AIM: To explore the mechanism of benign biliary stricture.METHODS: A model of trauma of bile duct was established in 28 dogs. The anastomosed tissues were resected and examined by light and electron microscopes on day...AIM: To explore the mechanism of benign biliary stricture.METHODS: A model of trauma of bile duct was established in 28 dogs. The anastomosed tissues were resected and examined by light and electron microscopes on day 3, in wk 1, 3 and mo 3, 6 after operation. CD68, TGF-β1 and α-SMA were examined by immunohistochemical staining, respectively.RESULTS: The mucosal epithelium of the bile duct was slowly recovered, chronic inflammation lasted for a long time,fibroblasts proliferated actively, extracellular matrix was over-deposited. Myofibroblasts functioned actively and lasted through the whole process. The expression of macrophages in lamina propria under mucosa, TGF-β1 in granulation tissue,fibroblasts and endothelial cells of blood vessels, α-SMA in myofiroblasts were rather strong from the 1st wk to the 6th mo after operation.CONCLUSION: The type of healing occurring in bile duct belongs to overhealing. Myofibroblasts are the main cause for scar contracture and stricture of bile duct. High expressions of CD68, TGF-β1 and α-SMA are closely related to the active proliferation of fibroblasts, extracellular matrix overdeposition and scar contracture of bile duct.展开更多
A 68-year-old man underwent cholecystectomy and choledochoduodenostomy for biliary obstruction and nephrectomy for a renal tumor. Based on clinical and histopathologic findings, autoimmune pancreatitis (AIP) was diagn...A 68-year-old man underwent cholecystectomy and choledochoduodenostomy for biliary obstruction and nephrectomy for a renal tumor. Based on clinical and histopathologic findings, autoimmune pancreatitis (AIP) was diagnosed. The renal tumor was diagnosed as a renal cell cancer. Steroid therapy was started and thereafter pancreatic inflammation improved. Five years after surgery, the patient was readmitted because of pyrexia in a preshock state. A Klebsiella pneumoniae liver abscess complicated by sepsis was diagnosed. The patient recovered with percutaneous abscess drainage and administration of intravenous antibiotics. Liver abscess recurred 1 mo later but was successfully treated with antibiotics. There has been little information on long-term outcomes of patients with AIP treated with surgery. To our knowledge, this is the second case of liver abscess after surgical treatment of AIP.展开更多
AIM To compare the outcomes of preoperative endoscopic nasobiliary drainage(ENBD) and endoscopic retrograde biliary drainage(ERBD) in patients with malignant distal biliary obstruction prior to pancreaticoduodenectomy...AIM To compare the outcomes of preoperative endoscopic nasobiliary drainage(ENBD) and endoscopic retrograde biliary drainage(ERBD) in patients with malignant distal biliary obstruction prior to pancreaticoduodenectomy(PD). METHODS Data from 153 consecutive patients who underwent preoperative endoscopic biliary drainage prior to PD between January 2009 and July 2016 were analyzed. we compared the clinical data, procedure-related complications of endoscopic biliary drainage(EBD) and postoperative complications of PD between the ENBD and ERBD groups. Univariate and multivariate analyses with odds ratios(ORs) and 95% confidence intervals(95%CIs) were used to identify the risk factors for deep abdominal infection after PD.RESULTS One hundred and two(66.7%) patients underwent ENBD, and 51(33.3%) patients underwent ERBD. Endoscopic sphincterotomy was less frequently performed in the ENBD group than in the ERBD group(P = 0.039); the EBD duration in the ENBD group was shorter than that in the ERBD group(P = 0.036). After EBD, the levels of total bilirubin(TB) and alanine aminotransferase(ALT) were obviously decreased in both groups, and the decreases of TB and ALT in the ERBD group were greater than those in the ENBD group(P = 0.004 and P = 0.000, respectively). However,the rate of EBD procedure-related cholangitis was significantly higher in the ERBD group than in the ENBD group(P = 0.007). The postoperative complications of PD as graded by the Clavien-Dindo classification system were not significantly different between the two groups(P = 0.864). However, the incidence of deep abdominal infection after PD was significantly lower in the ENBD group than in the ERBD group(P = 0.019). Male gender(OR = 3.92; 95%CI: 1.63-9.47; P = 0.002), soft pancreas texture(OR = 3.60; 95%CI: 1.37-9.49; P = 0.009), length of biliary stricture(≥ 1.5 cm)(OR = 5.20; 95%CI: 2.23-12.16; P = 0.000) and ERBD method(OR = 4.08; 95%CI: 1.69-9.87; P = 0.002) were independent risk factors for deep abdominal infection after PD.CONCLUSION ENBD is an optimal method for patients with malignant distal biliary obstruction prior to PD. ERBD is superior to ENBD in terms of patient tolerance and the effect of biliary drainage but is associated with an increased risk of EBD procedure-related cholangitis and deep abdominal infection after PD.展开更多
