Background:Hepatolithiasis after hepatic portoenterostomy for biliary atresia has been paid little attention,with only 22 reported cases. Patients and Methods:Fifteen patients underwent living-related liver transplant...Background:Hepatolithiasis after hepatic portoenterostomy for biliary atresia has been paid little attention,with only 22 reported cases. Patients and Methods:Fifteen patients underwent living-related liver transplantation for biliary atresia after hepatic portoenterostomy in our hospital between 1998 and 2004. The resected livers were examined for the existence and location of hepatolithiasis,composition of the calculi,and bacterial infection of bile. The relation between a history of cholangitis and the presence of hepatolithiasis was analyzed. Results:Intrahepatic calculi were found in 8 (53% ) of 15 patients. The calculi consisted of almost 100% calcium bilirubinate. Calculi were found in bile lakes in 8 patients. Bacteria were present in the bile in 8 (53% ) of the 15 patients. Of the 8 patients,7 (88% ) had a history of ascending cholangitis. Conclusions:Hepatolithiasis occurs after hepatic portoenterostomy for biliary atresiamore frequently than previously thought. Bile stasis and possibly bile infection are the main causes of calculi formation.展开更多
AIM： To evaluate the long-term outcome and surgical indications of hepaticojejunostomy （H J） for the treatment of hepatolithiasis. METHODS- Three hundred and fourteen elective cases with hepatolithiasis but without...AIM： To evaluate the long-term outcome and surgical indications of hepaticojejunostomy （H J） for the treatment of hepatolithiasis. METHODS- Three hundred and fourteen elective cases with hepatolithiasis but without biliary stricture or cystic dilatation treated in the past 10 years were reviewed retrospectively. The patients were divided into HJ group and T tube drainage group according to biliary drainage procedure. Furthermore, four subgroups were subdivided by hepatectomy as a balance factor, group A1： hepatectomy＋HJ; group A2： choledochoctomy＋HJ; group B1： hepatectomy ＋ choledochoctomy T tube drainage; group B2： choledochoctomy ＋ T tube drainage. The stone residual rate, surgical efficacy and long-term outcome were compared among different procedures. RESULTS： There was no surgical mortality among all patients. The total hospital mortality was 1.6%. The overall stone residual rate after surgical clearance was 25.9%. There was no statistical difference between HJ group and T tube drainage group in terms of stone residual rate after surgical clearance, however, after postoperative choledochoscopic lithotripsy, the total stone residual rate of T tube drainage group was significantly lower than that of HJ group （0.5% vs 16.7%, P 〈 0.01）. Hepatectomy ＋ choledochoctomy tube drainage achieved the optimal therapeutic effect, only 8.2% patients suffered from an attack of cholangitis postoperatively, which was significantly lower than that of hepatectomy ＋ HJ （8.2% vs 22.0%, P = 0.034）. The major reason for postoperative cholangitis was stone residual in the HJ group （16/23, 70.0%）, and stone recurrence in the T tube drainage group （34/35, 97.1%）. The operative times were significantly prolonged in those undergoing HJ, and the operative morbidity of HJ was higher than those of T tube drainage. CONCLUSION： The treatment result of HJ for hepatolithiasis is not satisfactory in this retrospective study due to high rate of stone residual and postoperative cholangi- tis. HJ could not drain residual stone effectively. HJ may hinder post-operative choledochoscopic lithotripsy, which is the optimal management for postoperative residual stone. The indications of HJ for hepatolithiasis should be strictly selected.展开更多
