2017 No. 2

The sphincter of Oddi:from incision to repair

Ceng JianPing, Dong JiaHong

2017, 33(2): 209-212. DOI: 10.3969/j.issn.1001-5256.2017.02.001

Abstract(976)

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The sphincter of Oddi is a valve that controls the biliopancreatic duct and plays an irreplaceable role in maintaining normal physiological functions of the biliopancreatic duct.However,sphincteroplasty and sphincterotomy may cause varying degrees of damage to the function of the sphincter of Oddi,which may further result in postoperative reflux of duodenal fluids and bacterial contamination in bile and increase the risks of recurrent common bile duct stones,reflux cholangitis,and even cholangiocarcinoma.Therefore,clinical physicians should protect the structure and function of the sphincter of Oddi.Based on our experience,under the premise that the extrahepatic bile duct can be preserved,patients with iatrogenic injury of the sphincter of Oddi can be treated with transduodenal sphincteroplasty to restore the structural integrity of the sphincter of Oddi and reduce biliopancreatic duct complications secondary to loss of function.

The practice guideline on prophylaxis and treatment of hepatitis B for liver transplantation in China( 2016 edition)

Chinese Society of Organ Transplantation, Chinese Medical Association, Chinese Society of Hepatology, Chinese Medical Association

2017, 33(2): 213-220. DOI: 10.3969/j.issn.1001-5256.2017.02.002

Abstract(208)

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Clinical practice guidelines for the interventional treatment of advanced pancreatic carcinoma( on trial)

Committee of Interventional Medicine, Cancer Foundation of China

2017, 33(2): 221-232. DOI: 10.3969/j.issn.1001-5256.2017.02.003

Abstract(282)

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An excerpt of international consensus recommendations for difficult biliary access in 2016

Feng YaDong, Chen XiaoXing

2017, 33(2): 233-237. DOI: 10.3969/j.issn.1001-5256.2017.02.004

Abstract(201)

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An excerpt of 2016 ESMO clinical practice guidelines for diagnosis, treatment and follow-up in biliary cancer

Fang Long, Fan YanHua

2017, 33(2): 238-243. DOI: 10.3969/j.issn.1001-5256.2017.02.005

Abstract(2437)

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Recommendations for JSGE guidelines for clinical evidence-based practice for gallstone disease (2016)

Ye JunFeng, Wu XinMin, Qi WenLei, Zhang JianWei, Wang GuangYi

2017, 33(2): 244-246. DOI: 10.3969/j.issn.1001-5256.2017.02.006

Abstract(2388)

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Diagnosis and surgical treatment of xanthogranulomatous cholecystitis

Li ZhenLi, Yang Tian

2017, 33(2): 247-252. DOI: 10.3969/j.issn.1001-5256.2017.02.007

Abstract(2979)

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Xanthogranulomatous cholecystitis( XGC) is a rare type of chronic cholecystitis characterized by severe proliferative fibrosis with infiltration of macrophages and foamy cells in the gallbladder wall.Since XGC and gallbladder carcinoma have similar clinical manifestations and radiological features,XGC is often misdiagnosed as gallbladder carcinoma in clinical practice,which leads to unnecessary extensive surgical resection and has an adverse effect on patients.At present,the preoperative diagnosis of XGC is still based on imaging results( ultrasound,computed tomography,and magnetic resonance imaging),and a definite diagnosis of this disease relies on intraoperative frozen biopsy or postoperative pathological examination.Meanwhile,XGC should be differentiated from gallbladder adenomyomatosis,gallbladder carcinoma,and gallbladder actinomycosis.Laparotomy or laparoscopic cholecystectomy is the major method for the treatment of XGC,but laparoscopic cholecystectomy is associated with a longer time of operation,more complications,and a higher rate of conversion to laparotomy.Therefore,surgeons are facing difficulties in preoperative diagnosis and intraoperative decision- making process of XGC.

Improvement of minimally invasive therapies and techniques for intra- and extrahepatic bile duct stones

Tian Yu, Wu ShuoDong

2017, 33(2): 253-255. DOI: 10.3969/j.issn.1001-5256.2017.02.008

Abstract(2184)

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This article introduces the explorations in improving minimally invasive therapies and techniques for intra- and extrahepatic bile duct stones in this center,including laparoscopic choledocholithotomy without the placement of T tube,laparoscopic partial hepatectomy for the treatment of intrahepatic bile duct stones using an anastomosis stapler for liver partition,and modification of percutaneous transhepatic cholangioscopy.The improved therapies and techniques above have achieved good clinical effects,and a scientific judgment of their clinical effects still depends on a large number of cases and randomized controlled clinical trials.

Wang ShuGuang

2017, 33(2): 256-259. DOI: 10.3969/j.issn.1001-5256.2017.02.009

Abstract(2469)

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Inappropriate treatment of bile duct injury and traumatic biliary stricture may cause serious consequences such as recurrent cholangitis,formation of hepatolithiasis,and biliary cirrhosis.This article elaborates on the influencing factors for the effect of the repair of bile duct injury and traumatic biliary stricture,repair principles,timing of repair or reconstruction,and related methods and techniques.It is pointed out that if there is no significant local infection and the bile duct wall defect is < 2 cm,end- to- end anastomosis should be used for repair;if the bile duct wall defect is > 2 cm,Roux- en- Y hepaticojejunostomy should be used for reconstruction.If the upper wall of the bile duct had a large defect and the lower wall has an integral structure,pedicled umbilical vein graft,pedicled jejunal wall seromuscular flap,or gastric wall seromuscular flap should be used for repair.The patients with severe congestion and edema at the site of injury should be treated with sufficient external drainage of the injured bile duct and then selective repair or reconstruction.Patients with hepatic duct stenosis in the liver lobe or hepatic segments and liver tissue atrophy can be treated with hepalobectomy or segmental hepatectomy.The key to successful repair is exposure and removal of high hilar bile duct stricture,while segmental hepatectomy of the Ⅳb segment can fully expose the left and right hepatic pedicles and help with the incision of the left and right hepatic ducts and secondary hepatic ducts,and therefore,it is a good method for exposing high bile duct stricture.

