Effects of bile acids on cyclooxygenase-2 expression in a rat model of duodenoesophageal anastomosis

AIM: To examine the expression of cyclooxygenase-2 (COX-2) and prostaglandin E2 (PGE2) in rat esophageal lesions induced by reflux of duodenal contents.

An end-to-end anastomosis model of guinea pig bile duct:A 6-mo observation

AIM:To establish the end-to-end anastomosis (EEA) model of guinea pig bile duct and evaluate the healing process of bile duct.METHODS:Thirty-two male guinea pigs were randomly divided into control group,2-,3-,and 6-mo groups after establishment of EEA model.Histological,immunohistochemical and serologic tests as well as measurement of bile contents were performed.The bile duct diameter and the diameter ratio (DR) were measured to assess the formation of relative stricture.RESULTS:Acute and chronic inflammatory reactions occurred throughout the healing process of bile duct.Serology test and bile content measurement showed no formation of persistent stricture in 6-mo group.The DR revealed a transient formation of relative stricture in 2-mo group in comparation to control group (2.94 ± 0.17 vs 1.89 ± 0.27,P=0.004).However,this relative stricture was released in 6-mo group (2.14 ± 0.18,P=0.440).CONCLUSION:A simple and reliable EEA model of guinea pig bile duct can be established with a good reproducibility and a satisfactory survival rate.

Application of a new-type sutureless anastomosis stent to the primary reconstruction of the bilioenteric continuity after acute bile duct injury in dogs

Objective： To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity （primarily under the circumstances of severe inflammation after acute bile duct injury in dogs ）. Methods： Establishing an animal model of acute bile duct injury with severe inflammation and bile peritonitis in dogs. The newtype sutureless magnetic bilioenteric anastomosis stent was used to reconstruct the bilioenteric continuity primarily. Results： The experiment group anastomosis healed well with a mild local inflammation reaction, and the collagen lined up in order without the occurrence of observable bile leakage and infection. Conclusion： It was safe and feasible to use the new-type anastomosis stent to reconstruct the bilioenteric continuity primarily under the circumstances of severe inflammation after acute bile duct injury in dogs.

Healing of Stoma After Magnetic Biliary-Enteric Anastomosis in Canine Peritonitis Models

Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis model in mongrel dogs(n=32). Magnetic anastomosis(group A, n=16) and traditional suture anastomosis(group B, n=16) were performed to reconstruct the biliary-enteric continuity in one stage. Half of the dogs in each group were euthanized on the 30 th postoperative day, and the other half on the 90 th postoperative day to harvest the stoma region. The healing conditions of the stoma after the 2 anastomotic approaches were observed with naked eyes, under light microscope and scanning electron microscope. Results The stoma leakage rate(50% versus 0% on the 30 th postoperative day, 37.5% versus 12.5% on the 90 th postoperative day, both P<0.05) and stenosis degree(13.9%±0.3% versus 7.1%±0.3% on the 30 th postoperative day, 17.2%±0.4% versus 9.4%±0.4% on the 90 th postoperative day, both P<0.01) were significantly higher in group B than in group A. Compared with traditional manual anastomoses, the histological analysis under light and electron microscope showed a more continuous stoma with more regular epithelium proliferation and collagen arrangement, less inflammation in group A. Conclusions Magnetic anastomosis stent ensures better healing of the stoma even under the circumstance of severe inflammation.

Does the addition of Braun anastomosis to Billroth Ⅱ reconstruction on laparoscopic-assisted distal gastrectomy benefit patients?

