目的 了解肝部分切除治疗肝内胆管结石的效果。方法回顾性分析1984年3月至1997年8月对95例肝内胆管结石施行肝部分切除，并辅以狭窄胆管切开整形及胆肠吻合等手术的治疗情况。结果 临床疗效优良者达93.7%，术后残留结石10例，残石率为10.5%。结论 肝部分切除治疗肝内胆管结石是目前较理想有效的手术方式。
ObjectiveTo develop and validate a nomogram for predicting the cancer-specific survival in patients with intrahepatic cholangiocarcinoma (ICC) after hepatectomy. MethodsSuitable patient cases were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Nomograms were established based on the independent prognostic factors identified by COX and Lasso regression models. The performance of the nomograms was validated internally and externally by using the concordance index (c-index), calibration plot, and decision curve analysis. ResultsThe multi factor COX regression results showed that: age, gender, T stage, tumor grade, tumour diameter and number of positive lymph nodes were independent prognostic predictors for cancer-specific survival (CSS) in ICC patients. Nomogram predicting CSS had a c-index of 0.66 (95%CI 0.64 to 0.69) in the training cohort and 0.67 (95%CI 0.63 to 0.72) in the internal validation cohort. The 1-, 3- and 5-year areas under the curve (AUC) of nomogram were 0.68, 0.74 and 0.75 in the training cohort respectively. In the validation cohort, the 1-, 3- and 5-year AUC of nomogram were 0.69, 0.68 and 0.71, respectively. ConclusionThe prediction model constructed based on six factors, including age, gender, pathological stage, T-stage, tumour diameter and number of positive lymph nodes, shows good prediction accuracy.
【摘要】目的 探讨纤维胆道镜对肝胆管狭窄的诊治价值。 方法 对45例肝胆管狭窄患者进行纤维胆道镜诊治，总结分析其方法的优越性。根据不同狭窄类型，治疗采取活检钳撕破狭窄膜或镜身扩张法、球囊扩张加支架支撑法。 结果 所有病例均成功治愈，无一例出现明显并发症。 结论 纤维胆道镜治疗胆管狭窄具有微创、安全、有效及方便等优点，是治疗肝胆管狭窄的有效手段。
ObjectiveTo investigate the feasibility and safety of subtotal hepatectomy with preservation of caudate lobe for extensive hepatolithiasis with atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe.MethodThe clinicopathologic data of patient with hepatolithiasis whose left and right hepatic lobe atrophied and caudate lobe obviously hypertrophied admitted to the West China Hospital of Sichuan University in February 2020 were analyzed retrospectively.ResultsThe patient was in good general condition before the operation. The cardiopulmonary and kidney functions were normal. The liver function was Child-Pugh A grade, and the liver reserve function was good. The body surface area of the patient was 1.745 m2 and the standard liver volume was 1 235 mL. The volume of caudate lobe calculated by the 3D reconstruction of CT image was 735 mL, accounted for 59.5% of the standard liver volume. The patient was evaluated to be able to tolerate the operation. The patient successfully experienced the operation of subtotal hepatectomy with caudate lobe preservation. The postoperative liver function recovered well. The gastric tube was removed on the 4th day after the operation. The peritoneal drainage tube was removed on the 5th day after the operation. The patient was discharged on the 6th day after the operation. The postoperative pathological diagnosis: The intrahepatic bile duct was dilated with stones inside. A large number of inflammatory cell infiltrated around the bile duct. The fibrous tissue hyperplasia, small bile duct hyperplasia and inflammatory cell infiltration were observed in the portal area. The pathological changes were consistent with the changes of hepatolithiasis.ConclusionAccording to analysis results of this case, subtotal hepatectomy with preservation of caudate lobe is safe and feasible for hepatolithiasis patient with obvious atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe.
ObjectiveTo detect the expressions of takeda G protein-coupled receptor 5 (TGR5) and mortalin protein 75 in the tissues of patients with intrahepatic cholangiocarcinoma (ICC), and to explore their relationship with prognosis.MethodsA total of 94 ICC patients who were admitted to Anyang District Hospital and received surgical treatment from March 2015 to March 2018 were selected as the research objects. The expressions of TGR5 and mortalin protein 75 in ICC cancer tissues and adjacent tissues were detected by immunohistochemistry and Western blot (WB). The relationship between the expressions of TGR5 and mortalin protein 75 in ICC cancer tissues and clinicopathological parameters and prognosis was analyzed. Multivariate Cox proportional hazards regression was used to analyze the risk factors of poor prognosis in patients with ICC. ROC curve was used to analyze the diagnostic value of TGR5 and mortalin protein 75 for poor prognosis in patients with ICC.ResultsImmunohistochemical results showed that the positive expression rates of TGR5 and mortalin protein 75 in cancer tissues were significantly higher than those in adjacenttissues (P<0.05). WB results showed that the protein expression levels of TGR5 and mortalin protein 75 in cancer tissues were significantly higher than those in adjacent tissues (P<0.05). The expression of TGR5 protein in cancer tissues of ICC patients was correlated with gender, tumor diameter, degree of differentiation, TNM staging, satellite focus, and liver cirrhosis (P<0.05). The expression of mortalin protein 75 was correlated with tumor diameter, TNM staging, nerve involvement, satellite focus, and liver cirrhosis (P<0.05). There were significant differences in gender, tumor diameter, TNM staging, microvascular invasion, satellite focus, liver cirrhosis, and the expressions of TGR5 and mortalin protein 75 between the poor prognosis group and the good prognosis group (P<0.05). The cumulative 3-year overall survival rate of TGR5 positive patients (32.00%) was significantly lower than that of TGR5 negative patients (63.16%), χ2=6.228, P=0.013; the cumulative 3-year overall survival rate of mortalin protein 75 positive patients (32.91%) was significantly lower than that of mortalin protein 75 negative patients (66.67%), χ2=6.079, P=0.014. Multivariate Cox proportional hazards regression analysis showed that the positive expression of TGR5 and mortalin protein 75, TNM Ⅲ+Ⅳphase, satellite focus, and cirrhosis were risk factors for poor prognosis in ICC patients (P<0.05). ROC results showed that when the expression level of TGR5 was 0.932 as the cut-off value, its AUC in the diagnosis of poor prognosis of ICC patients was 0.783, the sensitivity was 72.4%, the specificity was 72.2%; when the expression level of mortalin protein 75 was 0.756 as the cut-off value, its AUC in the diagnosis of poor prognosis of ICC patients was 0.805, the sensitivity was 84.4%, the specificity was 63.9%; the AUC of combined diagnosis of TGR5 and mortalin protein 75 was 0.884, the sensitivity was 79.3%, the specificity was 83.3%.ConclusionsThe high expressions of TGR5 and mortalin protein 75 in cancer tissues of ICC patients are associated with poor prognosis, and they are risk factors for poor prognosis. The combined detection of TGR5 and mortalin protein 75 has a certain value in predicting poor prognosis, and can be used as potential biological indicators.