Correct timing of bile duct injury repair

Wang Jian, Xu SunWang

2017, 33(2): 260-262. DOI: 10.3969/j.issn.1001-5256.2017.02.010

Abstract(2308)

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Surgical operation is the most important method for the treatment of iatrogenic bile duct injury,and correct selection of the timing of surgical repair is a prerequisite for successful injury repair.This article elaborates on the timing of immediate repair of bile duct injury found during surgery and the timing of delayed repair of bile duct injury found after surgery and summarizes the timing and methods for delayed repair based on the location and manifestations of injuries( such as biliary obstruction,bile leakage,and injury in the choledocho-pancreatico- duodenal junction).It is pointed out that the pathological state of injury is the critical factor for deciding surgical timing.The overall tendency of the timing of repair is early repair,and delayed repair should be performed as early as possible within 2- 4 weeks after effective control of inflammation.

Surgical treatment of congenital bile duct dilatation with involvement of the intrahepatic bile duct:advances,difficulties,and controversy

Yang ShiZhong, Xiang CanHong

2017, 33(2): 263-267. DOI: 10.3969/j.issn.1001-5256.2017.02.011

Abstract(342)

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Congenital bile duct dilatation may occur in any part of the biliary tree,and the diagnosis and treatment of lesions involving the intrahepatic bile duct is the most challenging issue.Surgical operation plays a dominant role in the management of congenital bile duct dilatation,with the purposes of relieving symptoms and preventing disease progression and malignant transformation.Surgical principles are radical resection of lesions and reconstruction of unobstructed bile drainage.Hepatectomy is the main surgical procedure for congenital bile duct dilatation with involvement of the intrahepatic bile duct,and liver transplantation can be used for diffuse lesions.Therefore,we believe that hepatectomy and early intervention will maximize patients' benefits.

Diagnosis and treatment of ampullary tumors

Yin Tao, Zhou YingKe, Wu HeShui

2017, 33(2): 268-271. DOI: 10.3969/j.issn.1001-5256.2017.02.012

Abstract(3687)

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Ampullary tumors mainly manifest as obstructive jaundice and ampullary mass in clinical practice and are difficult to be identified in early stage due to a complex structure of the anatomical site,a deep location,and hidden symptoms.Sometimes a qualitative diagnosis cannot be made.Based on the experience in the treatment of ampullary tumors for many years in our center,this article summarizes the features of ampullary tumors from the aspects of clinical manifestations,diagnosis,treatment,and prognosis,especially the issues regarding imaging evaluation of ampullary tumors,selection of surgical procedure,and prognosis.An early diagnosis is the key to the treatment of ampullary tumors,and early identification and treatment of lesions have great impacts on patients' prognosis.Accurate preoperative imaging evaluation,a professional diagnosis and treatment team,accurate preoperative and intraoperative pathological analysis,and implementation of reasonable therapeutic strategy are the key to patients' recovery.

Effect of Buqi Huoxue decoction on hemodynamics and liver fibrosis indices in hepatitis B patients with cirrhotic portal hypertension

Bai ZhiQin, Song HuiYing, Wu RuiQing, Gao Dong, Huo HongMin, Yang Jing, Chen Shu

2017, 33(2): 272-276. DOI: 10.3969/j.issn.1001-5256.2017.02.013

Abstract(2283)

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Objective To investigate the effect of Buqi Huoxue decoction on hemodynamics and liver fibrosis indices in hepatitis B patients with cirrhotic portal hypertension.Methods A total of 79 patients with hepatitis B cirrhosis who were admitted to The People's Hospital of Qingyuan District from December 2013 to August 2015 were enrolled and randomly divided into study group( 41 patients) and control group( 38 patients).The patients in both groups were given oral entecavir( 0.5 mg,once a day) and bicyclol tablets( 25 mg,three times a day);the patients in the control group were given propranolol( 10 mg,three times a day) in addition,and those in the study group were given Buqi Huoxue decoction in addition.The course of treatment was 12 weeks for both groups.The hemodynamics and liver fibrosis indices were compared between the two groups before treatment and after 12 weeks of treatment.The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups.Results After 12 weeks of treatment,both groups had significant reductions in diameter of the portal vein,diameter of the splenic vein,and portal vein flow and a significant increase in portal vein blood flow velocity( t = 3.847,4.672,3.524,5.237,3.578,3.829,3.468,and 3.673,P = 0.041,0.036,0.047,0.032,0.045,0.042,0.048,and 0.046),and the study group had significantly greater changes in these parameters compared with the control group( diameter of the portal vein:12.86 ± 2.34 mm vs 13.65 ± 2.45 mm,t = 3.725,P = 0.044;diameter of the splenic vein:9.50 ± 1.26 mm vs 11.15 ± 1.37 mm,t =- 6.672,P = 0.012;portal vein flow:1.23 ± 0.35 L / min vs 1.38 ± 0.44 L / min,t =-3.521,P = 0.047;portal vein blood flow velocity:19.50 ± 4.65 cm / s vs 17.57 ± 2.40 cm / s,t =- 6.225,P = 0.024).After 12 weeks of treatment,both groups had reductions in the four liver fibrosis indices hyaluronic acid,laminin,procollagen type Ⅲ,and collagen typeⅣ,and the study group had significantly greater reductions than the control group( hyaluronic acid:285.2 ± 53.4 μg /L vs 347.5 ± 63.4μg /L,t =- 7.252,P = 0.012;laminin:89.5 ± 25.6 μg /L vs 116.5 ± 29.7 μg /L,t =- 6.503,P = 0.018;procollagen type Ⅲ:63.5± 20.6 μg / L vs 98.7 ± 28.4 μg / L,t =- 5.279,P = 0.031;collagen type Ⅳ:85.5 ± 23.7 μg / L vs 122.5 ± 26.4 μg / L,t =- 6.977,P = 0.015).No patient experienced adverse drug reactions during the treatment.Conclusion Buqi Huoxue decoction can significantly improve hemodynamics and serum hepatic fibrosis indices in patients with cirrhotic portal hypertension.