BACKGROUND Operation is the primary therapeutic option for patients with distal gastrectomy.Braun anastomosis is usually performed after Billroth Ⅱ reconstruction,which is wildly applied on distal gastrectomy because it is believed to benefit patients.However,studies are needed to confirm that.AIM To identify whether the addition of Braun anastomosis to Billroth Ⅱ reconstruction on laparoscopy-assisted distal gastrectomy benefits patients.METHODS A total of 143 patients with gastric cancer underwent laparoscopy-assisted distal gastrectomy at Centre 1 of PLA general hospital between January 2015 and December 2019.Clinical data of the patients were collected,and 93 of the 143 patients were followed up.These 93 patients were divided into two groups:Group 1(Billroth Ⅱ reconstruction,33 patients);and Group 2(Billroth Ⅱ reconstruction combined with Braun anastomosis,60 patients).Postoperative complication follow-up data and relevant clinical data were compared between the two groups.RESULTS There were no significant differences between Group 1 and Group 2 in postoperative complications(6.1%vs 6.7%,P=0.679),anal exhaust time or blood loss.The follow-up prevalence of reflux gastritis indicated no significant difference between Group 1 and Group 2(68.2%vs 51.7%,P=0.109).The followup European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores revealed no evident difference between Group 1 and Group 2 as well.Group 1 had a shorter operating time than Group 2 on average(234.6 min vs 262.0 min,P=0.017).CONCLUSION Combined with Billroth Ⅱ reconstruction,Braun anastomosis has been applied due to its ability to reduce the prevalence of reflux gastritis.Whereas in this study,the prevalence of reflux gastritis showed no significant difference,leading to a conclusion that under the circumstance of Braun anastomosis costing more time and more money,simple Billroth Ⅱ reconstruction should be widely applied.

When should endovascular gastrointestinal anastomosis transection Glissonean pedicle not be used in hepatectomy?A case report

BACKGROUND The literature on post-hepatectomy bile duct injury(PHBDI)is limited,lacking large sample retrospective studies and high-quality experience summaries.Therefore,we reported a special case of iatrogenic bile duct injury caused by Glissonean pedicle transection with endovascular gastrointestinal anastomosis(endo-GIA)during a right hepatectomy,analyzed the causes of this injury,and summarized the experience with this patient.CASE SUMMARY We present the case of a 66-year-old woman with recurrent abdominal pain and cholangitis due to intrahepatic cholangiectasis(Caroli's disease).Preoperative evaluation revealed that the lesion and dilated bile ducts were confined to the right liver,with right hepatic atrophy,left hepatic hypertrophy,and hilar translocation.This problem can be resolved by performing a standard right hepatectomy.Although the operation went well,jaundice occurred soon after the operation.Iatrogenic bile duct injury was considered after magnetic resonance cholangiopancreatography review,and the second operation were performed 10 d later.During the second operation,it was found that the endo-GIA had damaged the lateral wall of the hepatic duct and multiple titanium nails remained in the bile duct wall.This led to severe stenosis of the duct wall,and could not be repaired.Therefore,the injured bile duct was transected,and a hepatic-jejunal-lateral Roux-Y anastomosis was performed at the healthy part of the left hepatic duct.After this surgery,the patient had a smooth postoperative recovery,and the total bilirubin gradually decreased to normal.The patient was discharged 41 d after operation.No anastomotic stenosis was found at the 6 mo of follow-up.CONCLUSION Not all cases are suitable for endo-GIA transection of Glissonean pedicle,especially in cases of intrahepatic bile duct lesions.PHBDI caused by endo-GIA is very difficult to repair due to extensive ischemia,which requires special attention.

肝移植术后胆道吻合口狭窄的诊疗进展

近年来,随着器官保存、手术技术、围手术期管理及免疫抑制方案的发展,肝移植手术成功率和受者生存率明显提高,已成为终末期肝病患者的最佳治疗方案。但胆道并发症依然是肝移植术后常见的并发症,尤其是胆道吻合口狭窄,严重的胆道吻合口狭窄不仅会增加治疗成本,还会导致移植物丢失,甚至影响受者生存率。因此,胆道吻合口狭窄的及时诊断和治疗对于提高肝移植术后受者生存率至关重要。本文就肝移植术后胆道吻合口狭窄的危险因素、临床症状、诊断及治疗进行综述,以期为肝移植术后胆道吻合口狭窄的研究和诊疗提供新的思路,进一步提高肝移植手术效果和受者生存质量。

