AIM:To investigate the feasibility and therapeutic effect of laparoscopic surgery for pyogenic liver abscess(PLA) with biliary pathology.METHODS:From January 2004 to October 2010,31 patients with PLA combined with bil...AIM:To investigate the feasibility and therapeutic effect of laparoscopic surgery for pyogenic liver abscess(PLA) with biliary pathology.METHODS:From January 2004 to October 2010,31 patients with PLA combined with biliary pathology meeting entry criteria received surgical management in our hospital.Of the 31 patients,13 underwent laparoscopic surgery(LS group) and 18 underwent open surgery(OS group).Clinical data including operation time,intraoperative blood loss,postoperative complication rate,length of postoperative hospital stay,and abscess recurrence rate were retrospectively analyzed and compared between the two groups.RESULTS:All patients received systemic antibiotic therapy.Four patients underwent ultrasound-guided percutaneous catheter drainage before operation.Postoperative complications occurred in 5 patients(16.1%,5/31) including 2 in the LS group and 3 in the OS group.One patient had retained calculus in the common bile duct and another had liver abscess recurrence in the OS group.No retained calculus and liver abscess recurrence occurred in the LS group.In the two groups,there was no mortality during the perioperative period.There were no significant differences in operation time,intraoperative blood loss and transfusion,postoperative complication rate and abscess recurrence rate between the two groups.Oral intake was earlier(1.9 ± 0.4 d vs 3.1 ± 0.7 d,P < 0.05) and length of postoperative hospital stay was shorter(11.3 ± 2.9 d vs 14.5 ± 3.7 d,P < 0.05) in the LS group than in the OS group.CONCLUSION:Laparoscopic surgery for simultaneous treatment of PLA and biliary pathology is feasible in selected patients and the therapeutic effect is similar to that of open surgery.展开更多
Cholangiopathies are a group of diseases primarily or secondarily affecting bile duct cells, and result in cholangiocyte proliferation, regression, and/or transformation. Their etiopathogenesis may be associated with ...Cholangiopathies are a group of diseases primarily or secondarily affecting bile duct cells, and result in cholangiocyte proliferation, regression, and/or transformation. Their etiopathogenesis may be associated with a broad variety of causes of different nature, which includes genetic, neoplastic, immune-associated, infectious, vascular, and drug-induced alterations, or being idiopathic. miRNAs, small non-coding endogenous RNAs that post-transcriptionally regulate gene expres sion, have been associated with pathophysiological processes in different organs and cell types, and are postulated as potential targets for diagnosis and therapy. In the current manuscript, knowledge regarding the role of miRNAs in the development and/or progression of cholangiopathies has been reviewed and the most relevant findings in this promising field of hepatology have been highlighted.展开更多
AIM： To clarify the clinicopathological significance of laminin-5 y2 （LNγ2） and 133 （LNI33） chains and MMP7 expression in biliary tract cancer. METHODS： We analyzed the association between immunohistochemically...AIM： To clarify the clinicopathological significance of laminin-5 y2 （LNγ2） and 133 （LNI33） chains and MMP7 expression in biliary tract cancer. METHODS： We analyzed the association between immunohistochemically detected LNγ2, LNβ3, and MMP7 expression in biliary tract cancer and clinicopathological characteristics. Activity of MMP7 was analyzed by casein zymography. An in vitro invasion assay after treatment with MMP7-specific siRNA was performed. RESULTS： LNγ2 expression was predominantly observed in carcinoma cells at the invasive front. LNγ2 expression was seen in 57% of patients with biliary tract cancer, and was associated with depth of invasion, histologic type, and advanced stage. The expression pattern of LNβ3 was classified Into two types： invasive front dominant type （38%） and diffuse type （28%）.The invasive front dominant type was associated with histologic type and advanced stage. MMP7 positivity was correlated with LNγ2 or LNβ3 expression but not with clinicopathological characteristics. Active MMP7 detected by casein zymography was correlated with depth of invasion and advanced stage. Downregulation of MMP7 expression by siRNA resulted in a significant decrease in biliary tract cancer cell invasion in vitro.CONCLUSION： Our results suggest that LNγ2 and LNβ3, in conjunction with MMP7, play a key role in the progression of biliary tract cancer.展开更多
