Telescopic technique associated with mucosectomy: a simple and safe anastomosis in pancreaticoduodenectomy

Pancreatic fistula remains a common problem and a main cause of morbidity and mortality after pancreaticoduodenectomy (PD). We have developed a safe and simple method of pancreaticojejunostomy in 33 patients, in whom approximately 3 cm of jejunal mucosa was cut to improve the adhesion between the loop and pancreatic parenchyma after end-to-end invagination. Furthermore, we have performed a purse-string procedure on 21 patients to secure the jejunum to the intussuscepted pancreatic stump instead of continuous running fashion with double needles of 5-0 monofilament synthetic absorbable sutures. This procedure was proved to be much more expeditious, and only 2 of 33 patients had pancreatic leakages. Therefore, the telescopic technique associated with mucosectomy is an acceptable and safe surgery for pancreaticojejunal anastomosis.     

Notch2基因在大鼠肝移植术后胆管损伤中的表达及其意义

目的 探讨大鼠肝移植术后损伤胆管中Notch 2基因的表达及其意义.方法 将96只健康雄性SD大鼠随机分为3组,A组:未手术组;B组:假手术组;C组:采用改良"二袖套"法建立大鼠肝移植.于术后1、7、14、28 d检测总胆红素(TBIL)、γ-GT、谷丙转氨酶(ALT),同时处死大鼠取肝组织,苏木素-伊红(HE)染色观察病理改变,免疫组织化学、Western blot检测Notch 2基因的表达.结果 大鼠肝移植术后TBIL(32.05±3.28)μmol/L,γ-GT(118.30±17.40)μmol/L明显升高(P＜0.05),HE染色显示损伤胆管增生(14 d),部分胆管破坏、消失(28 d).免疫组织化学显示,A和B组胆管细胞Notch 2染色阴性,C组胆管细胞Notch 2染色强阳性,Western blot检测显示Notch 2蛋白在C组肝组织中呈逐渐升高的强表达(P＜0.05).结论 大鼠肝移植术后随胆管损伤加重,Notch 2基因表达显著升高,该基因可能参与了胆管损伤.

Abstract：

Objective To investigate the expression and clinical significance of Notch 2 expression in postoperative injured bile duct of rat liver transplantation. Methods Ninety-six healthy male SD rats were divided into three groups randomly: un-operation group (A), Sham operation group ( B), and group of liver transplantation model by modified "two-muff" techniques (C). Total bilirubin (TBIL), γ-GT and alanine aminotransferase (ALT) were determined at 1st, 7th, 14th, 28th day after transplantation and the expression of Notch 2 in the liver was detected by immunohistochemisty and Western blotting at the same time. Results TBIL (32. 05 ±3. 28) μmol/L, and γ-GT ( 118.30 ± 17.40) μmol/L were increased obviously after liver transplantation ( P ＜ 0. 05 ). Hematoxylin-eosin ( HE ) staining showed the injured bile ducts obviously proliferated after 14 days, and partly posttransplanted bile ducts were destructed and vanished after 28 days. Immunohistochemisty revealed that Notch 2 staining in bile ducts was negative in groups A and B, but Notch 2 staining in hyperplasitic bile ducts was strong positive in group C. Western blotting confirmed that Notch 2 protein was upregulated gradually in the damaged bile ducts after rat liver transplantation (P ＜ 0. 05 ). Conclusion Bile duct injury is aggravated after rat liver transplantation, and Notch 2 gene expression is up-regulated remarkably.     

生长抑素预防胰十二指肠切除术后并发症的应用体会

目的 探讨生长抑素（思他宁）在胰十二指肠切除术后并发症预防的临床应用价值.方法 回顾分析我院2005年1月至2010年6月共收治的因壶腹部肿瘤和胰头癌行胰十二指肠切除术患者40例,其中14例术后预防性应用了生长抑素（思他宁）,余26例为同期对照组即术后没有预防性应用生长抑素,全组病例术后常规肠外营养及抗生素治疗,比较两...     