Association of hyponatremia with degree of liver injury and complications in patients with decompensated liver cirrhosis

Wu Jian, Yin Fang, Luo GuanHong, Zhu ShaoHua, Li Hong, Zhang Jing, Zheng YangYang, Sun Han, Zhou XinMin

2017, 33(2): 277-280. DOI: 10.3969/j.issn.1001-5256.2017.02.014

Abstract(2386)

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Objective To investigate the association of hyponatremia with the degree of liver injury and complications in patients with decompensated liver cirrhosis.Methods A retrospective analysis was performed for the clinical data of 142 patients with decompensated liver cirrhosis complicated by hyponatremia who were admitted to Department of Gastroenterology,Xijing Hospital of Fourth Military Medical University from July 2015 to July 2016.The patients were divided into mild group,moderate group,and severe group according to serum sodium concentration on admission.The Child- Pugh score,Model for End- Stage Liver Disease( MELD) score,and major complications were compared between groups.All the patients were followed up for 3 months,and the complications such as ascites,spontaneous bacterial peritonitis,and hepatic encephalopathy were recorded.The association of hyponatremia with complications and mortality was investigated.The chi- square test was used for comparison of categorical data between groups,and the Spearman corretation analysis was also performed.Results The mild group had a high proportion of Child- Pugh class A patients( 42.3%) and the severe group had a high proportion of Child- Pugh class C patients( 72.4%).There was a significant difference in Child- Pugh score between the mild,moderate,and severe groups( χ~2= 50.175,P = 0.000 2).The serum sodium level decreased with the increasing Child- Pugh score( r =- 0.464,P = 0.002 3).The mild group had a high proportion of patients with an MELD score of ≤9( 50.7%) and the severe group had a high proportion of patients with an MELD score of ≥30( 62.1%).There was a significant difference in the distribution of MELD scores between the mild,moderate,and severe groups( χ~2= 75.106,P = 0.000 8).The serum sodium level decreased with the increasing MELD score( r =- 0.644,P =0.004 5).The incidence rates of ascites,spontaneous bacterial peritonitis,and hepatic encephalopathy were 71.8% /92.9% /100.0%,14.1% /31.0% /65.5%,and 14.1% /35.7% /55.2%,respectively,in the mild,moderate,and severe groups.The mortality rate was12.7%,33.3%,and 65.5% in these three groups,respectively.There were significant differences in the incidence rate of complications and mortality rate between the three groups( χ~2= 14.127 and 24.467,both P < 0.05).Conclusion Serum sodium level can be used as a predictor for the incidence rate of complications in patients with decompensated liver cirrhosis.

Clinical effect and safety of hepatic arterial infusion of cinobufotalin injection combined with lipiodol chemoembolization in treatment of Barcelona Clinic Liver Cancer stage C primary liver cancer

Yu Tong, Zhai XiaoFeng, Liu Qun, Meng YongBin, Lu JianYing, Chen Zhe

2017, 33(2): 281-285. DOI: 10.3969/j.issn.1001-5256.2017.02.015

Abstract(1688)

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Objective To investigate the clinical effect and safety of hepatic arterial infusion of cinobufotalin injection combined with lipiodol chemoembolization( TACE) in the treatment of Barcelona Clinic Liver Cancer( BCLC) stage C primary liver cancer.Methods A retrospective analysis was performed for the clinical data of 82 patients with BCLC stage C primary liver cancer who were admitted to Department of TCM Oncology in Changhai Hospital from December 2010 to October 2014.According to intraoperative medication,the patients were divided into two groups.The 40 patients in the cinobufotalin group were treated with hepatic arterial infusion with cinobufotalin combined with lipiodol embolism,and the 42 patients in the control group underwent TACE with epirubicin.The objective response rate,time to progression,median survival time,and acute adverse events were compared between the two groups after a single treatment.The t- test was used for comparison of continuous data between groups,the chi- square test was used for comparison of categorical data between groups,and the Kaplan- Meier method was used for the analysis of cumulative survival rate.Results At 1.5 months after surgery,the cinobufotalin group had a significantly higher objective response rate than the control group( 27.5% vs 9.52%,χ~2= 4.429,P = 0.035).The time to progression was 2.4 months( 95% CI:1.978- 2.822) in the cinobufotalin group and 3.0 months( 95% CI:2.260- 3.740) in the control group,and there was no significant difference between the two groups( P = 0.344).The median survival time was 6.6 months( 95% CI:4.131-9.069) in the cinobufotalin group and 10.3 months( 95% CI:0.089- 20.511) in the control group,and there was no significant difference between the two groups( P = 0.132).At 5 days after surgery,the cinobufotalin group had significantly lower incidence rates of abnormal alanine aminotransferase level,white blood cell count,and platelet count,as well as adverse events including hepatalgia,abdominal distension,and nausea / vomiting than the control group( χ~2= 6.193,5.311,6.096,5.909,4.761,and 4.173,all P < 0.05).Conclusion As for patients with BCLC stage C primary liver cancer,hepatic arterial infusion of cinobufotalin injection combined with lipiodol chemoembolization has a better short- term therapeutic effect,milder adverse effects,and a similar long- term therapeutic effect compared with TACE with conventional chemotherapeutic agents.