AIM To investigate the factors predictive of failure when placing a second biliary self-expandable metallic stents(SEMSs). METHODS This study evaluated 65 patients with an unresectable malignant hilar biliary obstruct...AIM To investigate the factors predictive of failure when placing a second biliary self-expandable metallic stents(SEMSs). METHODS This study evaluated 65 patients with an unresectable malignant hilar biliary obstruction who were examined in our hospital. Sixty-two of these patients were recruited to the study and divided into two groups: the success group, which consisted of patients in whom a stent-in-stent SEMS had been placed successfully, and the failure group, which consisted of patients in whom the stent-in-stent SEMS had not been placed successfully. We compared the characteristics of the patients, the stricture state of their biliary ducts, and the implemented endoscopic retrograde cholangiopancreatography(ERCP) procedures between the two groups.RESULTS The angle between the target biliary duct stricture and the first implanted SEMS was significantly larger in the failure group than in the success group. There were significantly fewer wire or dilation devices(ERCP catheter, dilator, or balloon catheter) passing the first SEMS cell in the failure group than in the success group. The cut-off value of the angle predicting stent-in-stent SEMS placement failure was 49.7 degrees according to the ROC curve(sensitivity 91.7%, specificity 61.2%). Furthermore, the angle was significantly smaller in patients with wire or dilation devices passing the first SEMS cell than in patients without wire or dilation devices passing the first SEMS cell. CONCLUSION A large angle was identified as a predictive factor for failure of stent-in-stent SEMS placement.展开更多
文摘AIM: To explore the mechanism of benign biliary stricture.METHODS: A model of trauma of bile duct was established in 28 dogs. The anastomosed tissues were resected and examined by light and electron microscopes on day 3, in wk 1, 3 and mo 3, 6 after operation. CD68, TGF-β1 and α-SMA were examined by immunohistochemical staining, respectively.RESULTS: The mucosal epithelium of the bile duct was slowly recovered, chronic inflammation lasted for a long time,fibroblasts proliferated actively, extracellular matrix was over-deposited. Myofibroblasts functioned actively and lasted through the whole process. The expression of macrophages in lamina propria under mucosa, TGF-β1 in granulation tissue,fibroblasts and endothelial cells of blood vessels, α-SMA in myofiroblasts were rather strong from the 1st wk to the 6th mo after operation.CONCLUSION: The type of healing occurring in bile duct belongs to overhealing. Myofibroblasts are the main cause for scar contracture and stricture of bile duct. High expressions of CD68, TGF-β1 and α-SMA are closely related to the active proliferation of fibroblasts, extracellular matrix overdeposition and scar contracture of bile duct.
文摘A 68-year-old man underwent cholecystectomy and choledochoduodenostomy for biliary obstruction and nephrectomy for a renal tumor. Based on clinical and histopathologic findings, autoimmune pancreatitis (AIP) was diagnosed. The renal tumor was diagnosed as a renal cell cancer. Steroid therapy was started and thereafter pancreatic inflammation improved. Five years after surgery, the patient was readmitted because of pyrexia in a preshock state. A Klebsiella pneumoniae liver abscess complicated by sepsis was diagnosed. The patient recovered with percutaneous abscess drainage and administration of intravenous antibiotics. Liver abscess recurred 1 mo later but was successfully treated with antibiotics. There has been little information on long-term outcomes of patients with AIP treated with surgery. To our knowledge, this is the second case of liver abscess after surgical treatment of AIP.