Biloma is an encapsulated bile collection outside the biliary tree due to a bile leak. It is occasionally found following traumatic liver injury or iatrogenic injury to the biliary tract, induced either during an endo...Biloma is an encapsulated bile collection outside the biliary tree due to a bile leak. It is occasionally found following traumatic liver injury or iatrogenic injury to the biliary tract, induced either during an endoscopic or surgical procedure. It is a rare complication of transcatheter arterial embolization (TAE). Although biloma can be shrunk by appropriate aspiration or drainage in majority of cases,we report a case of intrahepatic biloma following repeated TAE for hepatocellular carcinoma (HCC) and complicated by infection and intrahepatic stones. This particular constellation of problems has not been reported before and the intrahepatic stones need to be removed by percutaneous procedure.展开更多
AIM： To evaluate the efficacy of hilar duct oriented hepatectomy for intractable hepatolithiasis, the ventral hilum exposure （VHE） method that has been applied by the authors. METHODS： From June 1994 to June 2004 ...AIM： To evaluate the efficacy of hilar duct oriented hepatectomy for intractable hepatolithiasis, the ventral hilum exposure （VHE） method that has been applied by the authors. METHODS： From June 1994 to June 2004 for a period of 10 years, 153 patients who had Tsunoda type Ⅲ or Ⅳ hepatolithiasis, received hepatectomy at our institution. Among these patients, 128 who underwent hepatectomy by the VHE method were the subjects for the study. We analyzed the risk of this procedure, residual rate of intrahepatic stones, and stone recurrent rates. RESULTS： The average age was 54.2 years, and the male to female ratio was 1：1.7. The average follow-up period was 25.6 mo （6-114 too）. There was no postoperative severe complication or mortality after the operation. The rate of residual stones was 5.4% and the rate of recurrent stones was 4.2%. CONCLUSION： VHE is a safe surgical procedure and provides favorable treatment results of intractable hepatolithiasis. Especially, this procedure has advantage in that intra-hepatic bile duct stricture may be confirmed and corrected directly during surgery.展开更多
AIM: To investigate the existence and significance of hepatitis B virus (HBV) DNA in the pathogenesis of IgA nephropathy(IgAN).METHODS: Fifty cases of IgAN with HBV antigenaemia and/or hepatitis B virus antigens (HBAg...AIM: To investigate the existence and significance of hepatitis B virus (HBV) DNA in the pathogenesis of IgA nephropathy(IgAN).METHODS: Fifty cases of IgAN with HBV antigenaemia and/or hepatitis B virus antigens (HBAg, or HBsAg, HBcAg)detected by immunohistochemistry in renal tissues were enrolled in our study. The distribution and localization of HBV DNA were observed using in situ hybridization.Southern blot analysis was performed to reveal the state of renal HBV DNA.RESULTS: Among the 50 patients with IgAN, HBs antigenemia was detected in 17 patients (34%). HBAg in renal tissues was detected in 48 patients (96%), the positive rate of HBAg, HBsAg, and HBcAg was 82% (41/50), 58% (29/50),and 42% (21/50) in glomeruli, respectively; and was 94%(47/50), 56% (28/50) and 78% (39/50) in tubular epithelia,respectively. Positive HBV DNA was detected in 72% (36/50)and 82% (41/50) cases in tubular epithelia and glomeruli respectively by in Situ hybridization, and the positive signals were localized in the nuclei of tubular epithelial cells and glomerular mesangial cells as well as infiltrated interstitial lymphocytes. Moreover, 68% (34/50) cases were proved to be HBV DNA positive by Southern blot analysis, and all were the integrated form.CONCLUSION: HBV infection might play an important role in occurrence and progress of IgAN. In addition to humoral immune damages mediated by HBAg-HBAb immune complex,renal tissues of some IgAN are directly infected with HBV and express HBAg in situ, and the cellular mechanism mediated by HBV originating from renal cells in situ may also be involved in the pathogenesis of IgAN.展开更多