Clinical effect of ultrasound- guided percutaneous transhepatic gallbladder drainage in treatment of acute cholecystitis

Huang Jie, Ren ShiPu, Yang LiWen

2017, 33(2): 286-288. DOI: 10.3969/j.issn.1001-5256.2017.02.016

Abstract(511)

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Objective To investigate the clinical effect of ultrasound- guided percutaneous transhepatic gallbladder drainage( PTGBD) in the treatment of acute cholecystitis.Methods A retrospective analysis was performed for the clinical data of 81 patients with acute cholecystitis who underwent ultrasound- guided PTGBD in General Hospital of Lanzhou Petrochemical Company from March 2013 to February 2016.The changes in related parameters after the placement of drainage tube were analyzed.The t- test was used for comparison of continuous data between groups.Results All the 81 patients underwent a successful one- time puncture.After the surgery,1 patient experienced tube dislodgement and 2 experienced obstructed bile drainage,while no patient experienced serious complications such as bleeding,bile leakage,and hemopneumothorax.Within 12 hours after surgery,there was a significant improvement in pain in the right upper quadrant and significant reductions in the major axis and radial width of the gallbladder( t = 13.28 and 9.54,P = 0.023 and 0.041),as well as significant reductions in white blood cell count and neutrophil count( t = 8.70 and 8.03,P = 0.028 and 0.034).Of all patients,38 achieved symptom remission after the placement of drainage tube and refused selective surgical treatment,and 43 underwent cholecystectomy within 3 months after surgery.Conclusion PTGBD is simple,convenient,visible,and safe and can effectively reduce patients' pain,increase the success rate of the treatment of acute cholecystitis,improve patients' clinical outcomes,and reduce the incidence of complications.It also provides the conditions of selective surgery for critically ill patients with acute cholecystitis,and therefore,it holds promise for clinical application.

Clinical effect of laparoscopic biliary reoperation in treatment of elderly patients with extrahepatic bile duct stones

Duan RenQuan, Wang Wei, Zhang HuiHui, Liang JingJing, Tang LuLu

2017, 33(2): 289-292. DOI: 10.3969/j.issn.1001-5256.2017.02.017

Abstract(1641)

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Objective To investigate the clinical effect of laparoscopic biliary reoperation in the treatment of elderly patients with extrahepatic bile duct stones.Methods A retrospective analysis was performed for the clinical data of 86 elderly patients with extrahepatic bile duct stones who were admitted to The First People's Hospital of Zaoyang from January 2013 to June 2015 and underwent laparoscopic biliary reoperation.The surgical conditions and follow- up results were compared between groups.The t- test was used for comparison of continuous data between groups,the chi- square test was used for comparison of categorical data between groups.Results All the patients underwent the surgery successfully and no patient died during the perioperative period.The postoperative stone clearance rate was 100%.There was no significant difference in the surgical procedure( primary suture / T- tube drainage) between the two groups( P > 0.05).Compared with the first operation group,the reoperation group had a higher rate of conversion to laparotomy,a longer length of hospital stay,higher intraoperative stone clearance rate and incidence rates of intraoperative and postoperative complications,and a significantly longer time of operation( t = 2.126,P = 0.036).In the first operation group,one patient experienced intraoperative cystic artery injury and was given ligation for hemostasis;in the reoperation group,2 patients experienced gastrointestinal serosal injury and were treated with embedding of the seromuscular layer.In the first operation group,1 patient each experienced bile leakage,pulmonary infection,and urinary system infection after surgery and were all cured after conservative treatment;in the reoperation group,1 patient experienced bile leakage and 2 experienced pulmonary infection,and all the patients were cured after conservative treatment.The overall follow- up rate was 94.19%( 50 /54) in the first operation group and 96.88%( 31 /32) in the reoperation group.The imaging examination showed no complications such as biliary stricture,residual bile duct stones,and recurrence of stones.Conclusion Laparoscopic biliary reoperation is safe and effective in the treatment of elderly patients with extrahepatic bile duct stones,but there are a certain rate of conversion to laparotomy and incidence rates of complications.The operation techniques should be improved to avoid intraoperative injury,surgical indications should be strictly followed,and perioperative management should be optimized.

Risk factors for short- term residual common bile duct stones after laparoscopic cholecystectomy

Liu HongFeng

2017, 33(2): 293-296. DOI: 10.3969/j.issn.1001-5256.2017.02.018

Abstract(1830)

