Objective To study the etiology of primary intrahepatic stones. MethodsThe literatures in the recent years on the etiology of intrahepatic stone were revieved. Results The formation of intrahepatic stone mainly caused by bacteria infection, parasitic infestation, bile stasis, congenital anatomic abnormalities and immunoreaction of bile tract. Further investigation found that metabolic, low protein diet, environment and ethnic factors and gene mutation were considered to play important roles in the formation of the intrahepatic stone. Conclusion The formation of intrahepatic stone is complex and are result of multiple factors. It closely related to the infection and stasis of the bile duct.
【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 investigate the recurrence of intrahepatic bile duct stones and study the relations to the primary intrahepatic stones.Methods One hundred and twenty nine patients who experienced complete lithotomy were followed up for 2-10 years. Results Thirty five cases had the recurrence of intrahepatic stones at 49 sites (27.13%). The recurrent stones were found at following sites: 13 at left duct, 12 right duct , 8 left medial segment, 6 right anterior segment, 4 right posterior segment, 3 left lateral segment, 3 caudate. Nine cases were asymptomic, 16 cases had slight symptoms and 10 cases suffered from the serious attacks of stones. The time of recurrence was from 2 to 9 years (5.49±2.25 years) after surgery. The recurrent rate was 27.13% in our group. Conclusion The recurrence of intrahepatic stones also developed at several sites in the liver. The recurrence of intrahepatic stones had a tendency to develop at the primary sites. The recurrence of intrahepatic stones may be asymptomic and most patients suffered from slight attack. Liver resection is the best way to prevent the recurrence from intrahepatic stones.
Objective To discuss the differentiation between transient intrahepatic cholestasis (TIHC) and acute rejection (AR) after liver transplantation． Methods Characteristics and the changes (before and within 21 d after transplantation) of alanine aminotransferase (ALT) and direct bilirubin (DBIL) in 30 patients undergone liver transplantation were observed. These patients were divided into TIHC group and AR group following the diagnosis criteria, and the serum levels of ALT and DBIL were compared respectively on day 1 before liver transplantation, day 3, 7 and 21 after liver transplantation． Results Compared with day 3 after transplantation in the TIHC group， DBIL significantly ascended while ALT was changeless on day 7 after transplantation. But in the AR group， DBIL ascended significantly and ALT showed an increasing tendency on day 7 after transplantation． After appropriate therapy, DBIL and ALT of two groups both descended significantly on day 21 after transplantation． Conclusion The changes of DBIL and ALT are available for the differentiation between TIHC and AR after transplantation.
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.
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 research base and current understanding of the mechanism of ischemia-reperfusion injury (IR) to intrahepatic cholangiocytes after l iver transplantation, so as to identify the key points of the mechanism and provide references for cl inical practice. Methods We searched PubMed (1970 to 2007) and CBM(1979 to 2007). Qual ity assessment and data collection were performed by two reviewers independently. Since the baseline supplied and the measure were very different, we decided to provide a descriptive summary only. Results The earliest study on liver IR was publ ished in 1970. A total of 65 papers were included. There were 13 on cl inical studies, 35 on basic research studies; and 17 review articles. Most basic studies focus on injury mechanism: ① The physiology of bile ducts and Intrahepatic Bil iary Duct Cells(IBDC); ②the IR caused injury mechanism of IBDC during or after liver transplantation; ③ the basic injury mechanisms include: cold ischemia, warm ischemia, reperfusion, injury of bile and bile salts. Most clinical studies focused on preventive measures, including surgical and non-surgical approaches. Based on the evidence from basic research, changing the composition and perfusion methods of perfusate and protecting the specific blood supply to biliary ducts and cholangiocytes during the operation were important in preventing or reducing such an injury. Conclusion ① The heterogeneity of morphology, function, status and the special blood supply in large and small IBDC are important material base. ② Our own study indicated that simple IR or H/R was able to change the expression of MHC, MIC, DR4, DR5 and other adhesion molecules. ③ Compared to hepatic cells, hIBDC can’ t resist cold ischemia and even worse in tolerating reperfusion injury. ④ Hydrophobic bile salts will could increase the harm to bile ducts during organ preservation. ⑤ Due to the low quantity and limited quantities of clinical researches, the power of evidence was low. The evaluation indexes and baseline conditions are not unified. So the conclusions are for reference only.
