Objective To improve the curative resection rate of hilar cholangiocarcinoma (H-CC).Methods Lileratures about surgical treatment of H-CC were collected and reviewed. Results The crucial points are as follow: ①Early diagnosis; ②Recognition of the invasion to liver; ③Rational resection of the tumor with associated vessels; ④Reduction of postoperative complications. Conclusion Improved longterm resection effects on H-CC is possible.
３０ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｐｒｉｍａｒｙ ｃａｒｃｉｎｏｍａ ｏｆ ｇａｌｌｂｌａｄｄｅｒ ｗｅｒｅ ｔｒｅａｔｅｄ ｓｕｒｇｉｃａｌｌｙ ｆｒｏｍ １９８７ ｔｏ １９９４． Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈｅ ｍｉｓｄｉａｇｎｏｓｉｓ ｒａｔｅｓ ｏｆ ｇａｌｌｂｌａｄｄｅｒ ｃａｎｃｅｒ ａｎｄ ｏｆ ｃａｎｃｅｒ ｗｉｔｈ ｇａｌｌｂｌａｄｄｅｒ ｓｔｏｎｅｓ ｗｅｒｅ ｈｉｇｈ． Ｍｏｓｔ ｏｆ ｐｒｉｍａｒｙ ｃａｒｃｉｎｏｍａ ｉｎ ｔｈｉｓ ｓｅｒｒｉｅｓ ｗｅｒｅ ａｄｅｎｏｃａｒｃｉｎｏｍａｓ． Ａｌｓｏ ｐｒｉｍａｒｙ ｇａｌｌｂｌａｄｄｅｒ ｃａｒｃｉｎｏｍａ ｃｌｏｓｅｌｙ ｒｅｌａｔｅｄ ｗｉｔｈ ｇａｌｌｂｌａｄｄｅｒ ｓｔｏｎｅｓ．
Objective To investigate the regulatory effect of somatostatin analogue (SMS201995,SMS) on proliferation and apoptosis in human cholangiocarcinoma cell line in vitro. MethodsProliferation curve, flow cytometry, agarose gel electrophoresis, Annexin VFITC and flow cytometric immunofluorescent technique were performed to identify the inhibitory effect on cell proliferation and the induction of apoptosis of human cholangiocarcinoma cells (SKChA1). ResultsSMS significantly reduced the SKChA1 cell growth by serum in long experiments and transiently accumulated it in G0/G1 phase. Dotplot analysis of cells duallabeled with Annexin VFITC and PI confirmed the induction of apoptosis by SMS in SKChA1 cells.AnnexinVFITC labeling was markedly enhanced following treatment with SMS for 24 h. DNA of treated SKChA1 cells appeared a ladder pattern characteristic of apoptosis. Besides, timedependent increase in bax and decrease in bcl2 occured during SMS treatment. Conclusion SMS could inhibit the proliferation activity and induce apoptosis of cholangiocarcinoma cell line SKChA1. The mechanisms of apoptosis might be correlated with the expression of apoptosisregulatory gene bax and bcl2.
Twenty-one patients(male 18 cases,femal 3 cases)died of primary liver cancer after operation are reviewed.The liver tumors were located in the right lobe(13 cases),left lobe(3 cases),middle position of liver(4 cases)and hepatic hilum(1 cases).The average diameter of the tumors were 9.0cm.All the patients had suffered from liver cirrhosis and were operated on (most of them partial hepatectomy).The times of death were about 7 days,7-14 days later after operation.The data suggest that causes of death were different from the different stage after operation.The relations between partial hepatectomy and hepatic failure,and the liver cirrhosis and liver regeneration are discussed.
ObjectiveTo investigate the change of renal endothelin (ET) excretion and its relation to renal dysfunctions in obstructive jaundice.MethodsSixty male Wistar rats were randomized into two groups, the common bile ducts were ligated to establish the model of obstructive jaundice in experimental group, and only sham operation was done in control group. Ten rats were taken from each group at 5, 10 and 15 days respectively after operation, renal functions were evaluated by paminohippuric acid clearance (CPAH), inulin clearance (CIN) and fractional sodium excretion (FENa+); furthermore, plasma endotoxin (EX) level was determined, and ET1 contents in renal arterial plasma, renal venous plasma and renal tissue were detected. ResultsOnly FENa+ was significantly increased at the 5th day in experimental group; since the 10th day, all the three renal functional parameters gradually decreased, and FENa+ was significantly lower than that in control group at 15th day (P＜0.01 vs control). ②The plasma EX sustained at significantly higher levels after operation in experimental group (P＜0.01 vs control). ③The renal arterial plasma ET1 was significantly decreased, while the contents in renal venous plasma and renal tissue were significantly increased after operation in experimental group (P＜0.01 vs control). ④There were positive correlation between plasma EX and renal ET1 content, negative correlation between renal ET1 content and CPAH/CIN, and positive correlation between renal ET1 content and FENa+ (P＜0.01).ConclusionThe increased excretion of renal ET stimulated by endotoxemia may play an important role in the renal dysfunctions in obstructive jaundice.