Objective To evaluate the combined surgical therapy for calculi of intrahepatic duct. Methods One hundred and eight cases of hepatolithiasis treated in our hospital from January 1986 to September 2003 were summarized ...Objective To evaluate the combined surgical therapy for calculi of intrahepatic duct. Methods One hundred and eight cases of hepatolithiasis treated in our hospital from January 1986 to September 2003 were summarized and analyzed retrospectively. The primary surgery included 57 cases of biliary tract exploration and cholangiolithotomy, 26 cases of cholangiojejunostomy, and 25 cases of partial hepatectomy. Of these cases, 156 operations were performed totally. There were 36 patients undergoing two or more operations for cholangiolithiasis problem. Fiberoptic choledochoscopy was employed to examine and remove the residual stones during and after operation in all cases. Results The residual stone rates were 57.89% (33/57), 26.92% (7/26), and 24.0% (6/25) for biliary tract exploration and cholangiolithotomy, cholangiojejunostomy, and partial hepatectomy, respectively. Fiberoptic choledochoscopy was utilized pre- and post-operatively for each patient, which was performed 2 to 9 times on each case. Following the combined treatment, the rate of residual stone after operation decreased to 12.96% (14/108). Conclusions The combined surgical therapy is valuable for resolving the problem of hepatolithiasis in most of the patients. Regarding the clinical outcomes of different surgical procedures, partial hepatectomy is superior to cholangiojejuno- stomy or biliary tract exploration and cholangiolithotomy. Fiberoptic choledochoscopy is also important to reduce the occurrence of residual stones and the rate of reoperation.展开更多
Heidan disease(black jaundice)is a kind of jaundice,which is caused by lingering and chronic jaundice,often with blood stasis and damp-heat,etc.The clinical symptoms of Heidan disease(black jaundice)are similar to tho...Heidan disease(black jaundice)is a kind of jaundice,which is caused by lingering and chronic jaundice,often with blood stasis and damp-heat,etc.The clinical symptoms of Heidan disease(black jaundice)are similar to those of cirrhosis caused by multiple chronic liver diseases in Western medicine.Heidan disease(black jaundice)generally belongs to yin jaundice type,and the pathogenesis is mostly related to blood stasis and dampness stagnation,often with damp-heat residue.According to Zhongjing Zhang,the prescription Xiaoshi Fanshi powder for the treatment of Heidan disease(black jaundice)is based on the understanding that the nature of Heidan disease(black jaundice)is inseparable from the two key pathological factors of dampness and blood stasis.The treatment of jaundice should be based on removing blood stasis and dampness,supplemented by soothing the liver and promoting the transportation function of spleen,removing blood stasis and harmonizing the collaterals,and promoting diuresis and reducing jaundice.In the treatment of jaundice,removing blood stasis and purging turbidity should be stressed,and powerful tonification should be used with caution.Since blood stasis and turbidity are always intermingling and often complicated with damp heat,the method of warm drying should be used with caution.For promoting blood circulation,removing blood stasis,and dredging the liver-biliarycollaterals,drasticmedicine shouldbeused withcaution.展开更多
文摘Background:Hepatolithiasis after hepatic portoenterostomy for biliary atresia has been paid little attention,with only 22 reported cases. Patients and Methods:Fifteen patients underwent living-related liver transplantation for biliary atresia after hepatic portoenterostomy in our hospital between 1998 and 2004. The resected livers were examined for the existence and location of hepatolithiasis,composition of the calculi,and bacterial infection of bile. The relation between a history of cholangitis and the presence of hepatolithiasis was analyzed. Results:Intrahepatic calculi were found in 8 (53% ) of 15 patients. The calculi consisted of almost 100% calcium bilirubinate. Calculi were found in bile lakes in 8 patients. Bacteria were present in the bile in 8 (53% ) of the 15 patients. Of the 8 patients,7 (88% ) had a history of ascending cholangitis. Conclusions:Hepatolithiasis occurs after hepatic portoenterostomy for biliary atresiamore frequently than previously thought. Bile stasis and possibly bile infection are the main causes of calculi formation.