大鼠原位肝移植解剖重建研究进展

大鼠肝移植模型的构建,为解决临床肝移植术后并发症及围手术期治疗等问题提供了理想的动物模型。随着对大鼠肝移植模型建立的深入研究,逐渐形成了经典的“二袖套”法。然而,在移植手术过程中,手术视野差、血管扭转、胆道损伤和无肝期较长等问题仍是传统方法无法避免的。目前国内外大鼠肝移植模型改进方式主要围绕肝上下腔静脉、门静脉、肝下下腔静脉和胆管这4个重要解剖结构的重建展开。为此,本文就肝上下腔静脉、门静脉、肝下下腔静脉和胆管重建领域的最新进展进行整理总结,以便为大鼠肝移植模型的构建提供参考,促进肝移植技术的进一步发展。

Iatrogenic bile duct injuries:Etiology,diagnosis and management

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

医源性胆管损伤的治疗进展

医源性胆管损伤(IBDI)指由于治疗过程中医源性因素如外科手术或其他有创性诊疗操作意外造成的胆管损伤。随着外科手术及微创技术的日渐成熟,现关于胆管损伤的治疗方式包括内镜治疗、胆管空肠Roux-en-Y吻合术、胆管对端吻合术、肝切除术及肝移植术等。针对IBDI,选择合理及有效的治疗方式是目前胆道外科的重点与难点。通过系统性回顾目前有关IBDI治疗的文献,对IBDI不同治疗方式进一步分析及总结。

腹腔镜联合一期吻合术对胆囊合并胆总管结石的疗效

目的对临床胆囊合并胆总管结石患者,应用腹腔镜联合一期吻合术治疗效果进行研究。方法研究样本,来源于太仓市第一人民医院确诊胆囊合并胆总管结石患者,共计100例,搜集时间2018年1月—2021年10月,按随机数字表法进行分组,接受常规开腹手术(n=40)患者纳入对照组,接受腹腔镜联合胆道镜胆总管一期吻合术(n=60)患者纳入研究组,对比两组最后临床效果。结果研究组手术时间、胃肠道功能恢复时间、引流时间短于对照组,差异有统计学意义(P<0.05);研究组治疗总有效率高于对照组,差异有统计学意义(P<0.05);研究组并发症发生率较对照组较低,差异有统计学意义(P<0.05)。结论胆囊合并胆总管结石患者的临床治疗方案,以腹腔镜联合胆道镜为主,同时在结合患者个体情况取石完整的情况下行胆总管一期吻合术,在缩短手术、胃肠道功能恢复,以及引流时间方面效果明显,促进患者治疗效果提升基础上,减少出现并发症的可能。

不同胆道引流方式在胆道再手术患者中的应用效果分析

目的:探讨不同胆道引流方式在胆道再手术患者中的应用效果。方法:选取2012年1月—2022年1月诸城市昌城卫生院收治的116例胆道再手术患者作为研究对象,以计算机随机分组法分为对照组与试验组,各58例。试验组实施胆道外引流,对照组实施胆道内引流。比较两组治疗效果、并发症发生情况、炎性因子水平、生活质量。结果:试验组治疗总有效率高于对照组,差异有统计学意义(P=0.015)。试验组并发症发生率低于对照组,差异有统计学意义(P=0.009)。术前,两组C反应蛋白(CRP)、白细胞计数(WBC)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF)水平比较,差异无统计学意义(P>0.05);术后,试验组CRP、WBC、IL-6、TNF水平均低于对照组,差异有统计学意义(P<0.001)。术前,两组各项生活质量评分比较,差异无统计学意义(P>0.05);出院时,试验组各项生活质量评分均高于对照组,差异有统计学意义(P<0.001)。结论:胆道内引流在胆道再手术患者中的应用效果优于胆道外引流,可提高治疗效果,减少并发症,降低炎性因子水平,提高生活质量。

749例肝内胆管结石外科治疗的临床分析

１９８３年１月至１９９４年１２月共手术治疗肝内胆管结石７４９例，其中左肝内胆管结石３４７例（４６．３３％）．肝胆管狭窄占６４．８２％，肝胆管癌占１．４７％。肝叶或肝段切除３７３例（４９．８０％），其中左肝叶或肝段切除占８９．９１％。在各术式中，肝叶或肝段切除优于其它术式，效果相差非常显著（Ｐ＜０．００５）。术后残石率较高，占３０．２５％，但左肝内胆管结石和肝叶或肝段切除后残石率较低，分别为１９．０２％和１９．９４％。肝叶或肝段切除术后并发膈下感染和胆瘘较多，重视其发生原因、加强预防措施，将会明显降低发生率。