文摘AIM To compare the outcomes of preoperative endoscopic nasobiliary drainage(ENBD) and endoscopic retrograde biliary drainage(ERBD) in patients with malignant distal biliary obstruction prior to pancreaticoduodenectomy(PD). METHODS Data from 153 consecutive patients who underwent preoperative endoscopic biliary drainage prior to PD between January 2009 and July 2016 were analyzed. we compared the clinical data, procedure-related complications of endoscopic biliary drainage(EBD) and postoperative complications of PD between the ENBD and ERBD groups. Univariate and multivariate analyses with odds ratios(ORs) and 95% confidence intervals(95%CIs) were used to identify the risk factors for deep abdominal infection after PD.RESULTS One hundred and two(66.7%) patients underwent ENBD, and 51(33.3%) patients underwent ERBD. Endoscopic sphincterotomy was less frequently performed in the ENBD group than in the ERBD group(P = 0.039); the EBD duration in the ENBD group was shorter than that in the ERBD group(P = 0.036). After EBD, the levels of total bilirubin(TB) and alanine aminotransferase(ALT) were obviously decreased in both groups, and the decreases of TB and ALT in the ERBD group were greater than those in the ENBD group(P = 0.004 and P = 0.000, respectively). However,the rate of EBD procedure-related cholangitis was significantly higher in the ERBD group than in the ENBD group(P = 0.007). The postoperative complications of PD as graded by the Clavien-Dindo classification system were not significantly different between the two groups(P = 0.864). However, the incidence of deep abdominal infection after PD was significantly lower in the ENBD group than in the ERBD group(P = 0.019). Male gender(OR = 3.92; 95%CI: 1.63-9.47; P = 0.002), soft pancreas texture(OR = 3.60; 95%CI: 1.37-9.49; P = 0.009), length of biliary stricture(≥ 1.5 cm)(OR = 5.20; 95%CI: 2.23-12.16; P = 0.000) and ERBD method(OR = 4.08; 95%CI: 1.69-9.87; P = 0.002) were independent risk factors for deep abdominal infection after PD.CONCLUSION ENBD is an optimal method for patients with malignant distal biliary obstruction prior to PD. ERBD is superior to ENBD in terms of patient tolerance and the effect of biliary drainage but is associated with an increased risk of EBD procedure-related cholangitis and deep abdominal infection after PD.
基金Supported by Department of Gastroenterology,Fukushima Medical University,School of Medicine
文摘AIM To investigate the factors predictive of failure when placing a second biliary self-expandable metallic stents(SEMSs). METHODS This study evaluated 65 patients with an unresectable malignant hilar biliary obstruction who were examined in our hospital. Sixty-two of these patients were recruited to the study and divided into two groups: the success group, which consisted of patients in whom a stent-in-stent SEMS had been placed successfully, and the failure group, which consisted of patients in whom the stent-in-stent SEMS had not been placed successfully. We compared the characteristics of the patients, the stricture state of their biliary ducts, and the implemented endoscopic retrograde cholangiopancreatography(ERCP) procedures between the two groups.RESULTS The angle between the target biliary duct stricture and the first implanted SEMS was significantly larger in the failure group than in the success group. There were significantly fewer wire or dilation devices(ERCP catheter, dilator, or balloon catheter) passing the first SEMS cell in the failure group than in the success group. The cut-off value of the angle predicting stent-in-stent SEMS placement failure was 49.7 degrees according to the ROC curve(sensitivity 91.7%, specificity 61.2%). Furthermore, the angle was significantly smaller in patients with wire or dilation devices passing the first SEMS cell than in patients without wire or dilation devices passing the first SEMS cell. CONCLUSION A large angle was identified as a predictive factor for failure of stent-in-stent SEMS placement.