操作路径在经皮椎体后凸成形术中预防骨水泥渗漏的作用

目的探讨设计的操作路径方案在经皮椎体后凸成形术(PKP)中预防骨水泥渗漏的作用。方法对不同时间段收治的292例患者(392椎),分别采用未实施操作路径(实施前组183椎),实施操作路径(实施后组209椎),统计分析两组治疗中出现的骨水泥渗漏变化,并同时对患者术前、术后疼痛进行VAS评价。结果实施前组29椎出现骨水泥渗漏(15.85%),实施后组12椎出现骨水泥渗漏(5.74%),两者比较差异有统计学意义(P<0.01)。VAS平均值:术前1 d为7.56分±0.65分,术后3 d为2.12分±0.95分,术后3个月为2.69分±1.16分,与术前1 d比较差异有统计学意义(P<0.05),术后3 d与术后3个月比较差异无统计学意义(P>0.05)。结论操作路径方案起到加强医疗管理、规范治疗行为、减少医源性失误作用,能有效降低和预防PKP治疗中骨水泥渗漏的发生。     

腹腔镜胆囊切除术后胆漏处理的体会

目的:探讨腹腔镜胆囊切除术( laparoscopic cholecystectomy,LC)术后胆漏的原因及防治方法.方法:回顾分析2000年1月至2011年1月14例LC术后胆漏患者的临床资料.结果:14例中胆囊管残端漏2例,迷走胆管漏1例,胆管残余结石10例,胆管损伤1例.5例胆管残余结石,均于术后3～5d行内镜...     

胆道肿瘤的潜在标志物Mrp14

目的 探讨胆道肿瘤特异性的标志物,为胆道肿瘤的早期诊断、判断预后、监测复发以及治疗等提供帮助,同时为进一步研究胆道肿瘤的发病机制提供线索。方法 收集经病理结果证实的胆道癌和胆囊癌患者的组织、胆汁标本以及良件胆道和胆囊疾病患者的组织、胆汁标本,应用双向电泳和MALDI-TOF-MS质谱技术检测出恶性和良性组织、恶性和良性病变患者胆汁之间差异表达的蛋白。对同时高表达于胆道癌、胆囊癌及恶性病变胆汁的蛋白Mrp14进行Western blot、免疫组化验证,RT-PCR监测基因表达水平。结果3组蛋白标本双向电泳后质谱成功鉴定出30个差异表达的蛋白,其中Mrp14同时在胆道癌、胆囊癌及恶性病变胆汁中高表达。Western blot、免疫组化及RT-PCR验证其在蛋白和基因水平于恶性组织中高表达。结论 Mrp14在胆道系统恶变后表达增高,可能为胆道肿瘤发生、发展的候选肿瘤标志物。     

Apr-1基因对胆管癌细胞QBC939细胞周期的调节机制研究

目的 研究Apr-1基因对胆管癌细胞的细胞周期调节作用及机制.方法 采用脂质体介导法将Apr-1基因转染胆管癌细胞系QBC939,建立稳定表达Apr-1基因的细胞模型(QBC939-Apr-1).运用RT-PCR检测转染前后QBC939细胞系中Apr-1 mRNA的表达;流式细胞分析以及生长曲线等方法观察目的 基因对该细胞系的细胞周期的影响.采用细胞周期基因芯片,观察Apr-1基因对细胞周期相关基因表达的调节作用.结果 Apr-1基因在QBC939细胞系中呈阴性表达,转染Apr-1基因的QBC939-Apr-1细胞出现了Apr-1 mRNA的表达,成功建立了稳定表达Apr-1基因的细胞模型,该细胞模型表现出细胞生长受抑,细胞周期显示G2期细胞由9%增加至13%(P＜0.01).细胞周期抑制;并且细胞周期基因芯片检测结果发现:Skp2、UBE基因的表达水平出现明显上调,而CDC6、Cyclin H等25种基因的表达下降,其中MRE11A、CKS2、CDK8、CDC45下调在3倍以上.结论 Apr-1基因在体外能够使QBC939细胞的细胞周期在G2期延长,出现细胞周期多种调节基因的表达差异.

Abstract：

Objective To investigate the role and the mechanism of Apr-1 gene on cholangiocarcinoma QBC939 cell lines proliferation and cell cycle regulation. Methods Apr-1 gene was transfected into QBC939 cells by using liposomes to establish a QBC939 cell model ( QBC939-Apr-1 ) stably expressing Apr-1 gene. Apr-1 mRNA expression and the changes in cell cycle and cell growth of QBC939 cells were analyzed by RT-PCR, flow cytometry ( FCM ) and growth curve before and after transfection. The regulatory effect of Apr-1 gene on the expression of cell cycle-related genes was investigated in QBC939 cells before and after Apr-1 transfection using cell cycle gene microarrays. Results Significant suppression of cell growth was observed with the cell model stably expressing Apr-1 gene. Apr-1 over-expression caused cell arrest from 9% to 13% (P ＜0. 01 ) increase in G2 population. Cell cycle gene microarrays demonstrated that the expression of Skp2 、UBE1 was up-regulated, while the expression of MRE11A 、CKS2 、CDK8 、CDC45 was down-regulated by more than 3 folds. Conclusions Apr-1 gene suppresses QBC939 cell proliferation in vitro, QBC939 cells presented with differences in the expression of cell cycle-related genes after Apr-1 gene transfection.     