ObjectiveTo summarize experience of multidisciplinary team (MDT) in diagnosis and treatment of rare patient with circumscriptus intrahepatic pneumatosis and explore its clinical differentiation with other common types of intrahepatic pneumatosis.MethodThe clinicopathologic data of rare patient with circumscriptus intrahepatic pneumatosis admitted to the Occupational Disease Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed.ResultsA 60-year old female patient was admitted to this hospital with " abdominal pain and septic shock”. After the MDT discussion and analysis, the treatment regimens were decided as follows: the early anti-shock treatment, corrections of electrolyte disorder and hypoalbuminemia, platelet transfusion, ultrasound guided percutaneous catheter drainage (200 mL gas and 10 mL pus, the pneumonic Klebsiella which proved by the bacterial culture). The drainage tube was removed on postoperative day 6. After 5 d of the anti-inflammatory treatment with imipenem and statin sodium injection, it was downgraded to the cefazoxime (the third-generation cephalosporin) injection, and the anti-inflammatory treatment was continued for 6 d as well as the blood glucose was controlled. On the 7th day after the treatment, the right upper abdomen pain was relieved and without positive sign. The abdominal CT showed the localized pneumoconiosis in the right lobe of the liver was completely absorbed. The result of laboratory examination was basically normal. The patient was discharged on the 12th day after the operation and had no discomfort symptoms on month 1 after the operation. The abdominal CT showed the liver was not abnormal.ConclusionSurgeons should be fully aware of various types of intrahepatic pneumatosis so as to sufficiently investigate pathophysiological clue of disease to improve cure rate and reduce complications.
ObjectiveTo discuss clinical manifestation, laboratory examination, imaging and pathological features of intrahepatic cholangiocellular carcinoma(ICC) patients with fever as initial symptom accompanied with liver area pain, in order to improve the clinicians' acquaintance for ICC under similar circumstances. MethodThe case informations including medical history, clinical manifestation, laboratory examination, imaging finding, pathological examination, and treatment of 4 patients diagnosed with ICC by pathological biopsy from july 2013 to October 2014 in the First hospital of Lanzhou University were analyzed retrospectively. ResultsAll of four cases showed the fever as the initial symptom accompanied with the liver area pain. All of them had got chronic HBV infection. The WBC, neutrophil percentage, and procalcitonin were increased on admission in 3 cases. the levels of serum ALP and GGT were elevated in 3 patients. The AFP was obviously increased in 1 patient. The serum CA19-9 had moderately elevated in 2 patients. the ferroprotein was obviously increased in 2 patients. All the patients were confirmed under the abdominal CT scans and the liver pathological biopsy. ConclusionPatients with fever and liver area pain as intial symptoms, and with chronic hepatitis B and space-occupying lesions, who should be alert for ICC.
【Abstract】ObjectiveTo investigate the anatomic feature and special clinical manifestations of variant right intrahepatic bile duct draining into left hepatic bile duct near the umbilical portion. MethodsVariant right intrahepatic bile ducts joining into left hepatic bile ducts near the umbilical portions were identified through cholangiograms in 52 patients, who were included in this study. Their history, clinical process and operations were reviewed. ResultsThere were total 38 cases of intrahepatic gallstone in this group. High incidence of intrahepatic calculi was found in variant right intrahepatic bile ducts （23/38 cases, 60.52%） and left hepatic ducts （33/38 cases, 86.84%）. Most of these cases were accompanied with dilatation and stricture of bile ducts in these area. The gallstones in the variant right intrahepatic bile ducts were not detected in 8 cases (8/23) and the rate of residual gallstone was as high as 86.95%(20/23). Injury of variant right intrahepatic bile duct took place when left hepatectomy was performed in one case. ConclusionGallstone is very likely to be formed in the variant right intrahepatic bile duct due to derangement of bile hydrokinetics and compression of blood vessel. Special attention should be paid to the diagnosis and operation of this abnormity.
Objective To discuss the therapeutic effectiveness of surgical approach to complex intrahepatolithiasis with biliary liver cirrhosis.Methods A case of complex intrahepatolithiasis with biliary liver cirrohosis, portal hypertension was treated with splenectomy and pericardial devascularization plus left hepatectomy and portal cholangio plasty with T tube drainage. Results Follow up one year and a half after operation, no symptom of cholangitis was found, and there is no relapse up to date. Conclusion Combined operation of hepatectomy with splenectomy is an ideal and effective treatment for complex intrahepatolithiasis with biliary liver cirrhosis.