Non-parasitic hepatic cysts with biliary communication are rare. qhe clinical symptoms involved are not specific to this condition, thereby making diagnosis difficult and treatment controversial. Here, we report a cas...Non-parasitic hepatic cysts with biliary communication are rare. qhe clinical symptoms involved are not specific to this condition, thereby making diagnosis difficult and treatment controversial. Here, we report a case of 70-year-old woman complaining of abdominal satiety, combined with non-specific pain in the right upper quadrant, qhe abdominal contrast-enhanced MR.I-scan revealed a large and thick-walled septus cystic lesion in the liver. During operation, the biliary fistula was confirmed in the cyst cavity. A silica gel tube was inserted via the cystic duct for cholangiography, which demonstrated communication between the cyst and biliary tract. We performed wide-scale cyst wall resection; the biliary fistula was completely repaired by the closure of communicated bile ducts. The postoperative course was uneventful, and the patient was discharged with no sign ofcholangitis or any other symptoms. The novel surgical management via wide resection of the cyst wall and closure of biliary communication proved to be an adequate and effective procedure for treating nonparasitic hepatic cysts with biliary communication.展开更多
In normal physiological anatomy, common bile duct opens in the major papilla and does not communicate with the minor papilla directly. There is little chance to calmulate biliary system via the minor papilla. There wa...In normal physiological anatomy, common bile duct opens in the major papilla and does not communicate with the minor papilla directly. There is little chance to calmulate biliary system via the minor papilla. There was no report of tmns-minor papilla biliary drainage in the literature. We presented a case with malignant obstructive jaundice that underwent trans-minor papilla biliary drainage. A 5F super slim nasobiliary tube was inserted into common bile duct successfully through minor papilla during endoscopic retrograde cholangio-pancreatography （ERCP）. The patient did not complain abdominal pain or any discomfort after procedure. Biliary drainage was effective （500-800 ml per day）. The patient＇s jaundice relieved significantly during follow-up展开更多
Biliary adenoma is uncommon benign neoplasm of the biliary system, of unknown aetiology and account for approximately 0.1%-2% of all gastrointestinal benign tumors. Most of patients are asymptomatic; a few patients ha...Biliary adenoma is uncommon benign neoplasm of the biliary system, of unknown aetiology and account for approximately 0.1%-2% of all gastrointestinal benign tumors. Most of patients are asymptomatic; a few patients have mild jaundice or abdominal discomfort. To our knowledge, there were only a few cases of biliary papillomatosis reported in the previous literatures, which only showed solitary tumor in bile duct. We presented a rare case with multiple biliary adenomas in extrahepatic bile duct confirmed by endoscopic retrograde cholangiopancreatography(ERCP) and histopathology. After 3 months follow-up, the patient remained asymptomatic.展开更多
文摘AIM:To investigate the feasibility and therapeutic effect of laparoscopic surgery for pyogenic liver abscess(PLA) with biliary pathology.METHODS:From January 2004 to October 2010,31 patients with PLA combined with biliary pathology meeting entry criteria received surgical management in our hospital.Of the 31 patients,13 underwent laparoscopic surgery(LS group) and 18 underwent open surgery(OS group).Clinical data including operation time,intraoperative blood loss,postoperative complication rate,length of postoperative hospital stay,and abscess recurrence rate were retrospectively analyzed and compared between the two groups.RESULTS:All patients received systemic antibiotic therapy.Four patients underwent ultrasound-guided percutaneous catheter drainage before operation.Postoperative complications occurred in 5 patients(16.1%,5/31) including 2 in the LS group and 3 in the OS group.One patient had retained calculus in the common bile duct and another had liver abscess recurrence in the OS group.No retained calculus and liver abscess recurrence occurred in the LS group.In the two groups,there was no mortality during the perioperative period.There were no significant differences in operation time,intraoperative blood loss and transfusion,postoperative complication rate and abscess recurrence rate between the two groups.Oral intake was earlier(1.9 ± 0.4 d vs 3.1 ± 0.7 d,P < 0.05) and length of postoperative hospital stay was shorter(11.3 ± 2.9 d vs 14.5 ± 3.7 d,P < 0.05) in the LS group than in the OS group.CONCLUSION:Laparoscopic surgery for simultaneous treatment of PLA and biliary pathology is feasible in selected patients and the therapeutic effect is similar to that of open surgery.
