Advances in biomarkers of biliary tract cancers

Tumor biomarkers can be applied for early diagnosis or precise treatment, thereby leading to personalized treatment and better outcomes. Biliary tract cancers (BTCs) are a group of cancers that occurs in different locations and have different clinical or genetic properties. Though the incidence of BTCs is rare, BTCs are among the most lethal cancers in the world and all have very low 5-year survivals. Lack of efficient early diagnostic approaches or adjuvant therapies for BTCs are main reasons. These urge us to broaden the researches into BTC biomarkers. Although few progresses of diagnostic biomarkers for BTCs have been achieved, there are still some advances in prognostic, predictive and therapeutic areas. In this review, we will focus on these achievements.     

Percutaneous transhepatic Laser lithotripsy for intrahepatic cholelithiasis

PurposeTo report the technical success, complications and long-term outcomes of patients with intrahepatic cholelithiasis not amenable to endoscopic retrograde cholangiopancreatography (ERCP) who were treated with percutaneous transhepatic biliary Laser lithotripsy (PTBLL).Patients and methodsA retrospective review of 12 patients who underwent PTBLL for intrahepatic cholelithiasis was performed. There were 5 men and 7 women with a mean age of 46 ± 18 (SD) years (range: 23–75 years). PTBLL was performed when stone clearance using ERCP had previously failed or was not appropriate due to unfavourable anatomy or the presence of multiple stones or a large stone. Percutaneous biliary access into intrahepatic ducts was obtained if not already present and lithotripsy was performed using a HolmiumYAG 2100 nM Laser. Patients files were analyzed to determine the technical success, complications and long-term outcomes.ResultsEleven patients (11/12; 92%) had a history of previous hepatobiliary surgery and nine (9/12; 75%) had multiple stones confirmed on preprocedure imaging. A 100% success rate in fragmenting the target stone(s) was achieved and 11/12 patients (92%) had successful first pass extraction of target stone fragments. Two patients (2/12; 17%) required repeat lithotripsy. One patient (1/12; 8%) experienced a major complication in the form of cholangitis. Of patients with long-term follow-up, 4/10 (40%) had recurrence of intrahepatic calculi with a mean time interval of 31 months (range 3–84 months).ConclusionFor patients with intrahepatic biliary calculi not amenable to ERCP, PTBLL provides an effective and safe alternate treatment.     

RPLU、FURL及PCNL治疗输尿管上段嵌顿性结石的疗效研究

目的探讨后腹腔镜切开取石术（retroperitoneal laparoscopic lithotomy，RPLU）、输尿管软镜碎石清石术（lithotripsy with flexible ureteroscope，FURL）及经皮肾镜碎石清石术（percutaneous nephrolithotomy，PCNL）种不同方法治疗输尿管上段嵌顿性结石的疗效，以明确直径大于1.5 cm的输尿管上段嵌顿性结石的最佳处理方案。 方法回顾性分析159例输尿管上段嵌顿性结石，收集其术前术中资料，按术式不同分为RPLU组56例、FURL组55例、PCNL组48例。对手术时间、术后住院时间、结石清除率、术后并发症等数据进行统计学分析。 结果FURL组手术时间和术后住院时间明显短于RPLU组和PCNL组，差异均有统计学意义（P＜0.05）。RPLU组术后3 d和术后1个月的结石清除率（100%，100%）稍高于FURL组（90.9%，94.5%）和PCNL组（93.8%，93.8%），3组患者术后无严重并发症出现，差异均无统计学意义（P＞0.05）。 结论3种不同手术方法治疗嵌顿性输尿管上段结石均安全有效，FURL组手术时间及住院时间更短，患者术后恢复更快，更具有优势。     

Neonatal Liver Disease Associated with Placental Transfer of Anti-mitochondrial Antibodies

Background: Anti-mitochondrial antibody is the diagnostic hallmark of primary biliary cirrhosis. Its role in the aetiology of primary biliary cirrhosis is controversial. Methods: Two cases of neonatal hepatitis seropositive for anti-mitochondrial antibody are described. Anti-mitochondrial antibody Ig isotype and epitopic specificity were investigated by immunofluorescence and enzyme immunoassays. Results: In both infants anti-mitochondrial antibody was of the G class, mainly G1 and G3 subclasses, and reacted with two synthetic peptides reproducing major M2 epitopic regions: inner lipoyl domain pyruvate dehydrogenase complex (PDC)-E2_162-176 and PDC-E3 binding protein (PDC-E3BP)_86-100. One infant also reacted with outer lipoyl domain PDC-E2_35-49, and 2-oxoglutarate dehydrogenase complex (OGDC)-E2_99-113. An identical pattern of reactivity was present in their mothers, indicating the maternal origin of the antibodies. Anti-mitochondrial antibody disappeared in the infants with the disappearance of the liver pathology. Conclusions: The simultaneous disappearance of hepatitis and anti-mitochondrial antibody in the infants suggests a possible causal link between the two.     