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Objective To investigate the risk factors for short- term residual common bile duct stones after laparoscopic cholecystectomy( LC),and to provide a reference for clinical prevention and treatment.Methods A total of 18 patients with short- term residual common bile duct stones after LC who were admitted to The First Affiliated Hospital of Nanyang Medical College from January 2014 to January 2016 were enrolled as observation group,and 320 patients without short- term residual common bile duct stones after LC who were admitted during the same period of time were enrolled as control group.The two groups were compared in terms of acute pancreatitis,alanine aminotransferase( ALT),aspartate aminotransferase( AST),emergency surgery,results of preoperative magnetic resonance cholangiopancreatography( MRCP),direct bilirubin( DBil),the gallbladder full of stones,number of gallstones,minimum stone diameter,gallbladder volume,cystic duct diameter,cystic duct length,and sand- like stones.The independent- samples t test was used for comparison of continuous data between groups,the chi- square test was used for comparison of categorical data between groups,and a logistic multivariate regression analysis was performed for variables with statistical significance.Results The univariate analysis showed that acute pancreatitis,emergency surgery,sand- like stones,retrograde cholecystectomy,preoperative MRCP,number of gallstones,minimum stone diameter,gallbladder volume,cystic duct diameter,and common bile duct diameter were associated with short- term residual common bile duct stones after LC( χ~2=9.801,16.217,5.802,9.865,and 5.145,t = 18.314,6.077,7.687,15.678,and 5.512,all P < 0.05).The multivariate logistic regression analysis showed that acute pancreatitis,retrograde cholecystectomy,common bile duct diameter,and cystic duct diameter were independent risk factors for short- term residual common bile duct stones after LC,while preoperative MRCP was a protective factor.Conclusion Active intervention for risk factors for short- term residual common bile duct stones after LC can reduce the incidence of postoperative residual bile duct stones.

Risk factors for recurrence of common bile duct stones after endoscopic retrograde cholangiopancreatography

Wang ChunQiu, Ma YingCai, Zhu ZhiYong, Yuan Ling

2017, 33(2): 297-299. DOI: 10.3969/j.issn.1001-5256.2017.02.019

Abstract(1719)

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Objective To investigate the clinical features of patients with recurrence after endoscopic retrograde cholangiopancreatography( ERCP) and cholecystolithotomy and related risk factors.Methods A retrospective analysis was performed for the clinical data of patients with common bile duct stones who visited our hospital from January 2013 to June 2015 and underwent ERCP and cholecystolithotomy.A total of 292 patients were enrolled,and according to the presence or absence of recurrence of common bile duct stones,these patients were divided into recurrence group with 31 patients and non- recurrence group with 261 patients.The clinical data including age,sex,body mass index( BMI),and the conditions of the biliary tract and bile duct stones were compared between the two groups.The chi- square test was used for comparison of categorical data between groups,and the binary logistic regression was used for the analysis of factors that were screened out.Results There were significant differences in the proportions of patients with a number of stones ≥2 or bile duct diameter ≥14 mm between the two groups( χ~2= 4.80 and 5.61,both P < 0.05).A previous history of cholecystectomy was an independent risk factor for the recurrence of common bile duct stones( OR = 20.10,95% CI:4.11- 98.25,P < 0.05).Conclusion A previous history of cholecystectomy increases the risk of recurrence of common bile duct stones after ERCP.

Clinical effects of two surgical procedures in treatment of gallstones complicated by common bile duct stones:a comparative analysis

Chen GaoFei, Lu XiaoLong, Li JianHui, Lyu ZongJun, Jing DongShuai, Zheng JianZhong

2017, 33(2): 300-303. DOI: 10.3969/j.issn.1001-5256.2017.02.020

Abstract(2455)

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Objective To investigate the clinical effects of laparoscopic common bile duct exploration( LCBDE) combined with laparoscopic cholecystectomy( LC) versus endoscopic retrograde cholangiopancreatography( ERCP) / endoscopic sphincterotomy( EST) combined with LC in the treatment of gallstones complicated by common bile duct stones.Methods A retrospective analysis was performed for the clinical data of56 patients with gallstones complicated by common bile duct stones who underwent minimally invasive surgeries in The Second Affiliated Hospital of Xinjiang Medical University from June 2013 to June 2016.Among these patients,24 were treated by LCBDE + LC and 32 were treated by ERCP / EST + LC.The clinical data including success rate of operation,time of operation,time to passage of gas by anus,length of hospital stay,hospital costs,and postoperative complications were compared between these two groups.The t- test was used for comparison of continuous data between groups.Results Of all patients in the LCBDE + LC group,22( 91.67%) underwent a successful surgery and 2( 8.33%)were converted to laparotomy;2 patients experienced bile leakage after surgery.Of all patients in the ERCP / EST + LC group,30( 93.75%)underwent a successful surgery and 2( 6.25%) were converted to laparotomy;6 patients experienced pancreatitis and 1 experienced bleeding after surgery.There were significant differences in incidence of pancreatitis between groups.Compared with the ERCP / EST + LC group,the LCBDE + LC group had significantly shorter time of operation and length of hospital stay and significantly lower hospital costs( t =- 5.818,- 5.393,and- 3.566,all P < 0.05).Conclusion Both LCBDE + LC and ERCP / EST + LC are effective minimally invasive therapies for gallstones complicated by common bile duct stones,but the treatment method should be selected based on patients' condition.

Risk factors for biliary complications after common bile duct exploration combined with primary suture

Zhang YinTao, Meng JinYing, Guo ChunGuang, Wang Hua

2017, 33(2): 304-307. DOI: 10.3969/j.issn.1001-5256.2017.02.021

Abstract(2731)

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Objective To investigate the incidence of biliary complications after laparoscopic common bile duct exploration combined with primary suture in the treatment of patients with common bile duct stones and related risk factors.Methods A total of 134 patients with common bile duct stones who underwent common bile duct exploration combined with primary suture in The First People's Hospital of Xianyang from June 2013 to June 2016 were enrolled,and biliary complications were evaluated according to the Clavien- Dindo classification.A univariate analysis was performed for 13 possible factors for biliary complications after primary suture,the chi- square test was used for comparison between groups,and a multivariate logistic regression analysis was performed for the factors screened out in the univariate analysis.Results A total of 12 patients experienced biliary complications after surgery,resulting in an incidence rate of 8.96%;among these patients,8 had bile leakage,2 had residual stones in the bile duct,1 had biliary stricture,and 1 had hematobilia.According to the Clavien- Dindo classification,3 had grade I,5 had grade II,2 had grade IIIa,and 2 had IIIb diseases.The univariate analysis showed that postoperative biliary complications were associated with plasma albumin level,biliary reoperation,nasobiliary drainage,and surgeon's experience( χ~2= 4.012,4.942,4.336,and 5.975,all P < 0.05),while they were not associated with age,sex,increased bilirubin level,maximum stone diameter,number of stones,medical diseases,gallstones,surgical procedure,and suture method( all P > 0.05).The multivariate analysis showed that biliary reoperation and surgeon's experience were independent risk factors for postoperative biliary complications( χ~2= 6.448 and 6.842,both P < 0.05).Conclusion There are certain risks of biliary complications after common bile duct exploration combined with primary suture,and biliary leakage is the most common complication,especially in patients undergoing biliary reoperation and when there is a lack of experience in surgeons.

