Evaluation of ERCP in the diagnosis of hepatocellular carcinoma invading bile ducts

Endoscopic retrograde cholangiopancreatography (ERCP) was performed preoperatively on 29 patients suffering from hepatocellular carcinoma (HCC) invading bile ducts. The outstanding features were: 1. Most of the filling defects were situated within the common, right or left hepatic duct associated with proximal bile duct dilatations (17 cases);2. Tumor encasement resulted in localised or diffused irregular strictures and dilatations (9 cases); 3. Displacement and stretching of the intrahepatic ducts by pressure of tumor mass (3 cases). These features are different from that in cholangiocarcinoma.ERCP should be considered as an important diagnostic procedure for HCC. It is especially useful for cases with obscure intrahepatic duct dialatation and/or an increase of AFP, and will help early diagnosis of HCC.     

Case Report :Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure widely used to diagnose and treat conditions of biliary or pancreatic ductal system. The post-ERCP severe acute pancreatitis (SAP) accompanied with duodenum perforation is rare but serious, remaining a challenge in clinic. In this study we report two such cases. Two Chinese women were treated for clinical suspicion of bile duct obstruction and underwent ERCP after admission. Both developed duodenum perforation and SAP after ERCP, and were ...     

Intraoperative ERCP and endoscopic sphincterotomy combined with laparoscopic cholecystectomy for treatment of cholelithiasis with choledocholithiasis

Objective: To evaluate the benefit of intraoperative ERCP and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC) in the treatment of cholelithiasis with choledocholithiasis. Methods: Fifty-two patients with cholelithiasis and choledocholithiasis (as determined by intraoperative cholangiography) were randomly divided into 2 groups during LC. In group A (27 patients), common bile duct stones were extracted by intraoperative EST during LC. In group B(25 patients), common bile duct (CBD) stones were extracted by conversion to open CBD exploration and cholecyctectomy. Results: The success rate was 26/27 (96.3%) in group A and 25/25 (100%) in group B (0.25<P<0.5); The mean postoperative hospitalization was 3.32±0.56 days in group A and 17.5±4.61 days in group B (P<0.001). In group A, two cases were complicated transient hyperamylasemia after the combined procedure. In group B, one case of bile leakage and one case of duodenal ulcer occurred after conversion to open cholecystectomy with CBD exploration. There were no retained stones in group A but 2 cases in group B. Conclusion: Intraoperative ERCP and endoscopic sphincterotomy combined with LC for treatment of cholelithiasis and chiledochlithiasis is safe, effective and results in shorter hospitalization and fewer complications than traditional open cholecystectomy with CBD exploration.     

Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure widely used to diagnose and treat conditions of biliary or pancreatic ductal system. The post-ERCP severe acute pancreatitis (SAP) accompanied with duodenum perforation is rare but serious, remaining a challenge in clinic. In this study we report two such cases. Two Chinese women were treated for clinical suspicion of bile duct obstruction and underwent ERCP after admission. Both developed duodenum perforation and SAP after ERCP, and were managed in the intensive care unit (ICU) and required an organ-failure support. The surgical intervention of the peri-pancreatic debridement with lumber-abdominal compound incisions and postoperative washing and drainage was performed, and the two patients recovered well. The therapeutic effect of the peri-pancreatic debridement with lumber-abdominal compound incisions combined with postoperative washing and drainage in the patients of severe post-ERCP-pancreatitis (PEP) and duodenum perforation is satisfactory.     

胆道手术后胆漏32例诊治分析

为探讨胆道手术后发生胆漏的原因、处理方法及预防措施。对1989年6月至2000年6月间2367例胆道术后发生胆漏的32例临床资料作回顾性分析。保守治疗24例，再手术治疗8例。除3例因胆系肿瘤晚期出现恶液质放弃治疗主动出院外，余均痊愈出院。提示胆漏多发生于胆囊切除术及拔T管后，主要原因系肝床毛细胆管或细小副肝管损伤、局部炎症、胆道梗阻、操作失误等。胆漏发生后应根据腹膜炎轻重、胆道有无梗阻以及腹腔引流是否通畅等选择保守治疗或再手术治疗．     

腹腔镜术中胆道造影的应用价值(附78例)

目的研究胆道造影在腹腔镜手术中的应用价值。方法回顾分析近六年间78例腹腔镜术中胆道造影者的临床资料。结果发现胆总管结石18例，胆管变异11例，相应处理．无死亡病例。结论充分意识到胆道造影在腹腔镜手术中的价值，掌握LIOC（laparoscopic intraoperative cholangiography腹腔镜术中胆道造影）的指征能显著降低胆道残留结石率、胆道损伤率和二次手术机会，可以为胆道疾病病因研究提供解剖依据。     