胆管空肠Roux-Y吻合术后胆道感染发生的原因

目的探讨胆管空肠Roux-Y吻合术后胆道感染的发生率及其原因。方法回顾研究1997年7月~2004年10月行胆管空肠Roux-Y吻合术62例,以及12例既往行胆管空肠Roux-Y吻合术,因胆道感染入我院再次手术的病例资料。结果62例中7例（占11.3%）出现术后胆道感染,平均随访44.1月,4例再手术,均发现胆管空肠Roux-Y吻合口狭窄。有吻合口直径资料56例,吻合口直径≤2.0 cm的20例中5例（占25.0%）出现术后胆道感染;直径〉2.0 cm,36例中仅1例（占2.8%）出现胆道感染。在12例胆管空肠吻合术后胆道感染再次手术病例中,发现原吻合口狭窄8例（占66.7%）,吻合口以上胆管狭窄3例,1例空肠失功肠襻胆石性肠梗阻。结论胆管空肠Roux-Y吻合术后胆道感染的发生率较低;胆道引流不畅是胆管空肠Roux-Y吻合术后发生胆道感染的主要原因,吻合口狭窄是术后胆道引流不畅的重要因素。

部分肝切除术与胆肠吻合术治疗肝内胆管结石的效果比较(附1025例分析)

目的总结并评价部分肝切除术在治疗肝内胆管结石病中的价值。方法回顾性分析1995年1月～2009年12月我院1025例肝内胆管结石的术后并发症、结石残留率及复发率的情况,评价部分肝切除术在治疗肝内胆管结石病中的安全性和有效性。结果本组1025例中687例(67.02%)行部分肝切除术,338例(22.98%)单纯行胆肠吻合术。术后并发腹腔感染53例(5.17%),胆漏34例(3.32%),胆道出血7例(0.68%),重症急性胆管炎7例(0.68%),术后死亡5例(0.49%)。行部分肝切除术组并发症的发生率与单纯行胆肠吻合术组比较差异无统计学意义(P>0.05)。两手术组结石残留率分别为6.11%和19.82%,结石复发率分别为18.63%和33.43%,部分肝切除术组的结石残留率和复发率均显著低于单纯行胆肠吻合术组(P<0.05)。结论部分肝切除术是治疗肝内胆管结石的安全、有效的手段,具有良好的近、远期疗效。

医源性胆管损伤18例个体化处理经验及教训

目的总结医源性胆管损伤个体化治疗的临床疗效、经验及教训。方法收集我院2005年1月至2013年12月收治的18例医源性胆道损伤患者的病例资料,对其临床特点、损伤类型、手术时机及方式、手术疗效进行回顾性分析分析。结果 18例患者参照Bismuthi-Strasberg分型标准。A型2例、C型1例均行局部缝扎或修补。D型4例,分别行胆管修补、或T管引流、ERCP+ENBD术。E1型3例,2例行胆管端端吻合术,其中1例术后出现胆漏、腹水,PTC提示吻合口断裂,经腹腔引流3个月后行肝肠吻合术;另1例行胆肠吻合术。其余E2型5例,E3型2例,E4型1例均行胆肠吻合术。结论明确病理损伤的类型是医源性胆管损伤修复的前提,根据患者的表现及身体状况制定个体化的修复方案,注重手术方法及细节,可提高手术疗效。

