To analyse the causes of biliary injuries and summuarize the experience of prevention of biliary injury during laparoscopic cholecystectomy (LC). Twenty-three patients with biliary duct injury were diagnosed and treated at our center between September 1992 and August 1998. The main causes were either misidentification of the bile duct or aberrant right duct as the cystic or injudicious use of thermal energy (cautery) to dissect, control bleeding, or divide tissue. Conclusion: The causes of biliary duct injury are complex. Training and experience of sugeon, the meticulous dissection of the calot′s triangle and preoperative or operative cholangiography are three key factors in prevention of biliary duct injury during LC.
To evaluate the effect of intercellular adhesiveness molecule-1 (ICAM-1), E-selectin on hepatic microcirculation in acute cholangitis. The Changes of hepatic tissue, content of blood flow and Evan′s blue (EB) in hepatic tissue in acute cholangitis were determinated. Results: The number of PMN in hepatic tissue and sinusin increased, degenaration and necrosis of the hepatic cells and hepatic sinusoidal endothelial cells and content of blood flow in liver were reduced, and content of EB in hepatic tissue increased remarkbly in the rats with acute cholangitis. Pretreatment of anti ICAM-1 and E-selectin mAb reduced the damage of hepatic microcirculation. Conclusion: ICAM-1 and E-selectin may play an important role in damage to hepatic microcirculation in acute cholangitis.
The mumber of Polymorphonuclear leukocyte (PMN) in hepatic tissue increased in the rats with cholangitis, PMN infiltration was mainly in the hepatic sinus in the early stage; and PMN infiltration presented around the hepatocytes 12 hours after infection. Degeneration and necrosis of the hepatic cells was also observed in the rats with acute cholangitis. Only 40 percent of the rats survived 24 hours after infection. Depletion of circulating PMN decreased the damage and necrosis of hepatocytes and improving the survival rate of the infected rats. The results suggest that PMN infiltration plays an important role in hepatic damage in acute cholangitis.
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.
Nucleus plasma ratio was measured and silver-binding nucleolar organizer (AgNORs) were counted in 31 cases of cholangiocarinoma (11 cases were well-differentiated, 10 case moderately differentiated and 10 cases poorly differentiated) and in 17 cases of atypical epithelial hyperplasia related to hepatolithiasis (9 cases were simple hyperplasia, 8 cases atypical epithelial hyperplasia) by AgNORs techique and image analysis.The results showed that mucleus plasma ratio and AgNORs counts increased significantly from well-differentiated to poorly differentiated cholangiocarcinoma (Ｐ＜0.01). No statistically significant differance was shown between nucleus plasma ratio of atypical hyperplasia and well-differentiated cholangiocarinoma.The data imply that chronic proliferative cholngitis in the presence of hepatolithiasis can progress to atypical epithelial hyperplasia which may be an important precursor of cholangiocarcinoma.
Objective To evaluate the role of endoscopic retrograde cholangio-pancreatography(ERCP)in diagnosis of anomalous converge of the cystic duct and prevention of bile duct injuries during laparoscopic cholecystectomy(LC). Methods From July, 1992 to June, 1999, LCs were performed in 4 500 patients with gallbladder stone or cholecystitis at our center. Preoperative ERCPs were performed in 780 of all patients (14.50%). Anomalous junctions of the cystic duct with common hepatic duct were investigated and the length and caliber of these cystic duct were measured and compared with 100 control cases. Results An overall anomalous converges of the cystic duct were found in 125(16.03%) of the 780 patients undergoing ERCP. Of 780 patients undergoing LC, 35 cases were converted to open cholecystectomy(4.5%), and various complications occurred in 6 cases (0.77%), but no death and biliary duct injuries occurred. Conclusion Various types of anomalous junctions of the cystic duct could be diagnosed precisely by ERCP before LC and the preoperative examination of ERCP may be helpful in prevention of bile duct injuries and other biliary complications in the laparoscopic time.
For an advanced elucidation of mechanisms of nm23-H1 suppressive effects on metastasis of primary hepatocellular carcinoma (HCC), it is necessary to investigate the correlation between nm23-H1 expression and relative factors involved in the HCC invasion. In present report, full-length cDNA of nm23-H1 was subcloned into pBKCMV vector and transfected into HCC cell line to observe its effects on invasion, cytosolic free Ca2+ and Nras mRNA expression. The results showed that lower expression of N-ras and higher cytosolic free Ca2+ in transfected cell line were detected, while the potential of invasion was depressed. It suggests that the suppressive effects on HCC metastasis might interact with intracellular signal transduction which is essential for stimulating cell invasion.
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.
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