Effect of fast track surgery on anxiety index and stress indices in patients undergoing laparoscopic cholecystectomy

Lu Xia, Jia HaiMing, Mi TaiYu, Zhang WenQuan, Gao Peng

2017, 33(2): 308-312. DOI: 10.3969/j.issn.1001-5256.2017.02.022

Abstract(2472)

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Abstract:
Objective To investigate the effect of fast track surgery( FTS) on anxiety index and stress indices in patients undergoing laparoscopic cholecystectomy.Methods The patients who were hospitalized in Department of General Surgery,The Second People's Hospital of Lanzhou,from March 2015 to July 2016 and underwent laparoscopic cholecystectomy were enrolled and randomly divided into FTS group and conventional treatment group,with 200 patients in each group.The patients in the FTS group were given FTS in the perioperative period,and those in the conventional treatment group were given conventional treatment.The C- reactive protein( CRP) level,white blood cell count( WBC),and interleukin- 6( IL- 6) level were measured on admission,at 1 hour before surgery,and at 24 and 48 hours after surgery,as well as the anxiety index in Hamilton anxiety scale( HAMA).The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups.Results There was no significant difference in anxiety index between the FTS group and the conventional treatment group on admission( P > 0.05);at 1 hour before surgery and at 24 and48 hours after surgery,there were significant differences in anxiety index between the two groups( χ~2= 12.73,13.17,and 14.12,all P <0.05).On admission and at 1 hour before surgery,there were no significant differences in the CRP level,WBC,and IL- 6 level between the FTS group and the conventional treatment group( all P > 0.05);at 24 and 48 hours after surgery,there were significant differences in the CRP level,WBC,and IL- 6 level between the two groups [CRP24h:8.47 ± 0.78 mg/L vs 17.56 ± 1.31 mg/L,t = 17.63,P < 0.05;WBC24h:( 8.3 ±3.4) ×10~9/ L vs( 10.2 ± 3.8) × 10~9/ L,t = 21.62,P < 0.05;IL- 624h:127.43 ±37.46 ng/L vs 146.25 ±42.56 ng/L,t =26.32,P < 0.05;CRP48h:( 6.57 ±1.27) mg/L vs( 10.76 ±1.25) mg/L,t =19.25,P <0.05;WBC48h:( 7.1 ±2.3) ×10~9/ L vs( 9.3 ±2.4) ×109/ L,t = 23.34,P< 0.05;IL- 648h:( 103.27 ± 38.54) ng/L vs( 127.76 ± 38.65) ng/L,t = 25.24,P < 0.05].There was a significant difference in the length of hospital stay between the FTS group and the conventional treatment group( 4 ± 1 d vs 7 ± 2 d,t = 13.15,P < 0.05),and there was also a significant difference in hospital costs( 7800 ± 500 yuan vs 9200 ± 600 yuan,t = 10.61,P < 0.05).Conclusion In patients undergoing laparoscopic cholecystectomy,FTS helps to reduce anxious emotion and stress response,shorten the length of hospital stay,and promote their rehabilitation.

Clinical effect of integrated traditional Chinese and Western medicine therapy in treatment of biliary ascariasis

Wang DaHai, Dai YongZe

2017, 33(2): 313-315. DOI: 10.3969/j.issn.1001-5256.2017.02.023

Abstract(2204)

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Abstract:
Objective To investigate an effective method for the treatment of biliary ascariasis.Methods A retrospective analysis was performed for the clinical data of 32 patients with biliary ascariasis who were treated in The People's Hospital of Huangmei County from January1994 to January 2014.All the patients were given spasmolysis,pain management,anti- infective therapy,traditional Chinese medicine syndrome differentiation- based treatment,Chinese materia medica for regulating qi and relieving pain,and ascariasis- relieving and parasite- expelling treatment.Patients were given surgical treatment due to poor response.Results Of all the 32 patients,5( 15.6%) had no response to the ascariasis- relieving treatment with Fructus Pruni Mume decoction and were given surgical treatment,and 27( 84.4%) were cured by Western medicine combined with Fructus Pruni Mume decoction.There were no complications such as acute pancreatitis,perforation of the gallbladder,and liver abscess.All the patients were treated with Fructus Pruni Mume decoction regularly after discharge and no patient experienced recurrence.Conclusion Integrated traditional Chinese and Western medicine therapy is effective,safe,and reliable in the treatment of biliary ascariasis and holds promise for clinical application.