Objective To assess the efficacy and safety of S-adenosyl-l-methionine (SAMe) for outcome improvement of intrahepatic cholestasis of pregnancy. Methods Randomized controlled trials (RCT) and quasi-randomized controlled trials were identified from MEDLINE (1983 to 2003), The Cochrane Library (Issue 4,2003), EMBASE (1980 to 2003), China Hospital Digital Library (CHDL) and Wanfang data (1994 to 2003). We also handsearched the relative references. Two researchers evaluated the quality of the trials and extracted the data independently. RevMan software 4.2 was used for meta-analysis. Results Eight studies involving 424 pregnant women were included. The following data were the results of meta-analysis of SAMe for improvements: ① Reducing cesarean-section ratio: no significant difference was seen between SAMe and placebo groups with OR 1.00, 95%CI 0.23 to 4.33 and P= 1.00; significant differences were seen SAMe versus dexamethasone and SAMe versus Dianglining with OR 0.44, 95%CI 0.23 to 0.85 and P=0.01; OR 0.28 95%CI 0.10 to 0.75 and P=0.01 respectively。② Prolonging the period of pregnancy: SAMe had no significant difference compared with placebo groups with WMD=0.70, 95%CI －0.69 to 2.10, P=0.32. SAMe was more effective than dexamethasone, Ganyinling and Qianglining on prolonging the period of pregnancy with WMD=1.10，95%CI 0.46 to 1.74, P=0.000 07; WMD=2.50，95%CI 1.86 to 3.14, P≤0.000 01; WMD=2.20，95%CI 1.61 to 2.79, P≤0.000 01 respectively；③ Increasing the weight of the newborn: meta-analysis showed that SAMe group had not significant difference compared with placebo group on increasing the weight of the newborn with WMD=-26.27，95%CI -338.35 to 285.82, P=0.87. Significant differences were seen between SAMe and dexamethasone, SAMe and Ganyiling, SAMe and Qiangling with WMD=386.86，95%CI 134.41 to 603.31, P=0.002; WMD=410.00,95%CI 321.10 to 498.90, P≤0.000 01 respectively. ④ Fetal distress: There was no significant difference compared with dexamethasone and Kuhuang groups on decreasing the fetal distress with OR=0.47, 95%CI 0.14 to 1.16, P=0.23; OR=0.44, 95%CI 0.10 to 1.97, P=0.29 respectively; ⑤ Decreasing pollution of amniotic fluid: no significant differences were seen in SAMe versus dexamethasone, SAMe versus ursoddeoxycholic and SAMe versus Kuhuang with OR=0.46, 95%CI 0.21 to 1.02, P=0.06; OR=0.68, 95%CI 0.20 to 2.31, P=0.53; OR=0.82 95%CI 0.24 to 2.81,P=0.75 recpectively. ⑥ Newborn stifile: SAMe group had no significant difference compared with dexamethasone and Kuhuang groups on decreasing the Newborn stifile with OR=0.19, 95%CI 0.01 to 4.06, P=0.29; OR=0.31, 95%CI 0.08 to 1.13, P=0.08 respectively. Compared with Qianglining group, SAMe group had better effect on reducing ratio of newborn stifile with OR=0.09, 95%CI 0.02 to 0.42, P=0.002. ⑦ Improving Apgar scores: no significant differences were seen between SAMe and placebo, dexamethasone and ursoddeoxycholic with OR=0.25, 95%CI 0.02 to 3.04, P=0.28; OR=2.09, 95%CI 0.70 to 6.27, P=0.19; OR=1.22, 95%CI 0.35 to 4.19, P=0.75 respectively. Six RCTs mentioned the side effects of S-adenosy-l-methionine, only one RCT reported mild gastrointestinal irritation. Conclusions SAMe is partly effective on improving the pregnancy outcomes of intrahepatic choletasis of pregnancy, such as reducting cesarean-section ratio, prolonging the period of pregnancy and increasing the weight of the newborn. The specified efficacy and safety of SAMe require rigorously designed, randomized, double-blind and placebo-controlled trials to offer evidence.
ObjectiveTo investigate the expression of forkhead box A2 (FXOA2) in intrahepatic cholangiocarcinoma (ICC), and to analyze the relationship between expression of FOXA2 and patient's prognosis after liver resection.
MethodsData of 85 patients with ICC who underwent liver resection between 2009 and 2013 in our hospital were collected retrospectively. The expression of FOXA2 was examined by immunohistochemical method, and then the relationship between expression of FOXA2 and patient's prognosis/clinical characteristics was expplored.
ResultsAmong the 85 patients, low expression of FOXA2 was detected in 50 patients, whereas high expression was observed in 35 patients. More advanced tumor (Ⅲ+Ⅳ staging) was found in patients with low expression of FOXA2 than patients with high expression of FOXA2 (P < 0.050). The median follow-up time was 15-month (3-73 months). During the follow-up period, 65 patients suffered from recurrence, whereas 64 patients died. The multivariate analysis suggested that, postoperative recurrence was associated with low expression of FOXA2, evaluated preoperative CA19-9, and presence of satellite nodes (P < 0.050). Low expression of FOXA2, evaluated preoperative CA19-9, nerves invasion, and presence of satellite nodes were predictive factors for postoperative prognosis (P < 0.050).
ConclusionLow expression of FOXA2 was associated with poor prognosis for patients with ICC after liver resection, and FOXA2 may be a prognostic factor for ICC.
ObjectiveTo investigate the expression of proapoptosis gene bad in intrahepatic cholangiocarcinoma (ICC) and its relationship to differentiation of the tumor.MethodsThe immunohistochemistry technique by Dako Envision system and rabbit antihuman bad polyclonal antibodies were adopted. The expression of bad was detected in 48 cases of ICC and 25 cases of control tissues.ResultsBad immunoreactivity in 48 cases of ICC was higher than that of bile duct epithelium in 25 cases of control tissues. And contrasted with 21 cases of well differentiated ICC, bad immunoreactivity was higher in 27 cases of middle and poor differentiated ICC.ConclusionThe expression of bad gene may be related to the differentiation of ICC.
