肝外胆管癌病人中的丙型肝炎病毒和乙型肝炎病毒感染

Objective:In China, the incidence of extrahepatic bile duct carcinoma (EBDC) tends to increase over the past decades. The etiology of the noted increase in EBDC is not identified. Approximately, in a half of the overall Chinese patients with EBDC, the causative factors in the development of EBDC have not been demonstrated. There is a high prevalence of hepatitis C virus (HCV) or hepatitis B virus (HBV)in China, both of which can induce malignant transformation of infected cells and strongly associated with hepatocellular carcinoma (HCC).In this study,EBDC tissues from Chinese patients were examined for the presence of HCV and HBV infection to investigate further the potential causes of EBDC. Methods:HCV NS5 protein and HBsAg were detected by labeled streptavidin biotin (LSAB) method; HCV RNA and HBV DNA were detected by in situ polymerase chain reaction (IS-PCR) in formalin fixed, paraffin embedded specimens from 51 Chinese patients with EBDC. HCV RNA and HBV DNA were detected by IS-PCR in 34 Chinese patients with specimens of benign lesions of hepatobiliary tract(control group). Results:In 51 case tissue sections of EBDC, NS5 protein was detected in 14 (27.5%), and HBsAg in 5 (9.8%), HCV RNA in 18(35.4%) and HBV DNA in 8 (15.9%), respectively, of which HCV and HBV co-infection was detected in 2 (3.9%). In 34 case tissue sections of the control group, HCV RNA was detected in 2 (5.9%), and HBV DNA in 3 (8.8%).Conclusion:In this study using standard histochemical and PCR techniques,HCV and HBV and HBV presence in EBDC tissues than would be expected on serologic grounds.The detectable rate of HCV RNA in EBDC tissues was significantly higher than in control group(x^2=9.808,P=0.002).As a result ,this study indicates that there is a correlation between the presence of HCV infection and EBDC,and HCV infection has possible ctiologic significance in the development of EBDCin China.While HBV DNA was detecled in EBDC tissues with the difference in the detectable rate of HBV.DNA being not significance betwwen EBDC tissues and the control group(x^2=0.853,P=0.356).Further research is necessary to determine the presence of a causal relationship between HCV/HBV infection and the development of EBDC.     

Biliary‐enteric bypass in unresectable malignant hilar biliary obstruction: Kwong Wah Hospital experience

Objective : To evaluate the efficacy of biliary‐enteric bypass in the palliation of malignant hilar biliary obstruction. Materials and Methods : Records of 19 patients from 1995 to 1998 were reviewed. There were 13 patients with cholangiocarcinoma and 6 patients with carcinoma of the gallbladder. Single biliary‐enteric bypass had been performed in 13 of the patients; the rest had more than one biliary‐enteric anastomosis. Results : The 30‐day mortality was 21% (4/19 patients). Bile leakage occurred in 2 patients, leading, in both, to fatality. Excluding the 30‐day mortality, the median survival of patients with carcinoma of the gallbladder and cholangiocarcinoma was 116 days (43–200) and 202 days (47–1207), respectively. The mean hospital stay was 31 days (13–59) and all patients were discharged with their symptoms relieved and a drop in bilirubin of at least two‐thirds their pre‐operative level. The late complication rate was 26.7% (4/15 patients). Conclusion : Biliary‐enteric bypass is effective in the palliation of symptoms of patients suffering from unresectable hilar biliary obstruction, although it carries considerable mortality and morbidity. Stenting, rather than surgery, should be considered for patients with unresectable gallbladder cancer.      

医源性胆管损伤18例临床分析

目的探讨医源性胆管损伤的原因及防治。方法回顾性分析我院1995—2006年处理的18例医源性胆管损伤的诊治经验。结果术巾发现7例，术后发现11例，分别给予不同处理，治疗效果满意。结论胆囊三角解剖不清是胆管损伤的主要原因；对于胆管损伤应力争早期诊断，正确处理，合理选择手术时机与手术方式。     

肝穿刺肝胆管支架治疗恶性梗阻性黄疸的护理

目的探讨经皮肝穿刺肝胆管支架治疗恶性梗阻性黄胆的术中及术后护理要点。方法23例恶性胆道梗阻患者采用经皮肝穿刺肝胆管支架置入术治疗，术前做好充分的准备、术中一丝不苟的配合，术后严密观察。结果共置入23枚镍钛记忆合金内支架，技术操作成功率100％。1周后复查时引流通畅，支架扩张良好。术前血清总胆红素（386．3±232．5）μmol／L，术后23例血清胆红素降到（86．2±42．5）μmol／L，通过术中医护密切配合和术后严密观察，该组无严重并发症。结论优质的护理可明显减少经皮肝穿刺支架置入手术并发症，提高支架置入的成功率和治疗效果，促进高龄患者康复。     

Does pancreatico-biliary maljunction play a role in spontaneous perforation of the bile duct in children?