An analysis of postoperative complications in children with biliary atresia after liver transplantation

Han HuanLi, Zhang MingMan, Guo ChunBao, Kang Quan, Li YingCun, Pu CongLun

2017, 33(2): 316-319. DOI: 10.3969/j.issn.1001-5256.2017.02.024

Abstract(331)

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Objective To investigate the postoperative complications and prognosis of children with biliary atresia treated with liver transplantation.Methods A retrospective analysis was performed for the clinical data of 41 children with biliary atresia who underwent primary liver transplantation in The Affiliated Children's Hospital of Chongqing Medical University from June 2006 to April 2014.Among these children,28 underwent living donor liver transplantation( LDLT) and 13 underwent liver transplantation from donation after cardiac death( DCD) donors.The children undergoing LDLT or DCD liver transplantation were followed up for 67- 90 months and 15- 56 months,respectively.The complications in the perioperative period and follow- up and prognosis were analyzed.The Fisher's exact test was used for comparison of categorical data between groups.Results Perioperative complications mainly included vascular complications,intra- abdominal hemorrhage,intestinal perforation,rejection reaction,and infection.The incidence of hepatic artery thrombosis in DCD groups was significantly higher than LDLT groups( P = 0.02).A total of 10 children died in the perioperative period,among whom 4 underwent LDLT( 1died of hepatic artery thrombosis,1 underwent DCD liver transplantation due to hepatic artery thrombosis and later died of primary graft failure,1 died of suffocation caused by vomiting,and 1 died of multiple organ failure) and 6 underwent DCD liver transplantation( 1 child each died of hepatic artery thrombosis,pulmonary Klebsiella pneumoniae infection,septic shock after intestinal leakage,circulatory failure,severe capillary leak syndrome,and primary graft failure).During the follow- up,4 children undergoing LDLT died,among whom 2 died of hepatic vein stenosis,1 died of biliary tract infection,and 1 died of biliary stricture.No children undergoing DCD liver transplantation died or experienced complications during follow- up.Conclusion Various complications after liver transplantation in children with biliary atresia are important factors affecting the success rate of liver transplantation and long- term survival rates.Early prevention,early diagnosis,and timely treatment are very important to improve the prognosis of children undergoing liver transplantation.

Analysis of pathogenic bacteria in bile and blood of patients with obstructive jaundice

Li Jing, Wu GuangLi, Wang Wei, Xiao Xin, Liu HuiNa, Qu DongDong, Cai YiWei

2017, 33(2): 320-323. DOI: 10.3969/j.issn.1001-5256.2017.02.025

Abstract(2286)

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Objective To investigate the distribution of pathogenic bacteria in the bile and blood samples of patients with obstructive jaundice.Methods A total of 322 patients with obstructive jaundice who were admitted to Department of Gastroenterology and Department of Hepatobiliary Surgery in The Affiliated Hospital of Binzhou Medical University from January 2012 to April 2016 were enrolled.Bile samples were obtained from all patients and blood culture was performed for 84 patients.The influence of benign and malignant obstruction and therapies on the detection rate of pathogenic bacteria in bile was analyzed,and the detection rate of pathogenic bacteria in bile and blood was compared.The chi- square test was used for comparison of categorical data between groups.Results Pathogenic bacteria were detected in246 patients( 246 /322),resulting in a detection rate of 76.40%.A total of 267 strains were detected,which consisted of 208 strains of Gram- negative bacteria,48 strains of Gram- positive bacteria,and 11 strains of fungi.Among the 256 patients who underwent endoscopic retrograde cholangiopancreatography( ERCP),199 were detected to have pathogenic bacteria,resulting in a detection rate of 77.73%;among the 66 patients who underwent surgery,47 were detected to have pathogenic bacteria,resulting in a detection rate of 71.21%.There was no significant difference in the detection rate of pathogenic bacteria between these two groups( χ~2= 1.238,P = 0.266).Among the 288 patients with benign obstructive jaundice,215 were detected to have pathogenic bacteria,resulting in a detection rate of 74.65%;among the34 patients with malignant obstructive jaundice,31 were detected to have pathogenic bacteria,resulting in a detection rate of 91.18%.There was a significant difference in the detection rate of pathogenic bacteria between these two groups( χ~2= 4.605,P = 0.032),and there was a significant difference in the distribution of pathogenic bacteria in bile between these two groups( χ~2= 0.159,P = 0.690).The types of pathogenic bacteria in bile samples were similar to those in blood samples,and there was a significant difference in the detection of pathogenic bacteria between them( χ~2= 13.235,P < 0.001).Conclusion There is no significant difference in the detection rate of pathogenic bacteria determined by ERCP or surgery in patients with obstructive jaundice.For patients who cannot undergo ERCP or surgery,blood culture results can be used to guide clinical medication.

Effect of Y- box binding protein 1 overexpression on the prognosis of patients with intrahepatic cholangiocarcinoma undergoing postoperative adjuvant chemotherapy

Liu Heng, Jiang Li, Xu XiaoYong, Xia Jun, Song YuLin

2017, 33(2): 324-328. DOI: 10.3969/j.issn.1001-5256.2017.02.026

Abstract(2254)

