Objective To investigate the phenotypic change and proliferation of fibroblasts in human inflammatory strictured bile duct wall. Methods We observed the density and ultrastructure of fibroblasts, and the histologic structure in human normal bile duct wall and inflammatory strictured bile duct wall by light and electron microscope.Results The results showed that fibroblasts were the main source of extracellular matrix production in bile duct wall. The phenotype of fibroblasts in inflammatory strictured bile duct wall changed obviously, quiescent fibroblasts were activated and transformed to myofibroblasts, with massive proliferation. Conclusion These data suggest that massive proliferation of activated fibroblasts and myofibroblasts is the main source of extracellular matrix overproduction which results in inflammatory bile duct stricture.
Objective To determine whether local delivery of c-myc shRNA could inhibit hyperplasia and lithogenic potentiality in a rat model of chronic proliferative cholangitis (CPC) via specific blockade of the c-myc expression. Methods The CPC animal model (CPC group) was established via retrograde insertion of a 5-0 nylon thread into the common bile duct through Vater’s papilla. Three kinds of c-myc shRNAs were then respectively injected in c-myc shRNA group, which were included shRNA-1, shRNA-2, and shRNA-3, respectively. Negative control group and sham operation group were established for comparison. Subsequently, histopathological changes of bile duct wall were observed by HE, Massion, and PAS/AB staining; c-myc protein was detected by immunohistochemistry method; 5-bromodeoxyuridine (BrdU) protein was tested by immumofluorescence method; c-myc, Mucin 3, and Procollagen Ⅰ mRNAs were detected by real time PCR; Ki-67 protein was determined by Western blot; Activity of β-glucuronidase was measured by modified Fisherman method. Results ①Compared with the CPC and negative control groups, biliary tract mucosa epithelium (HE staining), submucosal acid mucinous gland (mid-blue staining, PAS/AB staining), and degree of over-hyperplasia of collagen fiber in bile duct wall (blue staining, Massion staining) were weaker in the c-myc shRNA group. ②The expressions of c-myc mRNA, Mucin 3 mRNA, Procollagen Ⅰ mRNA, Ki-67 protein, and β-G activity in the c-myc shRNA group were lower than those of the CPC and negative control groups (Plt;0.05), but higher than those of the sham operation group (Plt;0.05). Conclusion c-myc shRNA treatment could effectively inhibit the hyperplastic behavior and lithogenic potential of CPC, which might help to prevent the biliary restenosis and stone recurrence.
To study the prognostic significance of proliferative cell nuclear antigen(PCNA)in bile duct carcinoma,expression of PCNA protein was studied immunohistochemically in 30 patients with bile duct carcinoma.Results:86.7 percent of bile duct carcinomas showed PCNA positive staining and significiant difference was observed between malignant and benign tissues.These results suggest that proliferative activity of malignant tissues was ber than that of the benign ones.In patients with cancer of stages 3,the mean survial time for those with high proliferative activity was 13 months in constrast with 26 months for those with low activity.PCNA is of prognostic significance for bile duct carcinoma patients.
Objective To observe the blood circulation compensation in the involved area of the liver following ligation of the third grade branches of hepatic artery and portal vein and bile duct enclosed in Glisson’s capsule. Methods Ligation of the third grade branches of these ducts was carried out in 7 pigs. Uptake of 99mTc-EHIDA in the liver was scanned with SPECT pre-and post-operatively. Liver angiography of hepatic artery and portal vein were taken at regular interval. Corrosion casts of these ducts were made with ABS following extirpation of the liver at the end of experiment. The histological specimens were examined with electronic microscope. Results Compensatory circulation occurred between involved and noninvolved part of the liver through the sinusoids in 30-60 minutes after ligation. In the 6 weeks following the procedure, there was also blood supply in the affected region of liver, and collateral developed through hepatic aterioles and capillaries. Conclusion Liver has an ability to establish compensatory blood supply on the condition of ischema in a local region of liver.
Objective To observe the expression and distribution of transforming growth factor-β1 (TGF-β1) in the healing process of bile duct and discuss its function and significance in the process of benign biliary stricture formation. Methods An injury to bile duct of dog was made and then repaired. The expression and distribution of TGF-β1 in the tissue at different time of the healing process were studied after operation with immunohistochemical SP staining. Results TGF-β1 staining was observed in the granulation tissue, fibroblasts and endothelial cells of blood vessels. High expression of TGF-β1 was observed in the healing process lasting for a long time. Conclusion The high expression of TGF-β1 is related closely with the fibroblast proliferating activity, extracellular matrix overdeposition and scar proliferation in the healing process of bile duct.