四种胆道姑息性引流手术的疗效比较

目的:应用4种胆道姑息引流手术处理恶性梗阻性黄疸病人的疗效比较。方法:收集1997年1月至2006年12月我院收治的153例因各种原因而分别行胆管T管外引流术、胆囊空肠Roux-en-Y吻合术、胆管空肠Roux-en-Y吻合术及胆管空肠T管架桥内引流术的恶性梗阻性黄疸病人,对4种胆道姑息引流手术的手术时间、术中出血量、手术退黄效果、肝功能恢复情况、手术死亡率、并发症率、术后住院天数、住院费用、术后生活质量以及病人生存期进行比较分析。结果:本组获随访者123人,随访率为80.39%。胆管空肠T管架桥内引流术组在平均手术时间[(100.31±34.29)min]、术中平均出血量[(223.97±120.79)ml]、术后平均住院天数(17.84±8.30d)和平均住院费用(22836.6±14112.24元)方面均显著低于胆管空肠Roux-en-Y吻合术组,而同胆管T管外引流术组和胆囊空肠Roux-en-Y吻合术组比较无显著性差异。4种胆道姑息引流手术在退黄效果、肝功能恢复、手术死亡率和并发症率方面经统计学检验亦无显著性差异。结论:胆管空肠T管架桥内引流术兼具T管外引流手术与胆肠内引流手术的优点,具有疗效确切、操作简便、手术创伤小、恢复快等特点。尤其适用于高龄和术前一般情况较差无法耐受长时间手术的病人。

成人先天性胆管囊状扩张症52例诊治经验

目的探讨成人先天性胆管囊状扩张症的诊断治疗经验。方法回顾性分析我院2006年7月至2011年8月间收治的成人先天性胆管囊状扩张症52例的临床资料。结果本组52例的临床表现为:腹痛45例(86.5%),黄疸18例(34.6%)、腹部包块7例(13.5%)。所有患者均接受超声检查,其中47例显示胆总管囊肿或扩张。36例行CT检查,22例行ERCP检查获得确诊。手术方式主要为囊肿切除,胆管空肠Roux-Y行吻合胆道重建术,具体操作因胆管扩张症分型稍有差异。术后并发症主要为胆道感染,经抗生素治疗后痊愈。全组无手术死亡病例,术后囊肿发生癌变2例。结论成人先天性胆管扩张症常见临床表现为腹痛、黄疸、腹部包块。B超、CT、ERCP等影像学检查是其术前诊断的重要手段。手术方式采用囊肿切除、胆管空肠Roux-Y行吻合胆道重建术。

胆肠Roux-en-Y吻合术在胆道再次手术中的应用

目的探讨胆肠Roux—en／一Y吻合术在再次胆道手术中的应用。方法对2005年1月-2012年5月我院再次胆道手术中行胆肠Roux—en—Y吻合的临床病例资料做回顾性分析。结果130例围手术期无死亡病例，术后并发伤口感染2例，胆漏、肠瘘、胰瘘各1例，经保守治疗后，均治愈。结论胆肠Roux—en—Y吻合是复杂、再次胆道手术重要的手术方式，但直该严格掌握其适应症及注意事项。

移行吻合术治疗肝门部良性胆管狭窄的实验研究

目的探索"移行吻合术"治疗肝门部胆管良性狭窄的新术式,探讨肝门部胆管良性狭窄进行"移行吻合术"的理论基础与实际应用可行性.方法小型猪30头随机分为:A、B、C 3组.A组(对照组)于十二指肠上缘分离出一段长约2 cm的胆总管;B组分离胆总管同A组,然后以钳夹、电热等方法制造胆管组织物理损伤;C组制造胆管损伤同B组,术后监测小型猪的饮食二便,ALT,AST和胆红素等指标,待狭窄形成后再次开腹行移行吻合术.术后观察饮食、精神状态及尿液颜色,术前和术后1 d及术后每7 d测ALT、AST、T-BIL、D-BIL,全部手术完成3个月后处死,取部分肝组织,并用液氮保存,待做病理检查.结果从术前到术后30 d,A组ALT、AST、T-BIL、D-BIL等指标无明显变化,B组、C组相关指标均有明显变化(P<0.05).B组术后21d的ALT、AST、T-BIL、D-BIL较术前及术后14 d明显升高(P<0.05).C组行移行吻合术后,各项指标在移行吻合术后14、21 d较移行吻合前明显减低(P<0.05).结论 "移行吻合术"治疗小型猪肝门部胆管良性狭窄是切实可行的,为临床以"移行吻合术"治疗肝门部胆管狭窄提供了实验基础.