A long-term recurrence-free survival of a patient with the mixed adeno-neuroendocrine bile duct carcinoma: A case report and review of the literature

IntroductionNeuroendocrine tumors arising primarily in the bile duct are rare. And among these tumors, mixed adeno-neuroendocrine carcinoma (MANEC) is quite uncommon. We report a patient with MANEC who achieved long-term recurrence-free survival. And our case report includes analysis previous case reports.Presentation of caseA 66-year-old man underwent investigation for persistent anorexia and fatigue. Laboratory tests showed that the values of hepatobiliary enzymes were increased. On CT, a 10 mm × 8 mm hypervascular tumor was observed in the distal bile duct and the proximal bile duct was markedly dilated. Endoscopic retrograde cholangiography (ERC) also showed a stenosis with a long diameter of 10 mm. Examination of a biopsy specimen obtained from the narrow site of the bile duct at the time of ERC revealed tubular adenocarcinoma. Therefore, pylorus-preserving pancreaticoduodenectomy was performed under a preoperative diagnosis of distal bile duct carcinoma. Postoperative pathologic examination revealed alveolar structures and a mixture of moderately differentiated adenocarcinoma with synaptophysin-positive and chromogranin-A-positive neuroendocrine carcinoma. Therefore, the final diagnosis was MANEC, pT3, pN1, M0, pStage II B (TNM classification of the UICC). Curative resection was achieved and there has been no recurrence after 30 months.DiscussionIn the previous reports, only five patients (14.7%) survived for 24 months or longer. Median survival was longer (14 months) in the curative resection group and shorter (6 months) in the non-curative resection group.ConclusionCurative resection is essential to achieve long-term survival in patients with bile duct MANEC, even if these patients have lymph node metastasis.     

Surgical treatment for the excluded bile leakage from Spiegel lobe after right hemihepatectomy: A case report

InroductionThe treatments of excluded bile duct leakage after hepatectomy are not easy and various strategies have been reported, such as surgery, ethanol or fibrin glue injection, and portal vein embolization.Presentation of caseA 72-year-old man with a surgical history of laparoscopic ileocecal resection for diverticular bleeding was diagnosed as having hepatocellular carcinoma. Right hemihepatectomy was performed, and computed tomography examination on postoperative day 9 showed abdominal fluid collection in the right subphrenic space. Percutaneous intra-abdominal fluid drainage was performed and it was diagnosed as bile leakage. After that it was diagnosed as excluded bile leakage from the Spiegel lobe by drip infusion cholangiographic-computed tomography and endoscopic retrograde cholangiography. To improve this clinical condition, we performed the Spiegel lobe excision on postoperative day 48. The postoperative course was uneventful and the patient was discharged.DiscussionAccording to the postoperative examination, it appeared that the bile duct from the Spiegel lobe joined to the right main bile duct or the bile duct of the right posterior section. This bile duct anomaly was not detected preoperatively on imaging examination. It is most likely that the bile duct from the Spiegel lobe was cut when the hepatoduodenal ligament in the hepatic hilum was peeled. To prevent excluded bile leakage, the hepatoduodenal ligament should be carefully peeled and ligated instead of using energy devices.ConclusionWe consider that surgical treatment for postoperative excluded bile leakage is both a quick and reliable procedure in patients with acceptable liver function and anatomical subject.     

Animal model of bile duct dilatation created with minimally invasive surgery

RATIONALE AND OBJECTIVES: The purpose of the study was to evaluate a method of producing obstruction of the common bile duct and concomitant biliary duct dilatation in an animal model. MATERIALS AND METHODS: Laparoscopic placement of a double-balloon occlusion device was used to produce common bile duct obstruction and bile duct dilatation in pigs. RESULTS: One week after the procedure, common bile duct obstruction and dilatation of the biliary tree were demonstrated with either percutaneous transhepatic cholangiography or percutaneous cholecystography. CONCLUSION: The use of this method is technically feasible and provides a useful subacute and chronic animal model of common bile duct obstruction and dilatation of the biliary tree for percutaneous interventional training and research purposes.