胰胆管合流异常与肝外胆系癌的相关性探讨

目的探讨胰胆管合流异常与肝外胆道系统癌(胆囊癌和肝外胆管癌)的相关性。方法回顾性分析2008年1月～2009年12月连续857例患者行磁共振胰胆管造影的临床及影像学资料,测量其胆胰汇合角度及共同管长度,确诊胰胆管合流异常67例。随机在790例不伴有胰胆管合流异常的病例中抽取78例为对照组,与67例胰胆管合流异常的病例行对照研究,分析胰胆管合流异常与肝外胆道系统癌的相关性。结果 67例胰胆管合流异常的患者中发生胆系癌56.72%(38例),对照组中发生胆系癌14.10%(11例),两组病例中胆系癌发生率存在显著性差异(χ2=22.27,P<0.05)。胰胆管合流异常并发胆系癌的病例中,胰胆管汇合类型对胆系癌的分化程度无显著影响(χ2=2.70,P>0.05)。结论胰胆管合流异常与肝外胆道系统癌发生有显著相关性,而胰胆管汇合类型对胆系癌的分化程度无显著影响。

胰胆管合流异常与胆系癌的相关性探讨

目的:探讨胰胆管合流异常(pancreaticobiliary maljunction,PBM)与胆系癌(胆囊癌和肝外胆管癌)的相关性。方法:回顾性分析1999年1月～2007年2月连续257例阻塞性黄疸(obstructive jaundice,OJ)患者行经皮肝穿刺胆管引流术(percutaneous transhepatic cholangiodrainage,PTCD)治疗的临床及影像学资料,其中PTCD术中胰管显影226、具例有不经伴皮有肝PB穿M刺的胆OJ道病钳例夹中活抽检取病8理9例资为料对者照3组5例,与,测31量例其伴共有同P管BM长的度O、J胆病胰例汇行合对角照度研,究确,诊分P析BMPB3M1例与。胆随系机癌的在相关性。结果:两组病例中胆系癌发生率存在显著性差异(P<0.05),PBM共同管长度、胆胰汇合角度对胆系癌发生率无显著影响(P>0.05),PBM汇合角度、汇合类型对并存的胆系癌分化程度无显著影响(P>0.05)。结论:PBM与胆系癌发生有显著相关性。

胆石症与肝外胆系癌

目的：探讨胆石症与胆外胆系癌关系。方法；对我院１０年间收治胆石症（３１４３例）肝外胆系癌做一回顾性分析。结果：见ＧＳ年手术数波动于１１４￣２９９例，胆囊癌年均手术数１例；前后５年ＨＳ手术数各为５０４和３７２例，胆管癌前后５年收治数为１０例和１７例，结论：本临床流行病学分析不支持肝外胆系癌与胆石症有直接联系；加强对高危人群动态超声监测，有利于早期检出胆囊癌。

原发性胆系癌的X影像诊断价值(附11例报告)

原发性胆系癌较少见，临床和X线诊断都有一定的困难，国内文献有所报导和论述（1－4），但术前X线诊断仍有一定的难度，许多同道强调用X线，超声和CT等手段综合影像诊断，以提高阳性率和准确性，本院自1980年以来共收治17例，我们收集其中资料比较完整，并经手术和病理证实的11例作报导。

胆系癌:现状与展望(综合报道)

胆系癌是继肝细胞癌之后的第二大肝胆系统的癌肿 ,每年均有为数不少的新增病例。为进一步提高胆系癌的诊疗水平 ,本文乃对迄今为止临床上所掌握的有关胆系癌诊断知识的现状作一回顾 ,并对今后发展作一展望。

胰胆管合流异常对胆系的致癌作用及预防研究进展

正常的胰液和胆汁分泌后分别经胰管、胆管于十二指肠壁内汇合从而产生消化食物的作用,胰胆管合流异常（Pancreaticobiliary maljunction,PBM）是指胰管与胆管在十二指肠壁外提前汇合,Oddis括约肌无法对胰胆管汇合部全程调控,使胰液、胆汁提前混合,相互逆流,从而产生大量的致癌物质,它是胆系癌的危险因素之一。PBM的标准化治疗包括胆囊切除及扩张的肝外胆管切除,Roux-en-Y肝管空肠吻合,对于没有肝外胆管扩张的PBM,单纯胆囊切除即可,因为胆管癌的发生率不高。但是近年来,多篇文献报道术后残存胆管及胰管再发癌变的发生率增高[1]。

