Objective To investigate the roles of NF-κB and EGFR in hepatolithiasis associated with intrahepatic cholangiocarcinoma. Methods Ninety cases of liver tissue specimens from hepatectomies performed in the 2nd Affiliated Hospital of Sun Yat-sen University between August 1989 and June 2009 were enrolled in the study. Among them, 33 cases of hepatolithiasis associated with intrahepatic cholangiocarcinoma were considered as observing group, 32 cases of hepatolithiasis as control group, and 25 cases of normal bile duct tissues as normal control group. The SP method of immunohistochemical staining was applied to detect the expressions of NF-κB and EGFR in intrahepatic biliary ducts epithelial cells, and their relations with clinicopathologic factors and the accumulated survival rate of hepatolithiasis associated with intrahepatic cholangiocarcinoma were analyzed. Results Expression rates of NF-κB and EGFR were gradually raised from normal control group, control group to observing group (Plt;0.01). Expression of EGFR in tumor patients was related to histopathologic differentiation grading and the depth of tumor invasion (Plt;0.05), but not to gender, age, or lymph node metastasis (Pgt;0.05)； there were no significant relationships between the expression of NF-κB and factors described above (Pgt;0.05). The survival rate of patients with tumor expressed EGFR was significantly lower than that of patients with tumor non-expressed EGFR (Plt;0.01). Conclusions NF-κB expression is in the early stage during intrahepatic cholangiocarcinoma genesis. NF-κB and EGFR play cooperating roles during hepatolithiasis carcinogenesis process. Over expression of EGFR is related with poor differentiation and prognosis of tumor.
Objective To investigate the value of indocyanine green fluorescence imaging in common bile duct reexploration. Methods The clinical data of 32 patients who underwent open common bile duct reexploration in the Affiliated Hospital of Southwest Medical University from January 2018 to December 2020 were collected retrospectively. All patients divided into the control group (conventional exploration group, 20 patients) and the fluorescence imaging group (using indocyanine green fluorescence imaging, 12 patients) according to the operational manner. The intraoperative and postoperative results of two groups were analyzed. Results The operative time [(165.2±6.9) min vs. (130.8±5.5) min], the time to find extrahepatic bile duct [(43.9±3.8) min vs. (23.1±4.1) min] and the amount of bleeding [(207.7±7.7) mL vs. (127.5±15.3) mL] in the control group were longer or more than those in the fluorescence imaging group (P<0.05). The incidence of postoperative infection in the control group [7 cases (35.0%) vs. 0 cases (0.0%)] and the length of hospital stay [(10.8±2.8) d vs. (7.1±1.3) d] were higher or longer than those in the fluorescence imaging group (P<0.05). There were no significant difference between the two groups in the incidence of postoperative bile fistula [6 cases (30.0%) vs. 2 cases (16.7%)] and the incidence of residual stones [3 cases (15.0%) vs. 3 cases (25.0%), P＞0.05]. Conclusion Indocyanine green fluorescence imaging appears to be a feasible, expeditious, useful, and effective imaging method while performing reexploration.
目的:探讨肝胆管结石合并胆管癌的临床表现特征和诊治经验。方法:分析了自2001年1月到2009年8月我院收治的30例肝胆管结石合并胆管癌患者的临床资料。结果:肝胆管结石合并胆管癌术前确诊10例,术中病理检查确诊14例,术后病理检查发现6例。左肝胆管癌16例,占533%,右肝胆管癌7例占233%,肝门部胆管癌5例占167%,其余2例为左右肝都有。肿瘤根治性切除术17例(567%),姑息性手术9例(30%),单纯活检4例(133%)。在30例随访资料中,根治性切除术者平均存活时间26个月。存活1年以上10例,2年以上5例,3年以上2例;姑息治疗者术后平均生存9个月;其余的≤4个月。结论:胆石症状易反复发作,胆道病史较长大于10年且术前CA199gt;2500 ng/mL的患者应高度怀疑合并有胆管癌。
目的考察皮下通道型胆囊肝胆管成形术（STHG）治疗肝胆管结石及胆管狭窄的中、远期疗效。方法对该院1994年12月至2000年6月期间行STHG手术的59例患者的术后中、远期并发症进行统计分析。结果STHG的术后并发症发生率较低，而且并发症的种类也较少； 本组病例术后无返流性胆管炎的表现，也无胃肠道功能紊乱和吻合口溃疡发生。结论STHG既保存了胆囊及Oddi括约肌功能，又保证了胆汁的生理流向，还能防止肠液的返流，从而避免了术后消化功能紊乱和返流性胆管炎的发生，是一种较为理想的治疗肝胆管结石和肝门部胆管狭窄的术式。
Endoscopic treatment of extrahepatic bile duct stones has become very common, but endoscopic treatment of intrahepatic bile duct stones for various reasons faces many difficulties and challenges. With the birth of new equipment and the advancement of technology, endoscopic treatment of intrahepatic bile duct stones has ushered in new opportunities, including peroral cholangioscopic technology and endoscopic ultrasonography, which have shown good application prospects. It will become an indispensable and important part in the treatment of intrahepatic bile duct stones.
