生理。对于超声不能很好评价的胆囊疾病患者应首选MRI检查。
Objective To investigate the phenotypic change and proliferation of fibroblasts in human inflammatory strictured bile duct wall. Methods We observed the density and ultrastructure of fibroblasts, and the histologic structure in human normal bile duct wall and inflammatory strictured bile duct wall by light and electron microscope.Results The results showed that fibroblasts were the main source of extracellular matrix production in bile duct wall. The phenotype of fibroblasts in inflammatory strictured bile duct wall changed obviously, quiescent fibroblasts were activated and transformed to myofibroblasts, with massive proliferation. Conclusion These data suggest that massive proliferation of activated fibroblasts and myofibroblasts is the main source of extracellular matrix overproduction which results in inflammatory bile duct stricture.
The contents of lipid peroxides(LPO)and vitamin E(V.E)and some functional index and histologic changes in the lungs from the the rabbit models of acute cholangitis of severe type(ACST)were measured dynamically.The results revealed that the V.E content decreased strikingly from 6 hours and the LPO level increased progressivelg from 12 hours in the lungs.Simultanuosly,the congestion and neutrophil infiltreation in the lung mesenchyme,and the endothelial cell damage and thrombosis in the lung blood capillaries had been observed.These suggest that acute lung injury induced by ACST is referable to the lipid peroxidation damage to the lung blood capillaries which is due to increased LPO and decreased antioxidants including V.E.
胆道并发症发生率的高低往往代表了一个肝移植中心的整体技术水平。欧美成熟的肝移植中心胆道并发症发生率为7%~10%，1年生存率达到90%。来自中国肝移植登记注册网（CTLR）的资料： 香港玛丽医院2006年统计了香港公民在大陆进行肝移植的148例患者，在长期随访中发现，有48%的受体发生了胆道并发症，1年生存率只有59%； 说明目前肝移植胆道并发症的防治仍然是亟待解决的难题。究其原因，还是对胆管微循环保护的研究不够深入和并发症发生的防治体系不够完善，笔者就此谈几点体会。1胆管微循环保护的理论人体肝脏胆管及血管铸型模型的研究显示，胆管为动脉单一供血，肝固有动脉和胃十二指肠动脉终末支分出3点、9点动脉滋养肝外胆管，并构成肝门部胆管周围血管丛(peribiliary vascular plexus,PVP)，胆管的动脉系统与门静脉之间无明显的交通血管，门静脉在胆管的血液供应中作用有限 (图1)。在动脉损伤时胆管很难从别的途径获得充分的血液供应，从而造成胆管的缺血性损伤。碳素墨汁灌注透明法显示，肝门部每个肝叶胆管及其分叉部均有肝固有动脉的较大分支支配，肝动脉的分支与胆管壁微血管之间呈垂直的连接方式。胆管厚切片透明后可清楚地显示出PVP的平面结构: 外层微血管直径较粗，内层微血管象链条一样排列，中层微血管连接在内、外层之间[３](图2)。动脉血流从外层较粗大血管流入位于胆管黏膜下的内层微血管，它是胆管动脉的终末分支,由内层微血管滋养的胆管上皮细胞层是胆管最易受损的部位(Achilles heel)。所以，肝移植中胆管动脉灌洗非常重要，应尽可能选用能够进入胆管黏膜内层血管网的低黏滞度灌注液。笔者研究证实了HCA液结合UW液灌注快速获取无心跳供体（NHBD）的肝脏，其保存效果优于单用UW液、Celsior液或HTK液，采用价廉低黏滞度HCA液联合UW液灌注，既能防止胆管PVP微血栓形成，又能充分发挥UW液对肝细胞和胆管细胞的保护作用.............................