Objective To explore application value of photodynamic therapy (PDT) in treatment of unresectable hilar cholangiocarcinoma. Method The literatures about PDT in the treatment of the unresectable hilar cholangiocarcinoma in the PubMed, MedLine, Embase, CNKI, and Wanfang databases were reviewed. Results The PDT combined with stent or chemotherapy was the main method in the treatment of the unresectable hilar cholangiocarcinoma, which could make the tumor down-staging, obviously reduce the jaundice, improve the quality of life, improve the survival rate, prolong the stent patency and be treated repeatedly. Especially, it was suitable for the patients with elderly, poor health, intolerance of surgery, could partly replace the R1 or R2 operation of hilar cholangiocarcinoma and avoid the risk of surgery and postoperative complications. The therapeutic effective of the PDT was related to the early therapy and times of therapy. However, the shortcomes of the PDT were that the depth of killing tumor was not enough and there was a certain incidence of adverse reaction. Conclusions Therapeutic effect of PDT combine with stent or chemotherapy for unresectable hilar cholangiocarcinoma is better than that of single therapy. It is expected to be a first-line scheme of palliative treatment for unresectable hilar cholangiocarcinoma.
ObjectiveTo analyze factors affecting post-hepatectomy liver failure (PHLF) of patients with hepatocellular carcinoma (HCC) and explore value of combining albumin-bilirubin (ALBI) score with standardized future liver remnant (sFLR) in prediction of PHLF.MethodsThe clinical data of patients with HCC underwent curative hepatectomy in the Second and the Fifth Departments of General Surgery of the First Hospital of Lanzhou University from January 2016 to June 2018 were retrospectively reviewed. The risk factors of PHLF were identified through the logistic regression, the area under the receiver operating characteristic curve (AUC) was used to analyze the predictive value of the ALBI score, sFLR, or ALBI score×sFLR.ResultsA total of 72 patients with HCC were enrolled, all of them were the Child-Pugh A grade. The incidence of PHLF was 27.78% (20/72) in these 72 patients with HCC, which was 12.96% (7/54) and 72.22% (13/18) in the 54 patients with ALBI- Ⅰ grade and 18 patients with ALBI- Ⅱ grade respectively, the difference was statistically significant (P<0.001). The results of multivariable analysis of PHLF showed that the PLT (OR=0.030, P=0.018), ALBI grade (OR=11.758, P=0.020), and sFLR (OR=0.835, P=0.003) were identified as the independent predictors of PHLF. The AUC for the ALBI score×sFLR in predicting the PHLF was 0.892, it was greater than that of the ALBI score (AUC=0.799) or the sFLR (AUC=0.773).ConclusionCompared with Child-pugh grade, ALBI grade is more accurate in predicting PHLF of HCC patients, and combining ALBI score with sFLR is better than sFLR or ALBI score alone in predicting PHLF of patients with HCC.
Objective To evaluate safety and long-term efficacy of fully covered self-expandable mental stent (FCSEMS) in treatment of biliary stricture after liver transplantation (LT). Methods From January 2010 to June 2018, the data of patients with the biliary stricture after the LT underwent the endoscopic retrograde cholangiagraphy (ERCP) at the First Hospital of Lanzhou University were collected retrospectively. The therapeutic effect of the FCSEMS was evaluated. Results A total of 21 patients with the biliary stricture after the LT were treated. The success rate of the stent placement was 100%. The FCSEMSs were used in 7 cases and the only multiple plastic stents (MPSs) were used in 14 cases. There were no significant differences in the gender, age, time of biliary stricture, frequency of ERCP, recurrence time of biliary stricture, cure time of biliary stricture, curative effect, recurrence of biliary stricture, and incidence of complications between the patients treated with the FCSEMS and the MPS (P>0.050), but the number of plastic stents in the patients treated with the FCSEMS was significantly less than that in the patients treated only with the plastic stents (P<0.050), while the duration of stent retention was longer than that in the patients treated only with the plastic stents (P<0.050). Six patients were cured, 1 was remitted, and 2 were relapsed by the FCSEMS. Eight were cured, 3 were remitted, 3 were ineffective, and 5 were relapsed by the MPS alone. Conclusions FCSEMS might be an safe effective alternative to plastic stent in treatment of biliary stricture after LT, resulting in a longer duration placement, less number of plastic stent use. It is necessary to further accumulate cases to validate cure rate and recurrence rate of biliary stricture.