文摘AIM： To evaluate the long-term outcome and surgical indications of hepaticojejunostomy （H J） for the treatment of hepatolithiasis. METHODS- Three hundred and fourteen elective cases with hepatolithiasis but without biliary stricture or cystic dilatation treated in the past 10 years were reviewed retrospectively. The patients were divided into HJ group and T tube drainage group according to biliary drainage procedure. Furthermore, four subgroups were subdivided by hepatectomy as a balance factor, group A1： hepatectomy＋HJ; group A2： choledochoctomy＋HJ; group B1： hepatectomy ＋ choledochoctomy T tube drainage; group B2： choledochoctomy ＋ T tube drainage. The stone residual rate, surgical efficacy and long-term outcome were compared among different procedures. RESULTS： There was no surgical mortality among all patients. The total hospital mortality was 1.6%. The overall stone residual rate after surgical clearance was 25.9%. There was no statistical difference between HJ group and T tube drainage group in terms of stone residual rate after surgical clearance, however, after postoperative choledochoscopic lithotripsy, the total stone residual rate of T tube drainage group was significantly lower than that of HJ group （0.5% vs 16.7%, P 〈 0.01）. Hepatectomy ＋ choledochoctomy tube drainage achieved the optimal therapeutic effect, only 8.2% patients suffered from an attack of cholangitis postoperatively, which was significantly lower than that of hepatectomy ＋ HJ （8.2% vs 22.0%, P = 0.034）. The major reason for postoperative cholangitis was stone residual in the HJ group （16/23, 70.0%）, and stone recurrence in the T tube drainage group （34/35, 97.1%）. The operative times were significantly prolonged in those undergoing HJ, and the operative morbidity of HJ was higher than those of T tube drainage. CONCLUSION： The treatment result of HJ for hepatolithiasis is not satisfactory in this retrospective study due to high rate of stone residual and postoperative cholangi- tis. HJ could not drain residual stone effectively. HJ may hinder post-operative choledochoscopic lithotripsy, which is the optimal management for postoperative residual stone. The indications of HJ for hepatolithiasis should be strictly selected.
文摘Biloma is an encapsulated bile collection outside the biliary tree due to a bile leak. It is occasionally found following traumatic liver injury or iatrogenic injury to the biliary tract, induced either during an endoscopic or surgical procedure. It is a rare complication of transcatheter arterial embolization (TAE). Although biloma can be shrunk by appropriate aspiration or drainage in majority of cases,we report a case of intrahepatic biloma following repeated TAE for hepatocellular carcinoma (HCC) and complicated by infection and intrahepatic stones. This particular constellation of problems has not been reported before and the intrahepatic stones need to be removed by percutaneous procedure.
文摘AIM： To evaluate the efficacy of hilar duct oriented hepatectomy for intractable hepatolithiasis, the ventral hilum exposure （VHE） method that has been applied by the authors. METHODS： From June 1994 to June 2004 for a period of 10 years, 153 patients who had Tsunoda type Ⅲ or Ⅳ hepatolithiasis, received hepatectomy at our institution. Among these patients, 128 who underwent hepatectomy by the VHE method were the subjects for the study. We analyzed the risk of this procedure, residual rate of intrahepatic stones, and stone recurrent rates. RESULTS： The average age was 54.2 years, and the male to female ratio was 1：1.7. The average follow-up period was 25.6 mo （6-114 too）. There was no postoperative severe complication or mortality after the operation. The rate of residual stones was 5.4% and the rate of recurrent stones was 4.2%. CONCLUSION： VHE is a safe surgical procedure and provides favorable treatment results of intractable hepatolithiasis. Especially, this procedure has advantage in that intra-hepatic bile duct stricture may be confirmed and corrected directly during surgery.
