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.
ObjectiveTo investigate the clinical application effect of descending hilar plate technology in laparoscopic heminephrectomy for intrahepatic bile duct calculus.MethodsThe clinical data of 40 patients with intrahepatic bile duct calculus who underwent laparoscopic heminephrectomy in our hospital from January 2015 to December 2019 were retrospectively analyzed. The patients were grouped according to different surgical procedures, 21 patients with Pringle method of total hepatic vascular exclusion were classified in the control group, and 19 patients with descending hilar plate technology of blood occlusion technology were classified in the observation group. The operation time, intraoperative bleeding volume, postoperative hospital stays, liver function recovery, and postoperative complications were compared between the two groups.ResultsThere was no statistically significant difference between the two groups in the intraoperative bleeding volume and operation time (P>0.05), but the postoperative hospital stays in the observation group shortened (P=0.025). The changes on the ALT, TB, and AST in the observation group was obvious than those of the control group (P<0.05). There was no statistically significant incidence between the two groups in the total incidence of complications (P=0.128).ConclusionsCompared with Pringle method of total hepatic vascular exclusion, descending hilar plate technology in laparoscopic heminephrectomy can fully expose the Glisson pedicles of the left and right livers, and it is convenient to implement hemihepatic blood flow occlusion. It has less damage to healthy side of the liver and quicker liver function recovery, and it can reduce postoperative complications and shorten postoperative hospital stay.
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。
Objective To observe the effect of gefitinib on expression of epidermal growth factor receptor (EGFR) in bile duct epithelial cells, and the feasibility of inhibiting hyperplasia of bile duct epithelial cells with gefitinib. Methods Sixty-one patients with hepatolithiasis having to be in hospital for surgery from the First People’s Hospital of Shuangliu county were selected, with 25-65 years old, average 46.92 years. The patients were randomly divided into therapy group and control group. There were 30 cases in therapy group, in which fine duct was placed on lesion bile duct during operation, and through whom gefitinib solution was perfused after operation. There were 31 cases in control group with only T tube drainage after operation. The bile duct sample was obtained respectively during the operation and 6 weeks and 12 weeks after operation. The histology and expression change of EGFR were observed by HE staining, immunohistochemistry and RT-PCR method respectively. Results There were no significant differences in pathohistology changes of bile duct and the EGFR protein and mRNA expression between therapy group and control group during operation. The hyperplasia of epithelium mucosae and submucosal gland in the therapy group were obviously decreased as compared with those in control group, the EGFR mRNA and protein expression in therapy group were weaker than those of control group （Plt;0.05） 6 weeks and 12 weeks after gefitinib treatment. Conclusion EGFR is overexpressed in the chronic proliferative cholangitis, and continuously local application of gefitinib after operation can specifically interrupt the activation and expression of EFGR and then effectively inhibit the hyperplasia of bile duct epithelial cells.
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.
ObjectiveTo investigate the option of biliary drainage for surgical management of hepatolithias. MethodsThe clinical data of 146 patients with hepatolithiasis, who were admitted to the First Affiliated Hospital of Anhui Medical University from March 2006 to June 2014, was analyzed retrospectively.These patients were divided into biliary enteric drainage group and T tube drainage group according to the function of sphincter of Oddis.The intra-operative related data, postoperative complications, and long-term efficacy were compared between two groups. Results①The two groups were comparable in terms of gender, age, body weight, preoperative liver function, preoperative symp-toms and signs, preoperative biochemical index, calculus distribution, preoperative complications (P > 0.05).②There were no significant differences of the hepatolobectomy rate, intraoperative blood loss, intraoperative blood transfusion, times and time of hepatic portal occlusion, bile culture positive rate, hospital stay and hospitalization expenses between two groups (P > 0.05).But the operation time of the biliary enteric drainage group was significantly longer than that of the T tube drainage group (P < 0.001).③The total complications rate and specific complication rate were not signifi-cantly different between two groups (P > 0.05).④The stone instant clearance rate of the biliary enteric drainage group was significantly higher than that of the T tube drainage group (P=0.031).But the stone final clearance rate was not significantly different between two groups (P=0.841).⑤The postoperative quality of life was not significantly different between two groups (Excellent and good:P=0.560;Poor:P=0.560).The rates of stone residual, recurrence, mortality and canceration were not significantly different between two groups (P > 0.05). ConclusionThe biliary drainage for surgical management of hepatolithias is selected according to the function of sphincter of Oddi.Biliary enteric drainage and Roux-en-Y anastomosis are firstly selected for patients with the loss of function of sphincter of Oddi.