ObjectiveTo review the role of intestinal flora on the tumor microenvironment and the effect of both on the development of hepatocellular carcinoma (HCC), with a view to providing new ideas on the causes of HCC development and progression. MethodRelevant articles in the direction of intestinal flora and tumor microenvironment and HCC as well as the relationship between intestinal flora and tumor microenvironment in recent years were searched and summarized. ResultsThe tumor microenvironment played an important role in the occurrence, development and postoperative recurrence of HCC. The intestinal flora, as one of the important regulators of tumor microenvironment, could induce HCC by affecting the tumor microenvironment in addition to interacting with the liver through the gut-liver axis. ConclusionIntestinal flora can influence to HCC by regulating the tumor microenvironment, and its specific mechanism of action still needs to be further investigated, which can be a new direction for HCC research.
【Abstract】Objective To study the expression of cyclooxygenase-2 (COX-2) in hepatic inflammatory reaction of rats with sepsis, and to explore a new way of protecting hepatic cell. Methods Fifty-four Wistar rats were randomly divided into 3 groups: sham operation group, sepsis group and NS398 group. All rats were subjected to cecal ligation and puncture (CLP) or sham operation. RT-PCR was used to determine COX-2 mRNA expression, serum IL-6, TNF-α and IL-10 were determined by ELISA; and ALT and AST and liver pathological changes were determined in 3 groups and at different times (3, 6, 12 and 24 h) respectively. Results ①The expression of COX-2 mRNA of hepatic tissue was low in sham operation group. It obviously enhanced after CLP at 3 h and peaked at 6 h. High expressions were showed at 12 and 24 h. In NS398 group, it was lower than that of sepsis group at the same time, but higher than that of sham operation group. ②Serum ALT, AST and IL-6, TNF-α were increased in sepsis group than those of sham operation and NS398 group (P＜0.05)； Serum IL-10 was higher in NS398 group than that of sham operation and sepsis group (P＜0.05). ③Hepatic pathological injury extenuate after injected with NS398. Conclusion COX-2 may play an important role in hepatic injury with sepsis.
目的 探讨胰腺恶性纤维组织细胞瘤的诊断及治疗。方法 对兰州大学第一医院收治的1例胰腺恶性纤维组织细胞瘤患者，结合国、内外文献对其临床特点，影像学、病理学及免疫组化特征、治疗和预后进行分析。结果 行胰腺肿瘤切除，术后医用直线加速器采取三维适形精确放疗，随访9个月，未见肿瘤复发。结论 胰腺恶性纤维组织细胞瘤恶性度高，易复发、转移，生存率低，诊断主要依靠病理和免疫组化检查。外科手术联合放射治疗可延长生存时间和延缓肿瘤的复发。
【Abstract】Objective To investigate the detection and significance of micrometastasis in lymph nodes of periampullary carcinoma. MethodsThe immunoreactivity of CK19, CK7 and CK18 in 220 lymph nodes from 60 patients who had been carried out radical resection of periampullary carcinoma were revealed by immunohistochemical method. Combining with clinical data and the followup result discussion and analysis were made. All the lymph nodes collected from January 1997 to August 2004 in this hospital were examined to be nonlymphonodus metastasis by histological HE stain. The criterion of positive CK was established and micrometastasis will be diagnosed if CKs revealed to be positive combining with the morphological changes of lymph node tissue through the observation of microscope. ResultsFortythree of 220 lymph nodes of periampullary carcinoma had been micro metastasized. The detection rates of micrometastasis were 19.55%（43/220）， 14.55%（32/220）and 11.36%（25/220） with CK19，CK7 and CK18 antibody, respectively, which meant that CK19 were better than CK18 for detection of micrometastasis. Detection rates of CK7， CK19 were higher in Ⅲ， Ⅳ stage than inⅠ， Ⅱ（P＜0.05）, whereas it had no relationship with gender, age and tumor differentiation degree. The oneyear survival rate for micrometastasis patients was lower than nonmicrometastasis patients’ (P＜0.05). Conclusion Micrometastasis of periampullary carcinoma may be the early stage of tumor metastasia. The CK antibodies are significant levels to detect micrometastasis of periampullary carcinoma and to guide the clinical treatment and prognostic judgment.