基金Supported by the National Natural Science Foundation of China, NO.39770292
文摘AIM: To investigate the existence and significance of hepatitis B virus (HBV) DNA in the pathogenesis of IgA nephropathy(IgAN).METHODS: Fifty cases of IgAN with HBV antigenaemia and/or hepatitis B virus antigens (HBAg, or HBsAg, HBcAg)detected by immunohistochemistry in renal tissues were enrolled in our study. The distribution and localization of HBV DNA were observed using in situ hybridization.Southern blot analysis was performed to reveal the state of renal HBV DNA.RESULTS: Among the 50 patients with IgAN, HBs antigenemia was detected in 17 patients (34%). HBAg in renal tissues was detected in 48 patients (96%), the positive rate of HBAg, HBsAg, and HBcAg was 82% (41/50), 58% (29/50),and 42% (21/50) in glomeruli, respectively; and was 94%(47/50), 56% (28/50) and 78% (39/50) in tubular epithelia,respectively. Positive HBV DNA was detected in 72% (36/50)and 82% (41/50) cases in tubular epithelia and glomeruli respectively by in Situ hybridization, and the positive signals were localized in the nuclei of tubular epithelial cells and glomerular mesangial cells as well as infiltrated interstitial lymphocytes. Moreover, 68% (34/50) cases were proved to be HBV DNA positive by Southern blot analysis, and all were the integrated form.CONCLUSION: HBV infection might play an important role in occurrence and progress of IgAN. In addition to humoral immune damages mediated by HBAg-HBAb immune complex,renal tissues of some IgAN are directly infected with HBV and express HBAg in situ, and the cellular mechanism mediated by HBV originating from renal cells in situ may also be involved in the pathogenesis of IgAN.
文摘Objective To evaluate the combined surgical therapy for calculi of intrahepatic duct. Methods One hundred and eight cases of hepatolithiasis treated in our hospital from January 1986 to September 2003 were summarized and analyzed retrospectively. The primary surgery included 57 cases of biliary tract exploration and cholangiolithotomy, 26 cases of cholangiojejunostomy, and 25 cases of partial hepatectomy. Of these cases, 156 operations were performed totally. There were 36 patients undergoing two or more operations for cholangiolithiasis problem. Fiberoptic choledochoscopy was employed to examine and remove the residual stones during and after operation in all cases. Results The residual stone rates were 57.89% (33/57), 26.92% (7/26), and 24.0% (6/25) for biliary tract exploration and cholangiolithotomy, cholangiojejunostomy, and partial hepatectomy, respectively. Fiberoptic choledochoscopy was utilized pre- and post-operatively for each patient, which was performed 2 to 9 times on each case. Following the combined treatment, the rate of residual stone after operation decreased to 12.96% (14/108). Conclusions The combined surgical therapy is valuable for resolving the problem of hepatolithiasis in most of the patients. Regarding the clinical outcomes of different surgical procedures, partial hepatectomy is superior to cholangiojejuno- stomy or biliary tract exploration and cholangiolithotomy. Fiberoptic choledochoscopy is also important to reduce the occurrence of residual stones and the rate of reoperation.
基金supported by the National Natural Science Foundation of China(81403407)Special Program of the International Cooperation in Chinese Medicine of the State Administration of Traditional Chinese Medicine(China-Australia Chinese Medicine Center[Melbourne]GZYYGJ2021024)。
文摘Heidan disease(black jaundice)is a kind of jaundice,which is caused by lingering and chronic jaundice,often with blood stasis and damp-heat,etc.The clinical symptoms of Heidan disease(black jaundice)are similar to those of cirrhosis caused by multiple chronic liver diseases in Western medicine.Heidan disease(black jaundice)generally belongs to yin jaundice type,and the pathogenesis is mostly related to blood stasis and dampness stagnation,often with damp-heat residue.According to Zhongjing Zhang,the prescription Xiaoshi Fanshi powder for the treatment of Heidan disease(black jaundice)is based on the understanding that the nature of Heidan disease(black jaundice)is inseparable from the two key pathological factors of dampness and blood stasis.The treatment of jaundice should be based on removing blood stasis and dampness,supplemented by soothing the liver and promoting the transportation function of spleen,removing blood stasis and harmonizing the collaterals,and promoting diuresis and reducing jaundice.In the treatment of jaundice,removing blood stasis and purging turbidity should be stressed,and powerful tonification should be used with caution.Since blood stasis and turbidity are always intermingling and often complicated with damp heat,the method of warm drying should be used with caution.For promoting blood circulation,removing blood stasis,and dredging the liver-biliarycollaterals,drasticmedicine shouldbeused withcaution.