目的：探讨急性胆源性胰腺炎(ABP)手术时机和术式的选择。方法：回顾性分析247例急性胆源性胰腺炎的临床资料。 结果：非手术治疗10例，死亡4例；12例急诊手术后发生并发症5例，死亡2例；169 例延期手术术后发生并发症1例，治愈；56例择期手术无并发症发生。结论：以胆道梗阻为主的ABP应急诊手术解除胆道梗阻；胆道无梗阻先采用非手术治疗，胰腺炎控制后，再处理胆道病变。
The quantitative studies of secretory granules andand lysosomes in gallbladder epithelium and gallbladder bile glycoprotein were performed in 20 gallstone patients and 15 gallstone-free subjects. The results showed that the number, the volume density and the total secrectory granules were significantly increased in gallstone patients compared with gallstone-free controls. The gallstone patients had a markedly reduced number,volume destiny and total lysosome area compared with gallstone-free subjects. The glycoprotein concenrtation in gallblader bile was increased up to 21.04±4.92g/L in gallstone paients,as compare with 13.02±5.72g/L(Plt;0.05)in the stone-free controls. The qualitity of secretory granules and lysosomes was directly proprtational to that of bile glycproteins. Evidence and secrectory granules and lysosomes was directly proporional to taht of bile glycoproteins. Evidence and argument are presentded suggesting that gallblader epithelium secrectory granules affect the concentration of bile glycoprotein and lysosomemay be related to the intracellular degradation of secretory granules.
目的 探索急性化脓性梗阻性胆管炎20世纪90年代后期与80年代以前的差异，探讨对本病治疗的方向。 方法 收集我院1996～2000年病例，并与我院1950～1981年资料进行比较。 结果 ①发病率显著降低，从46.08%降至15.62%； ②发病年龄延后10～20岁； ③入院时病情相对较轻，有休克者从51.39%降至22.80%； ④病死率明显下降，从25.78%降至3.50%； ⑤再手术患者显著增加，从12.12%增至55.20%。造成上述差异的原因与患者就诊早，及时的治疗，医务人员的水平提高，药品与医学的发展等有关。 结论 对急性梗阻性化脓性胆管炎患者，虽然发病率和死亡率已明显下降，仍需足够重视，因术后T管造影和B超检查发现肝内残石或胆管狭窄者，高达85.1%，复发再手术率达55.2%，远不能令人满意。为提高远期效果，应在急诊手术引流后，待患者病情平稳后，再进一步检查和彻底处理肝内病变。
【摘要】目的探讨不同病理状态下结石嵌顿性胆囊炎腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床应用价值。方法回顾性分析2001年1月〖CD3/5〗2009年10月期间172例结石嵌顿性胆囊炎患者行腹腔镜手术的临床资料。结果腹腔镜手术成功164例,成功率为9535％,中转开腹8例,中转率为465％。术中出血1例,术后并发胆漏1例,胆管残余结石1例,切口感染1例,并发症发生率为233％(4/172),无胆管损伤,无死亡。结论LC治疗结石嵌顿性胆囊炎安全、可行,但必须严格掌握手术适应证、时机和技巧。适时中转手术是提高手术成功率、降低并发症的关键。