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11.
目的:探讨细胞角蛋白7(CK7)、细胞角蛋白20(CK20)在肝内胆管癌及肝内胆管结石旁胆管组织中的表达及临床意义。方法:免疫组织化学方法检测30例肝内胆管癌、例肝内胆管结石旁胆管组30织及15例正常肝内胆管组织中的CK7、CK20表达。结果:CK7在肝内胆管癌、正常肝内胆管组织中的阳性表达率分别为96.7%(29/30)、13.3%(2/15),差异有统计学意义(P〈0.01);CK20在肝内胆管癌组织、正常肝内胆管组织中阳性表达率分别为43.3%(13/30)、(1/15),差异有统计学意义(P〈0.01)。CK76.7%在肝内胆管结石旁胆管组织阳性表达率为76.6%(23/30),与正常肝内胆管组织阳性表达率13.3%(2/15)比较,差异有统计学意义(P〈0.05)。CK20在肝内胆管结石旁胆管组织阳性表达率为6.7%(2/30),与正常肝内胆管组织阳性表达率6.7%(1/15)比较,差异无统计学意义(P〉0.05)。结论:CK7和CK20可能成为肝内胆管癌特异性肿瘤标志物。 相似文献
12.
《Diagnostic and interventional imaging》2019,100(12):793-800
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. 相似文献
13.
目的:中西医治疗肝胆管结石。方法:分析431例规则性肝切除与89例非规则性肝切除治疗肝胆管结石病在各个方面的差异,包括手术时间、住院时间、术中出血量、术后输血人数、术后并发症、结石清除率和随访情况以及30例中医药物治疗肝胆管结石等等。结果:规则性肝切除在术中出血量、术后输血人数、术后并发症、结石清除率以及随访情况等方面全部优于非规则性肝切除术。结论:规则性肝段切除治疗肝胆管结石病优于非规则性肝切除术。 相似文献
14.
Lijin Zhao Rigao Yang Long Cheng Maijian Wang Yan Jiang Shuguang Wang 《Journal of Korean medical science》2010,25(7):1066-1070
The purpose of this study was to explore the role of epithelial-mesenchymal transition in the pathogenesis of hepatolithiasis. Thirty-one patients with primary hepatolithiasis were enrolled in this study. Expressions of E-cadherin, α-catenin, α-SMA, vimentin, S100A4, TGF-β1 and P-smad2/3 in hepatolithiasis bile duct epithelial cells were examined by immunohistochemistry staining. The results showed that the expressions of the epithelial markers E-cadherin and α-catenin were frequently lost in hepatolithiasis (32.3% and 25.9% of cases, respectively), while the mesenchymal markers vimentin, α-SMA and S100A4 were found to be present in hepatolithiasis (35.5%, 29.0%, and 32.3% of cases, respectively). The increased mesenchymal marker expression was correlated with decreased epithelial marker expression. The expressions of TGF-β1 and P-smad2/3 in hepatolithiasis were correlated with the expression of S100A4. These data indicate that TGF-β1-mediated epithelial-mesenchymal transition might be involved in the formation of hepatolithiasis. 相似文献
15.
16.
Yu-Fan Cheng Tai-Yi Chen Sheung-Fat Ko Chung-Cheng Huang Tung Liang Huang Hsu-Huei Weng Tze-Yu Lee Shyr-Ming Sheen-Chen 《Cardiovascular and interventional radiology》1995,18(2):77-81
Purpose: The authors report their experience with the treatment of intrahepatic bile duct strictures associated with hepatolithiasis.
Methods: Eighty patients had multiple postoperative retained intrahepatic duct stones trapped behind intrahepatic biliary strictures.
Before stone extraction, the strictures were opened gradually by semirigid dilators, followed by stent placement to create
enough patency for stone removal. All procedures were carried out through the T-tube tracts and were aided by cholangioscopy
and electrohydraulic lithotripsy.
Results: Complete clearance of stones was achieved in 69 patients. Failure to dilate the strictures was due to acute and multiple
ductal angulations. These included the right posterior inferior intrahepatic duct at its junction with the left intrahepatic
ducts when it was more than 2 cm distal to the hepatic bifurcation, when the angle between the T-tube tract and the common
bile duct was smaller than 90°, and when stones were located in peripheral intrahepatic ducts with more than five angulations.
Conclusion: This technique is considered safe and effective for complicated hepatolithiasis with intrahepatic biliary strictures 相似文献
17.