文摘Cholangiopathies are a group of diseases primarily or secondarily affecting bile duct cells, and result in cholangiocyte proliferation, regression, and/or transformation. Their etiopathogenesis may be associated with a broad variety of causes of different nature, which includes genetic, neoplastic, immune-associated, infectious, vascular, and drug-induced alterations, or being idiopathic. miRNAs, small non-coding endogenous RNAs that post-transcriptionally regulate gene expres sion, have been associated with pathophysiological processes in different organs and cell types, and are postulated as potential targets for diagnosis and therapy. In the current manuscript, knowledge regarding the role of miRNAs in the development and/or progression of cholangiopathies has been reviewed and the most relevant findings in this promising field of hepatology have been highlighted.
基金Supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture,Sports,Science and Technology of Japan (H.Y. and K.I.)Grants-in-Aid for Cancer Research and for the Third Term Comprehensive 10-Year Strategy for Cancer Control from the Ministry of Health,Labor and Welfare of Japan (H.Y. and K.I.)
文摘AIM： To clarify the clinicopathological significance of laminin-5 y2 （LNγ2） and 133 （LNI33） chains and MMP7 expression in biliary tract cancer. METHODS： We analyzed the association between immunohistochemically detected LNγ2, LNβ3, and MMP7 expression in biliary tract cancer and clinicopathological characteristics. Activity of MMP7 was analyzed by casein zymography. An in vitro invasion assay after treatment with MMP7-specific siRNA was performed. RESULTS： LNγ2 expression was predominantly observed in carcinoma cells at the invasive front. LNγ2 expression was seen in 57% of patients with biliary tract cancer, and was associated with depth of invasion, histologic type, and advanced stage. The expression pattern of LNβ3 was classified Into two types： invasive front dominant type （38%） and diffuse type （28%）.The invasive front dominant type was associated with histologic type and advanced stage. MMP7 positivity was correlated with LNγ2 or LNβ3 expression but not with clinicopathological characteristics. Active MMP7 detected by casein zymography was correlated with depth of invasion and advanced stage. Downregulation of MMP7 expression by siRNA resulted in a significant decrease in biliary tract cancer cell invasion in vitro.CONCLUSION： Our results suggest that LNγ2 and LNβ3, in conjunction with MMP7, play a key role in the progression of biliary tract cancer.
文摘Non-parasitic hepatic cysts with biliary communication are rare. qhe clinical symptoms involved are not specific to this condition, thereby making diagnosis difficult and treatment controversial. Here, we report a case of 70-year-old woman complaining of abdominal satiety, combined with non-specific pain in the right upper quadrant, qhe abdominal contrast-enhanced MR.I-scan revealed a large and thick-walled septus cystic lesion in the liver. During operation, the biliary fistula was confirmed in the cyst cavity. A silica gel tube was inserted via the cystic duct for cholangiography, which demonstrated communication between the cyst and biliary tract. We performed wide-scale cyst wall resection; the biliary fistula was completely repaired by the closure of communicated bile ducts. The postoperative course was uneventful, and the patient was discharged with no sign ofcholangitis or any other symptoms. The novel surgical management via wide resection of the cyst wall and closure of biliary communication proved to be an adequate and effective procedure for treating nonparasitic hepatic cysts with biliary communication.
文摘In normal physiological anatomy, common bile duct opens in the major papilla and does not communicate with the minor papilla directly. There is little chance to calmulate biliary system via the minor papilla. There was no report of tmns-minor papilla biliary drainage in the literature. We presented a case with malignant obstructive jaundice that underwent trans-minor papilla biliary drainage. A 5F super slim nasobiliary tube was inserted into common bile duct successfully through minor papilla during endoscopic retrograde cholangio-pancreatography （ERCP）. The patient did not complain abdominal pain or any discomfort after procedure. Biliary drainage was effective （500-800 ml per day）. The patient＇s jaundice relieved significantly during follow-up
文摘Biliary adenoma is uncommon benign neoplasm of the biliary system, of unknown aetiology and account for approximately 0.1%-2% of all gastrointestinal benign tumors. Most of patients are asymptomatic; a few patients have mild jaundice or abdominal discomfort. To our knowledge, there were only a few cases of biliary papillomatosis reported in the previous literatures, which only showed solitary tumor in bile duct. We presented a rare case with multiple biliary adenomas in extrahepatic bile duct confirmed by endoscopic retrograde cholangiopancreatography(ERCP) and histopathology. After 3 months follow-up, the patient remained asymptomatic.