Objective To provide experimental evidence for the clinical application of ischemia therapy to treating pancreatic cancer. Methods After the model of pancreatic transplanted cancer was established in nude mice with orthotransplantation of human pancreatic cancer cell line into the pancreas, the ischemia of the right lobe of the pancreas was induced with ligation of the gastroduodenal, inferior pancreaticoduodenal and dorsal pancreatic arteries. Effects of regional ischemia on the growth of transplanted cancer and the pathomorphology of the transplanted cancer and pericancerous tissue were investigated. Results The transplanted cancer grew slower and its doubling time was longer in the ischemic group than in the control. On the 3rd, 7th and 14th day after operation, the size of transplanted cancer, the proliferative index and protein content of the cancer cells were significantly lower in the ischemic group than in the control (Ｐ＜0.01). Optical microscopy revealed large areas of coagulation necrosis, necrobiotic cells and the infiltration of inflammatory cells. The atrophy of acini, fibrosis and the infiltration of lymphocyte cells were found in pericancerous tissue. Conclusion Regional ischemia can destroy and inhibit the pancreatic transplanted cancer in nude mice effectively. The ischemia changes of pericancerous tissue may be unfavourable for the growth of the pancreatic transplanted cancer.
Four hundred and eighty two paients suffering from intrahepatic bile duct stone undergoing lobectomy and segmental resection (from 1975 to 1994,9) has reported. 63% of the patient in this group underwent 1-5 operations, including different types of biliary-intestinal anastomosis (21.6%). 482 cases underwent different types of hepatectomy, including left lateral-lobetomy 321 cases (66.6%),left hemihepatectomy 80 cases(16.6%), right hemihepatectomy 19 cases (3.9%), and multiple segmental resections 39 cases (8.1%, including Ⅴ+Ⅷ 11 cases, Ⅵ+Ⅶ 28 cases). Other type hepatectomy combined with guadrate lobectomy 20 cases (4.1%). Postoperative complication rate was 10.2%, including diliary fistula. hemobilia and subdiaphragmatic and resectional surface infectioin, 85% of the patients were followed up with an excellent result of 88%. The authors emphsize that hepatic lobectomy nad segmental resection is the core of treatment and selection of operative methods depends on clinical-patholigic types of the disease.
目的 探討胰十二指腸切除術后嚴重并發癥的防治方法。方法 分析2002～2005年7例胰十二指腸切除術后嚴重并發癥的資料。結果 手術嚴重并發癥發生率為25.9%（7/27），經積極治療后無一例死亡。結論 術中仔細操作和操作技術改進是降低胰十二指腸切除術并發癥發生率的關鍵，并發癥經積極治療后有望痊愈。
目的探討肝內膽管結石合并肝膽管癌的臨床診斷和治療經驗。 方法回顧性分析我院手術治療28例肝內膽管結石合并肝膽管癌的病例資料。結果本組28例占同期肝內膽管結石病例的6.7%。術前各類影像學檢查發現癌灶17例，5例獲細胞學檢查確診。術中7例經快速組織活檢證實。另4例系術后確診。腫瘤多為腺癌，位于肝門膽管18例，肝內膽管9例，肝內、肝門部廣泛浸潤1例。根治性腫瘤切除8例，獲隨訪6例，平均生存23個月； 姑息性腫瘤切除8例，獲隨訪6例，平均生存11個月； 僅行外引流者7例，其中3例于術后2周內死亡，3例術后9個月內死亡，1例生存4個月后失訪。結論長期肝內膽管結石刺激及繼發感染是肝膽管癌發生的重要因素。聯合應用影像學檢查結合病理活檢獲得早期診斷和選擇合理的根治性肝切除術是提高療效的有效措施。