Hepatolithiasis is more frequently seen in East Asian countries than in Western countries, and it is well known to represent
a high-risk state for intrahepatic cholangiocarcinoma. Intrahepatic cholangiocarcinoma is an aggressive tumor that shows a
dismal outcome even after resection. Cancer results from multistep carcinogenesis; however, the precise molecular mechanisms
involved in the genetic alterations in cancer remain unknown. The accumulation of alterations in cancer-related genes leads
to disruptions in cell-cycle regulation and also to continuous cell proliferation. The present review provides an overview
of cancer-related genes in intrahepatic cholangiocarcinogenesis arising in hepatolithiasis. Further study of molecular mechanisms
in hepatolithiasis-related intrahepatic cholangiocarcinoma, and the delineation of the influence of the genes involved should
lead to our understanding of cholangiocarcinogenesis. 相似文献
18.
目的总结手术治疗肝胆管结石的临床经验,方法回顾性分析261例肝胆管结石病人的手术方式及其疗效。结果261例中141例行胆管切开取石为主的联合手术,120例行肝切除术为主的联合手术(45.9%),其中早期的肝切除33例。肝切除组与非肝切除之间术后残石率差异显著,有统计学意义(11.6%vs34%,P<0.05),其中早期肝切除术后残石率为0。187例获得随访(75.8%),手术至随访时间6个月至15年,疗效优良者比例肝切除组优于非肝切除组(89.1%vs70.1%),其中早期肝切除优良率为100%。结论肝切除,特别是早期的规则性肝切除,是肝胆管结石目前最有效的治疗手段。 相似文献
19.
Wen-jie Ma Yong Zhou Anuj Shrestha Hui Mao Fu-yu Li Nan-sheng Cheng Wei Zhang Rui-hua Xu Yong-qiong Zhang Ting Jiang Huan Feng Wen Li Qiang Han 《The Journal of surgical research》2014
Background
Hepatolithiasis is the presence of calculi within the bile ducts of the liver. It represents a significant problem for hepatobiliary surgery because of its high recurrence rate and the associated risk for partial hepatectomy. This study was designed to explore the long-term efficacy of chemical biliary duct embolization (CBDE) to treat recurrent hepatolithiasis.Materials and methods
A rabbit model of hepatolithiasis was established, and CBDE was achieved using oxybenzene and N-butyl-cyanoacrylate. The short-term (6 wk) and long-term (12 wk) efficacy of CBDE treatment was compared by observing the degree of atrophy, fibrosis, proliferation of collagen fibers, and apoptosis of hepatocytes and hepatic stellate cells in the embolized hepatic lobe. Biochemical measurement of β-glucuronidase was also evaluated to determine the effect of CBDE on stone formation.Results
Six weeks after CBDE, there was liver cell destruction, collagen accumulation, and bile duct proliferation only in the peripheral part of the target lobe. Twelve weeks after CBDE, “self-cut” chemical hepatectomy was achieved, as manifested by the destruction of almost all the hepatocytes in the target lobe, bile duct proliferation, and collagen fiber accumulation. The β-glucuronidase activity was markedly lower in the embolized lobe than in the nonembolized lobe. In contrast, bax, caspase-3, caspase-9, and α-smooth muscle actin expression was substantially higher in the embolized lobe than in the sham-operation group at 6 wk, but was lower at 12 wk.Conclusions
CBDE is a potentially effective therapeutic approach for treating and preventing the recurrence of hepatolithiasis. 相似文献20.
复发及残余肝胆管结石的外科治疗 总被引:4,自引:1,他引:3
目的 探讨复发及残余肝胆管结石的治疗效果。方法 对我院 1993年 6月~ 2 0 0 1年6月收治的 10 5例复发及残余肝管结石的结石部位、病理情况、手术方式、治疗效果及随访结果等资料进行回顾性分析。结果 根据结石分布部位及胆管狭窄程度等采取肝叶切除 (5 2 .4%,5 5 /10 5 )、肝段切除 (13.2 %,14/10 5 )、胆肠吻合 (2 4.8%,2 6 /10 5 )、Ⅰ~Ⅲ级肝管切开引流加胆总管探查 (9.5 %,10 /10 5 )。所有病例随访 6月~ 8年 ,彻底治愈者 79%(83/10 5 ) ,效果优良者 94.2 %(99/10 5 )。结论 对于复发及残余肝胆管结石患者 ,应根据结石的部位、狭窄的程度等采取相应的治疗方法。肝叶及肝段切除是复发及残余肝胆管结石的较好外科治疗方法。胆肠吻合应掌握严格的适应证。Ⅰ~Ⅲ级肝管的多处切开引流加术中、术后胆道镜亦为有效方法之一。 相似文献