Metastasis of primary gallbladder carcinoma in lymph node and liver

AIM: To evaluate the patterns with metastasis of gallbladder carcinoma in lymph nodes and liver. METHODS: A total of 45 patients who had radical surgery were selected. The patterns with metastasis of primary gallbladder carcinoma in lymph nodes and liver were examined histopathologically and classified as TNM staging of the American Joint Committee on Cancer. RESULTS: Of the 45 patients, 29 (64.4%) had a lymph node positive disease and 20 (44.4%) had a direct invasion of the liver. The frequency of involvement of lymph nodes was strongly influenced by the depth of the primary tumor (P= 0.0001). The postoperative survival rate of patients with negative lymph node metastasis was significantly higher than that of patients with positive lymph node metastasis (P= 0.004), but the postoperative survival rate of patients with Nl lymph node metastasis was not significantly different from that of patients with N2 lymph node metastasis (P= 0.3874). The postoperative survival rate of patients without hepatic invasion was significantly better than that of patients with hepatic invasion (P= 0.0177). CONCLUSION: Complete resection of the regional lymph nodes is important in advanced primary gallbladder carcinoma (PGC). The initial sites of liver spread are located mostly in segments IV and V. It is necessary to achieve negative surgical margins 2 cm from the tumor. In patients with hepatic hilum invasion, extended right hepatectomy with or without bile duct resection or portal vein resection is necessary for curative resection.

Establishment of an arsenic-resistant human gallbladder carcinoma cell line and analysis of the differential expressions of genes associated with apoptosis

Objective： The aim of the study was to establish an arsenic trioxide （ATO）-resistant cell line of human gallbladder carcinoma, GBC-SD/ATO, and to analyze the differential expressions of its apoptosis-associated genes, so as to investigate a correlation between ATO induced resistance of gallbladder carcinoma and expressions of apoptosis associated genes. Methods： The resistant cell line was obtained in vitro by culture of human gallbladder carcinoma cell line GBC-SD with increasingly stepwise concentrations of ATO. The sensitivities of GBC-SD cells and GBC-SD/ATO cells to ATO were determined by MTT assay respectively, cDNA microarray containing 458 apoptosis-related human genes was used to compare the gene expression profiles of GBC-SD/ATO cells and corresponding sensitive cell line GBC-SD. Results： GBC-SD/ATO cell line was established successfully after 8 months of exposure to increasing concentrations of ATO. Compared with the parental cell line, GBC-SD/ATO was 13.6 times more resistant to ATO. Of the 458 apoptosis-related genes, 17 genes were detected having 〉 2-fold difference of expression between the GBC-SD/ATO and GBC-SD cells, with 6 genes up-regulated and 11 genes down-regulated in GBC-SD/ATO cells. Conclusion： The 17 genes invoJved in the apoptosis pathway might be relevant to the resistance of GBC-SD/ATO cells to ATO, suggesting that the modulation of expression of apoptosis-related genes may be a main mechanism of acquired resistance in GBC-SD/ATO.

Association of cyclin D1, p16 and retinoblastoma protein expressions with prognosis and metastasis of gallbladder carcinoma