Spontaneous perforation of the bile duct (SPBD) is a rare disease in children. Pancreatico-biliary maljunction (PBM) has been postulated to contribute to its etiology. We have treated three children with SPBD over 30 years, two of whom had PBM. There was one boy and two girls aged 10 months to 2 years with symptoms of abdominal distension, vomiting, abdominal pain, jaundice, and acholic stools. The diagnosis of SPBD was made by paracentesis showing biliary ascites, and primary biliary and intra-abdominal drainage was performed in all cases. The site of perforation was at the connection of the common bile duct (CBD) with the cystic duct in all cases. In two cases reflux of contrast into the pancreatic duct was noted, the common channel was long (17 and 12 mm, respectively), and the bile amylase level in the CBD was abnormally high (50,000 and 67,000 IU/l, respectively). In the third patient there was no reflux of contrast into the pancreatic duct and the bile amylase and trypsin levels in the CBD and gallbladder were not measurable. Thus, SPBD in children may not be due solely to PBM, but may involve multiple mechanisms. Accepted: 11 January 2000     

胆囊切除术后近期胆管结石分析

目的探讨胆囊切除术后6个月内近期胆管结石的形成原因、与胆囊切除的关系、治疗方法。方法总结分析2004年以来我院收治的21例胆囊切除术后近期内胆管结石的病例。结果全部病例均接受保守治疗,5例保守治疗痊愈,16例保守治疗后仍反复发作,其中5例接受手术治疗,术后2例复发。结论胆囊切除术后近期内胆管结石的形成与胆汁代谢异常、胆道运动障碍、Oddi括约肌功能不良等多种因素相关,与胆囊切除存在相关性。临床治疗比较棘手,需根据病情选择个性化治疗方案。     

小儿先天性胆管扩张症囊肿内胆汁酸盐的LC-MS/MS分析

目的 探讨小儿先天性胆管扩张症囊肿内胆汁中胆汁酸谱的特点及其意义.方法 通过建立人类已知的全部15种胆汁酸改良的液相色谱串联质谱定量检测方法 ,以我院2002年10月至2004年6月收治小儿先天性胆管扩张症(CBD)16例为研究对象,其中男11例,女5例,年龄11～134个月,平均(44.8±24.6)个月,术前B超和(或)CT、术中胆道造影确诊为先天性胆管扩张症.对16例先天性胆管扩张症囊肿内胆汁进行胆汁酸定量检测.结果 先天性胆管扩张症囊肿内总胆汁酸的浓度与对照组比较明显降低,组成胆汁酸谱的各种胆汁酸与对照组比较相应减少,未见致癌性胆酸浓度增高.儿童胆汁中甘氨熊脱氧胆酸含量较高,总胆汁酸的降低与肝纤维化程度呈正相关.结论 先天性胆管扩张症患儿存在胆汁酸代谢异常,可能与肝脏继发性损伤程度有关,异常的胆汁酸谱可能与胆结石的发生相关.     

胆源性胰腺炎胆总管探查的指征分析

目的 探讨胆源性胰腺炎胆总管探查的指征。方法 回顾性分析我院两阶段胆源性胰腺炎胆总管探查的病例资料：1995年-1999年间的46例术前B超提示胆囊结石、胆总管结石、扩张或伴有黄疸。2001年-2006年间的30例术前B超提示胆囊结石、胆总管结石、扩张或伴有黄疸，并经过磁共振胰胆管成像（MRCP）筛检确认。结果 第一阶段术中探查及术后T管造影示无结石28例，占60．8％（28/46）。第二阶段术中探查及术后T管造影示无结石7例，占23．3％（7／30）。结论 根据B超显示胆总管扩张及黄疽而行胆总管探查的阴性率高（P〈0．05），胆源性胰腺炎应严格掌握胆总管探查指征，MRCP可无创性地显示胆总管系统，有助于胆源性胰腺炎是否行胆总管探查的决定。     

成年大鼠胰腺导管干细胞的体外分离?培养及鉴定

目的:建立成年大鼠胰腺导管干细胞的体外分离、培养及鉴定的方法.方法:V型胶原酶溶液灌注消化成年大鼠胰腺组织,并经过Ficoll密度梯度离心去除胰岛组织,培养于含10%胎牛血清的RPMI1640培养液,而后加入表皮生长因子(EGF)和碱性成纤维细胞生长因子(bFGF)继续培养,7天可形成单层细胞,用0.25%胰酶-EDTA消化并传代培养.取第2代细胞利用免疫荧光染色和RT-PCR方法检测CK19、Pdx-1、Nestin、insulin及glucagon的表达.结果:经胶原酶灌注消化胰腺导管上皮,再经过Ficoll密度梯度离心去除胰岛组织,可使胰腺导管细胞得到较好的纯化.免疫荧光结果示:胰腺导管细胞CK19、Pdx-1和Nestin染色呈阳性,阳性细胞率分别为(88.6±6.2)%、(84.6±8.6)%和(79.3±10.5)%,而insulin及glucagon染色为阴性.RT-PCR结果显示该细胞表达CK19、Pdx-1和Nestin基因.结论:该方法可较好的分离出胰腺导管细胞.经鉴定该法培养所获细胞具有胰腺干细胞的特性.     

C-myc反义寡核苷酸对人胆管癌细胞增殖和侵袭力的影响

目的 探讨C-myc反义寡核苷酸(ASODN)对人胆管癌QBC939细胞增殖和侵袭力的影响.方法 合成C-mycASODN,并将其转染QBC939细胞;四甲基噻唑蓝(MTT)实验检测C-myc ASODN抑制QBC939细胞增殖的影响;Transwell法检测C-myc ASODN抑制QBC939细胞侵袭力的影响.结果 ASODN组细胞的存活率低于空白对照组(P<0.05);ASODN组较空白对照组的细胞穿透数目下降(P<0.01);空载体组细胞的存活率及细胞穿透数目较空白对照组差异无统计学意义(P>0.05).结论 C-myc ASODN能抑制QBC939细胞的增殖和侵袭力.