肝内胆管结石术后病人的观察及护理

目的总结肝内胆管结石围手术期的护理要点、总结护理经验。方法回顾性分析我院自2005年1月-2010年12月手术治疗肝内外胆管结石150例的临床、护理资料,对其术前全身及营养情况做详细评估,术后密切观察生命体征及病情变化,保证有效循环血量,防治低血压;保持各引流管通畅,加强基础护理及术后并发症的观察及护理。结果该150例复杂肝内胆管结石患者均做了肝叶切除术,无1例手术死亡,其中,伤口感染20例,膈下感染10例,胆漏55例,肺部感染15例,均经非手术治愈。150例共81例获得随访,随访率53.0%,疗效优良率为77.8%,残石率为21.0%,结石复发率为8.7%。结论做好围手术期的护理,尤其是增强术后的护理观察,提高术后护理质量,巩固手术疗效和促进病人康复至关重要。     

腹腔镜胆总管探查术的临床应用（附47例报告）

目的探讨腹腔镜胆总管取石术的优势、手术要点及术后处理。方法分析47例胆囊结石合并胆总管结石患者行腹腔镜胆囊切除＋胆总管切开取石术的手术方法和操作要点。结果47例腹腔镜手术均获成功,无中转开腹,平均手术时间115min,平均术中出血50mL,平均住院8d。结论腹腔镜胆囊切除＋胆总管切开取石术是理想的微创治疗胆囊结石合并胆总管结石的术式。     

Primary duct closure versus T-tube drainage after laparoscopic common bile duct exploration: a meta-analysis

Journal of Zhejiang University-SCIENCE B - Laparoscopic common bile duct exploration (LCBDE) is considered a safe and effective method for the removal of bile duct stones. However, the choice of...     

腹腔镜胆囊切除术胆管损伤的原因及预防

目的:探讨腹腔镜胆囊切除术胆管损伤的原因及预防方法.方法:2002.7～2004.12月间在我院施行腹腔镜胆囊切除术的病人共623例,其中胆管损伤3例,结合临床资料,分析其损伤原因.结果:胆囊切除术胆管损伤的主要原因为术者技术操作原因及胆囊周围局部不良因素.结论:提高术者技术操作水平及正确的操作过程对预防腹腔镜胆囊切除术胆管损伤有重要作用.     

57例显微镜下泪小管断裂吻合手术临床分析

目的：探讨在显微镜下泪小管断裂断端的寻找方法及泪小管断裂吻合联合泪道引流管置管术的疗效,提高泪小管吻合术的成功率。方法：选择2006年1月至2013年5月收治泪小管断裂57例患者,采用在显微镜直视下寻找的方法,找到泪小管鼻侧断端和泪囊侧断端,置入硬膜外管作为泪小管内支撑物,吻合泪小管断端,留置引流管3-6个月,拔管后3-12个月随访观察疗效。结果：治愈53例,拔管后泪道冲洗均通畅,无溢泪现象,4例主观感觉有少许溢泪症状,但冲洗泪道试验通畅,行泪道扩张冲洗2-3次后症状消失,无眼睑内外翻或泪小管撕裂等症状。结论：在显微镜下行泪小管断端吻合术,较容易寻找到泪小管鼻侧断端,手术成功率高,恢复泪道排泪功能效果肯定。     

肝门区胆管癌的多层螺旋CT术前评估价值

目的探讨肝门区胆管癌的多层螺旋CT（multislice spiral CT,MSCT）表现及术前评估价值。方法对31例肝门区胆管癌MSCT平扫及增强表现进行分析研究,术前评估肿瘤手术切除的可能性．并与手术病理对照。结果31例肝门区胆管癌均显示肝内胆管不同程度扩张,胆管狭窄、中断．其中可见肝门区肿块24例。MSCT增强扫描以延迟强化为主。术前可切除性评估与手术病理对照．其差异性无统计学意义（P〉0．05）。结论MSCT平扫结合三期增强对显示肝门区胆管癌的直接和间接征象有较大帮助．大大提高了术前评估的准确性。     

高渗盐水抗休克作用的淋巴机制

本实验采用肠淋巴管引流术,在失血性休克大鼠模型的基础上,观察高渗盐水治疗失血性休克过程中肠淋巴流量及其蛋白含量的变化,旨在探讨高渗盐水对失血性休克大鼠治疗的淋巴机制。结果表明,休克大鼠输入高渗盐水或生理盐水后,两组大鼠的血压、肠淋巴流量及其蛋白输出量均比休克期明显升高,高渗盐水治疗组显著高于生理盐水对照组(P<0.01),而且治疗组大鼠肠淋巴流量及其蛋白输出量远远高于休克前水平(P<0.01)。结果提示,高渗盐水的抗休克机制可能与其恢复休克大鼠的淋巴流量及其蛋白输出量、改善休克时肠淋巴循环障碍有关。     

血清CA-19-9测定对胰腺癌的诊断价值

目的：寻求胰腺癌的诊断方法，方法：用免疫放射分析法（IRMA）检测血清CA－19－9含量，106例血清CA－19－9含量3700u/L，进行追踪随访，结果：106例中，胰腺癌66例，结肠癌15例，胆管癌13例，肺癌9例，结论：检测血清CA－19－9含量，有利于胰腺癌的诊断和与结肠癌，胆管癌，肺癌等恶性肿瘤的鉴别。     