蔡妙珊治疗泌尿系结石经验

蔡妙珊教授认为泌尿系结石病机多为脾肾气虚为本,湿热气滞血瘀为标,治疗常用清热利湿、通络、补虚三法,自拟金石芍苓汤,融三法于一方,疗效较好。同时结合针刺、穴位注射、总攻疗法及综合疗法等,缩短治疗周期,加快排石,促进中、大型结石的排出,疗效显著。     

多重影像学手段在多通道经皮肾镜治疗鹿角形结石中的应用

目的:探讨以术前泌尿系CT三维成像、术中B超与X射线联合引导为主要特点的多重影像学手段在多通道经皮肾镜取石术(PCNL)治疗鹿角形结石中的价值,并研究其适用条件。方法:对2011年9月~2013年9月在我院进行多通道PCNL治疗的鹿角形结石患者的临床资料进行回顾性分析,根据采用的影像学方法的区别而分成不同的观察组:多重影像学组、B超X射线联合组和B超组,并且对手术时间、出血量、结石清除率等指标进行统计学分析。结果:采用多重影像学检查的患者手术时间、出血量、结石清除率等指标均优于其他各组(P0.05)。结论:通过多重影像学手段可以更全面地反应此类患者的病情,包括结石大小、位置、形态等,并可以提高穿刺定位的准确性,最终改善手术效果,减少并发症的发生。     

前列腺剜除术联合小切口膀胱切开术治疗大体积前列腺增生并膀胱结石的疗效观察

目的:探讨"半微创技术"即经尿道2μm激光前列腺剜除术联合小切口膀胱切开术,治疗大体积良性前列腺增生(BPH)合并大体积或多发膀胱结石的疗效。方法:对21例大体积BPH合并膀胱结石患者,采用经尿道2μm激光剜除前列腺,后经耻骨上正中切口显露膀胱,将所剜除腺体及结石取出。结果:21例手术均成功,手术时间明显缩短,患者均未输血。术后4~6d拔除尿管。术前与术后6个月Qmax分别为(6.1±2.6)ml/s和(20.5±4.3)ml/s;剩余尿分别为(125.7±61.5)ml与(19.0±5.8)ml;国际前列腺症状评分(IPSS)分别为(21.6±5.2)分与(5.4±3.0)分;生活质量评分(QOL)分别为(4.3±0.5)分与(1.9±0.8)分。四项指标手术前后比较差异均有统计学意义(P0.01)。术后随访3~6个月,2例出现暂时性尿失禁,全部患者无尿瘘、切口感染等手术并发症。结论:经尿道2μm激光前列腺剜除术结合小切口膀胱切开术,一次性治疗大体积BPH合并多发膀胱结石能明显减少手术时间,具有安全、高效的优点,对于大体积BPH合并膀胱多发结石或质硬、直径3cm结石的高龄患者值得推荐应用。     

甲状旁腺增生致反复泌尿系结石1例报告并文献复习

目的：总结甲状旁腺增生导致的反复泌尿系结石的诊断和治疗经验，提高泌尿外科医师对此病的认识、分析和治疗水平。方法：回顾性分析1例由甲状旁腺增生导致的反复泌尿系结石患者的临床资料：因反复泌尿系结石伴双上肢骨痛十余年，反复行体外冲击波碎石、输尿管镜碎石及相关骨科治疗，症状控制不理想。本次就诊时在详细追问病史下经科室会诊考虑为甲状旁腺机能亢进导致的泌尿系结石，遂经实验室检查证实。联合甲状腺乳腺外科进行手术。结果：术后患者症状明显缓解，病理检查结果为甲状旁腺增生。泌尿外科遂为患者清除输尿管结石。术后随访2年，未再发结石和骨痛。结论：泌尿外科医师在接诊反复结石患者时应考虑有甲状旁腺机能亢进的可能性；甲状旁腺激素检查有助于临床诊断；多学科团队模式可提高该类患者的诊疗效果。