AIM: To investigate the role of cyclin D1, p16 and retinoblastoma in cancerous process of gallbladder carcinomas and to assess the relation between cyclin D1, p16, Rb and the biological characteristics of gallbladder carcinoma. METHODS: Forty-one gallbladder carcinoma, 7 gallbladder adenoma and 14 chronic cholecystitis specimens were immunohistochemically and histopathologically investigated for the relation of cyclin D1, p16 and Rb with Nevin staging and pathologic grading. RESULTS: The expression rates of abnormal cyclin Dl in gallbladder carcinoma (68.3%)and gallbladder adenoma (57.1%) were significantly higher than those in chronic cholecystitis (7.1%) (P<0.05). No significant difference was found both among the pathological grades G1, G2 and G3 and among Nevin stagings S1-S2, S3 and S4-S5 of gallbladder carcinoma. The positive rates of p16 (48.8%) and Rb (58.5%) in gallbladder carcinoma were significantly lower compared to those in adenoma (100.0%) and cholecystitis (100.0%) (P<0.05). The positive rates of p16 and Rb in Nevin stagings S1-S2 (80.0% and 90.0%) and S3 (46.2% and 61.5%) gallbladder carcinomas were significantly higher than those in S4-S5(33.3% and 38.8%) (P<0.05), and those in pathologic grades G1(54.5% and 81.8%) and G2 (50.0% and 62.5%) gallbladder carcinoma were significantly higher than those in G3 (28.6% and 35.7%) (P<0.05). The protein expression of p16 and Rb had a negative-correlation in gallbladder carcinoma (r= -0.2993, P<0.05), and this negative-correlation was correlated with Nevin staging (P<0.05). Moreover, the protein expression of p16 and cyclin Dl had a negative-correlation in gallbladder carcinoma (r = -0.9417, P<0.05). CONCLUSION: Cyclin Dl may play a role in the early stage of gallbladder carcinoma. Mutation of p16 and Rb genes might be correlated with progression of gallbladder carcinoma. Analysis of p16 and Rb can estimate the prognosis of gallbladder carcinoma. Expression of p16 and Rb may be correlated with Nevin staging and pathologic grading in gallbladder carcinoma.

EFFECT OF SOMATOSTATIN ON THE CELL CYCLE OF HUMAN GALLBLADDER CANCER CELL

Objective To explore the effect of somatostatin on the cell cycle of human gallbladder cancercell. Methods Growth curve of gallbladder cancer cell was measured after somatostatin treated on gradientconcentration. Simultaneously, the change of gallbladder cancer cell cycle was detected using flow cytometry.Results Concentration-dependent cell growth inhibition caused by somatostatin was detected in gallbladder cancercell(P <0. 05). Cell growth was arrested in S phase since 12h after somatostatin treated, which reached its peak at24h, then fell down. The changes in apoptosis index of gallbladder cancer cell caused by somatostatin correlatedwith that’s in cell cycle. Conclusion Somatostatin could inhibit the cell growth of human gallbladder cancer cellin vitro on higher concentration. It might result from inducing growth arrest in S phase in early stage and inducingapoptosis in the late stage.

A simple scoring system to predict early recurrence of Bismuth–Corlette type IV perihilar cholangiocarcinoma

Background:Early recurrence has been reported to be predictive of a poor prognosis for patients with perihilar cholangiocarcinoma(pCCA)after resection.The objective of our study was to construct a useful scoring system to predict early recurrence for Bismuth–Corlette type IV pCCA patients in clinic and to investigate the value of early recurrence in directing post-operative surveillance and adjuvant therapy.Methods:In total,244 patients who underwent radical resection for type IV pCCA were included.Data on clinicopathological characteristics,perioperative details and survival outcomes were analyzed.Survival curves were generated using the Kaplan–Meier method.Univariate and multivariate logistic-regression models were used to identify factors associated with early recurrence.Results:Twenty-one months was defined as the cutoff point to distinguish between early and late recurrence.Univariate and multivariate analysis revealed that CA19-9 level>200 U/mL,R1 resection margin,higher N category and positive lymphovascular invasion were independent predictors of early recurrence.The scoring system was constructed accordingly.The early-recurrence rates of patients with scores of 0,1,2,3,4,and 5 were 23.9%,38.7%,60.0%,78.6%,83.4%,and 100%,respectively.Adjuvant therapy was significantly associated with higher overall survival rate for patients with early recurrence,but not for those with late recurrence.Patients in the early-recurrence group with scores2 had better prognoses after adjuvant therapy.Conclusions:A simple scoring system using CA19-9 level,N category,resection margin and lymphovascular invasion status could predict early recurrence,and thus might direct post-operative surveillance and adjuvant therapy for patients with type IV pCCA.