X线造影术在猪器官解剖上的应用

试验选用硫酸钡植物油甘油混悬液作造影剂,对四头幼猪(10.7±0.75公斤)的全身动脉,尿路和四个离体幼猪肝内胆管及门静脉进行了灌注,并透视和拍摄了肾区动脉、头部动脉、肾盂、输尿管、肝内胆管及肝内门静脉分支和行经的X线片。结果证明该造影剂可清晰显示200微米左右的细小管腔。在造影液灌注剂量充足的情况下,固定与否以及固定期长短对管腔显影的清晰度无影响。     

Association of hypomethylation of LINE-1 repetitive element in blood leukocyte DNA with an increased risk of hepatocellular carcinoma

Global DNA hypomethylation has been associated with increased risk for cancers of the colorectum, bladder, breast, head and neck, and testicular germ cells. The aim of this study was to examine whether global hypomethylation in blood leukocyte DNA is associated with the risk of hepatocellular carcinoma (HCC). A total of 315 HCC cases and 356 age-, sex- and HBsAg status-matched controls were included. Global methylation in blood leukocyte DNA was estimated by analyzing long interspersed element-1 (LINE-1) repeats using bisulfite-polymerase chain reaction (PCR) and pyrosequencing. We observed that the median methylation level in HCC cases (percentage of 5-methylcytosine (5mC)=77.7%) was significantly lower than that in controls (79.5% 5mC) (P=0.004, Wilcoxon rank-sum test). The odds ratios (ORs) of HCC for individuals in the third, second, and first (lowest) quartiles of LINE-1 methylation were 1.1 (95% confidence interval (CI) 0.7–1.8), 1.4 (95% CI 0.8–2.2), and 2.6 (95% CI 1.7–4.1) (P for trend <0.001), respectively, compared to individuals in the fourth (highest) quartile. A 1.9-fold (95% CI 1.4–2.6) increased risk of HCC was observed among individuals with LINE-1 methylation below the median compared to individuals with higher (>median) LINE-1 methylation. Our results demonstrate for the first time that individuals with global hypomethylation measured in LINE-1 repeats in blood leukocyte DNA have an increased risk for HCC. Our data provide the evidence that global hypomethylation detected in the easily obtainable DNA source of blood leukocytes may help identify individuals at risk of HCC.     

B型超声诊断胆囊管结石的价值

目的：旨在探讨B型超声检查对胆囊管结石的诊断价值及临床意义。方法：收集本院1995－2001年经手术治疗胆囊管结石病例共89例，分析其中78例术前经超声诊断为胆囊管结石的声像图特征，结果：胆囊管结石具有胆囊结石的声像图特征外，还具有胆囊肿大，胆囊管扩张，超声检查对胆囊管结石具有良好的显示效果，术前超声对胆囊管结石诊断的准确率为87．6％，结论：超声检查对胆囊管结石的诊断具有较高的特异性和敏感性。且具有重要的临床意义。     

EST联合LC治疗胆囊结石合并继发性胆管结石

目的：探讨内镜下0ddi括约肌切开取石术（endoscopic sphincterotomy,EST）联合腹腔镜胆囊切除术（1apanroscopic cholecystectomy,LC）治疗胆囊结石合并继发性胆管结石的疗效。方法：对21例胆囊结石合并继发性胆管结石患者先行EST术,再行LC术。结果：21例均完成EST和LC术,其中1例患者LC术后经胆道造影见胆总管结石残留,再次行EST术。结论：EST联合LC治疗胆囊结石合并继发性胆管结石是一种安全有效的微创治疗模式。     

Inducible nitric oxide synthase expression is related to angiogenesis,bcl-2 and cell proliferation in hepatocellular carcinoma

In this study, we examined the expression of inducible nitric oxide synthase (iNOS) and vascular endothelial growth factor (VEGF) by immunohistochemical staining in 76 tissue sections collected from hepatocellular carcinoma (HCC) patients undergoing hepatectomy. Microvascular density (MVD) was determined by counting endothelial cells immunostained using anti-CD34 antibody. We performed DNA-flow cytometric analyses to elucidate the impact of iNOS and VEGF expression on the cell cycle of HCC. Most of the HCC cells that invaded stroma were markedly immunostained by iNOS antibody. The iNOS stain intensity of the liver tissue close to the tumor edge was stronger than that of HCC tissue, and the strongest was the hepatocytes closer to the tumor tissue. However, iNOS expression in 10 normal hepatic samples was undetectable. VEGF positive expression ratio was 84.8% in iNOS positive expression cases, and the ratio was 35.3% in negative cases. There was significant correlation (P=0.000) between iNOS and VEGF expression. Moreover, iNOS expression was significantly associated with bcl-2 and MVD, but without p53 expression. DNA-flow cytometric analyses showed that combined expression of iNOS and VEGF had significant impact on the cell cycle in HCC. PI (Proliferating Index) and SPF (S-phase fraction) in the combined positive expression of iNOS and VEGF group was significantly higher than that in the combined negative group. The present findings suggested that iNOS expression was significantly associated with angiogenesis, bcl-2 and cell proliferation of HCC. Project supported in part by the National Ninth-Five-Years Project Fund (No. 96909121), China     

Inducible nitric oxide synthase expression is related to angiogenesis, bcl-2 and cell proliferation in hepatocellular carcinoma

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