Objective To comment the diagnosis and treatment the bile leakage from the injuried abnormal minute biliary in our laparosicopic cholecystectomy (LC) practice. Methods Fourteen cases of minute biliary duct injury in 2 050 cases of LC were studied retrospectively. Among them, 6 cases had been found the points of leakage during operation, and the points were treated by titanium nips. In 4 cases even though the bile leakage could be seen, but the points of leakage could not found, and were treated by drainage. Four cases with peritonitis, 1 needed to be explored, and treated with suture ligature, 1 was explored by laparoscopy again, another two cases were treated with multiple hole catheters to drainage of the abdominal cavities through stab wounds. Results All 14 cases recovered. Conclusion Small bile leakage in LC is almost inevitable. It is the best that the bile leakage can be discovered during operation and to be treated. If it is discovered after operation, an open or laparoscopic exploratory laparotomy and adequate drainage would be needed. In the case of small amount of leakage, catheter drainage through stab wound is feasible.
摘要:目的: 探讨拔T管后出现胆漏的预防和治疗。 方法 :对1986～2006年间取T管后发生胆漏的12例临床资料作回顾性分析。 结果 :12例经保守治疗后均痊愈。 结论 :拔T管后胆漏的发生是多因素的结果,改进手术技巧,适当延长拔T管的时间有助于预防胆漏的发生。胆漏发生后及时用导尿管置入窦道作引流是首选的治疗方法。Abstract: Objective: To investigate the prophylaxis and treatment of biliary fistula after removal of Ttube. Methods : The clinical data of 12 patients with biliary fistula after removal of Ttube from 1986 to 2006 were analyzed retrospectively. Results : Fistula was cured with conservative treatment in 12 patients. Conclusion : Many factors may affect the development of biliary fistula after removeal of Ttube. Improvement of surgercial technique and the proper prolongation for the time of removal of Ttube may contribute to prophylaxis the biliary fistula. Inserting a Nelaton’s catheter into the sinus tract to drain is the first choice to treat the local bile peritonitis that has occurred.
【Abstract】ObjectiveTo evaluate the injury of common bile duct in immediate removal of the ligation in cholecystectomy. MethodsEighteen healthy Japanese rabbits were selected and divided into three groups randomly: A group treated with simple cholecystectomy, B group with cholecystectomy plus common bile duct crossligation and C group with cholecystectomy plus hepatic bile duct conjunction “Y”type ligation. The ligation was removed after 5 min in B and C groups. The levels of serum transaminase and bilirubin and pathological changes of bile duct and liver in each group were observed respectively. ResultsThere were no statistic difference in the levels of GPT, GOT, total bilirubin (TB), direct bilirubin (DB) and DB/TB on 12 hours before operation and the 1st and 7th day after operation between A and ligation groups (Pgt;0.05). But there were statistic difference in the those indexes and pathological changes of bile duct and liver between A and ligation groups on the 30th and 90th day after operation (Plt;0.05). ConclusionDuring cholecystectomy, immediate removal of common bile duct ligation doesn’t affect shortterm results, but the long-term results are bile duct stricture and obstruction.
Immunohistochemical study on 39 specimens of hepatobilibary duct stricture due to stones were performed. Collagen types Ⅲ and Ⅳ were studied by quantitative analysis. The results showed that significant increase of type Ⅲ collagen was found in the stenotic bile duct wall, the portal area and liver sinusoid with fibrosis. Abnormal increasing of type Ⅳ collagen was found in the liver sinusoid of the stenotic bile duct.
Pancreatic and biliary duct fistula are the most severe and common complication following pancreatoduodenectomy. To prevent this complication, anastomosis should be appropriately performed and drainage of the pancreatic and bile duct is crucial. For proper drainage, the authers designed a cross-shaped tube for both the pancreatic and bile duct drainage, which has been practised on 16 patients with no pancreatic and biliary fistula happened. This new model combines the internal and external pancreatic drainages with biliary T-tube drainage and gives better drainage in practice so that the leakage might be lessened.