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Objective To investigate the association between Y- box binding protein 1( YB- 1) overexpression and the prognosis of patients with intrahepatic cholangiocarcinoma( ICC) undergoing postoperative adjuvant chemotherapy.Methods The paraffin- embedded specimens were collected from 58 patients with ICC who underwent surgical treatment and postoperative adjuvant chemotherapy in The First Affiliated Hospital of Anhui Medical University from January 2010 to January 2015.Immunohistochemistry was used to measure the expression of YB- 1 in ICC tissue;after ICC cells were transfected with YB- 1 plasmid,the thiazolyl blue method was used to observe the change in gemcitabine sensitivity,and q PCR was used to observe the changes in the expression of multidrug resistance genes.The independent samples t- test was used for comparison of continuous data between two groups and a one- way analysis of variance was used for comparison of continuous data between multiple groups;the chi- square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to calculate survival rates and the log- rank test was used for survival difference analysis.Results Among the 58 patients,44( 75.9%) had high expression of YB- 1 in the cytoplasm of ICC cells( cytoplasm YB- 1 positive group) and 14( 24.1%)had no expression of YB- 1 in the cytoplasm of ICC cells( cytoplasm YB- 1 negative group).Of all patients in the cytoplasm YB- 1 positive group,18( 40.9%) also had positive nuclear expression of YB- 1( nuclear YB- 1 positive group);the other 40 patients had no nuclear expression of YB- 1( nuclear YB- 1 negative group).The nuclear YB- 1 negative group had a significantly longer survival time than the nuclear YB- 1 positive group( 63 months vs 28 months,χ~2= 17.99,P < 0.05).In the control plasmid group,the half- maximal inhibitory concentration( IC_(50)) of gemcitabine in HCCC- 9810 cells was 0.054 μmol,and in the p SG5- YB- 1 plasma transfection group,IC_(50) increased to 0.460 μmol after YB- 1 overexpression,which was 10 times higher than that in control plasmid group( P < 0.05).There was a significant increase in the YB- 1 transcriptional level after HCCC- 9810 cells were transfected with p SG5- YB- 1 plasmids( t =19.02,P < 0.05).After YB- 1 overexpression,HCCC- 9810 cells had significant increases in the transcriptional levels of multidrug resistance protein 1( MDR1) and multidrug resistance- associated protein 1( MRP1)( t = 13.34 and 11.35,both P < 0.05).Conclusion YB- 1 overexpression can be found in most ICC tissues,and nuclear positive expression of YB- 1 may indicate the poor effect of postoperative adjuvant chemotherapy,which may be associated with the increase in multidrug resistance after the expression of MDR1 and MRP1.

Protective effect of autophagy in mice with acute liver injury induced by D- galactosamine / lipopolysaccharide and related mechanisms

Shi HongBo, Shi HongLin, Zhang XiangYing, Chen DeXi, Duan ZhongPing, Ren Feng

2017, 33(2): 329-333. DOI: 10.3969/j.issn.1001-5256.2017.02.027

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Objective To investigate the role and mechanism of autophagy in acute liver injury induced by D- galactosamine / lipopolysaccharide( D- Gal N / LPS) in mice.Methods C57 BL /6 mice were used to establish a mouse model of acute liver injury using intraperitoneally injected D- Gal N / LPS.In this animal experiment,the mice were divided into control group,D- Gal N / LPS group,rapamycin + D-Gal N / LPS group,3- MA + D- Gal N / LPS group,and Atg7 siRNA + D- Gal N / LPS group.The survival of the mice was observed,and liver pathological changes were observed to analyze liver injury.An automatic biochemical analyzer was used to measure the serum levels of alanine aminotransferase( ALT) and aspartate aminotransferase( AST),quantitative real- time PCR was performed to measure the mRNA expression of tumor necrosis factorα( TNFα) and interleukin- 6( IL- 6),and a fluorescence microscope was used to observe the apoptosis of hepatocytes.A One- way ANOVA was used for comparison between multiple groups;the least significant difference t- test was used for homogeneity of variance and the Games- Howell method was used for heterogeneity of variance.Results Compared with the D- Gal N / LPS group,the rapamycin + D- Gal N / LPS group had a significant increase in survival rate( 80% vs 40%),significantly reduced liver hemorrhage,inflammation,and necrosis and apoptosis of hepatocytes,and significant reductions in serum levels of ALT( 427.4 ± 195.5 U / L vs977.7 ± 247.3 U / L,P = 0.002) and AST( 378.2 ± 169.7 U / L vs 1100.0 ± 438.0 U / L,P = 0.004),as well as significant reductions in the mRNA expression of TNFα( 0.288 ± 0.010 vs 1.136 ± 0.267,P = 0.003) and IL- 6( 0.272 ± 0.061 vs 0.869 ± 0.317,P =0.010).Compared with the D- Gal N / LPS group,the 3- MA + D- Gal N / LPS group and Atg7 siRNA + D- Gal N / LPS group had significant reductions in survival rate( 0% /10% vs 40%),significantly aggravated liver hemorrhage,inflammation,and necrosis and apoptosis of hepatocytes,and significant increases in serum levels of ALT( 1836.0 ± 560.5 U / L and 1654.0 ± 627.6 U / L vs 977.7 ± 247.3 U / L,P =0.006 and 0.034) and AST( 1948.0 ± 645.5 U / L and 1804.0 ± 492.6 U / L vs 1100.0 ± 438.0 U / L,P = 0.029 and 0.033),as well as significant increases in the expression of TNFα in liver tissue( 2.026 ± 0.342 and 1.994 ± 0.286 vs 1.136 ± 0.267,P = 0.006 and0.005).Conclusion In the mouse model of acute liver injury induced by D- Gal N / LPS,autophagy has an important protective effect,and its regulating mechanism may be associated with the inhibitory effect on inflammatory factors and apoptosis of hepatocytes.

A case of chronic hepatitis B with mesenteric vasculitis

Zhang PanPan, Wang Song, Meng XiangWei, Hua Rui

2017, 33(2): 334-335. DOI: 10.3969/j.issn.1001-5256.2017.02.028

Abstract(2023)

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A case of hepatic epithelioid hemangioendothelioma with portal vein thrombosis

Tang ShanHong, Ceng WeiZheng, Chen YiHua, Wu XiaoLing, Lin Wei, Ma WenBin, Jiang MingDe

2017, 33(2): 336-338. DOI: 10.3969/j.issn.1001-5256.2017.02.029

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A case of Madelung disease

Xin ZhiYing, Gao Hui, Kui YiWen, Jin QingLong, Wen XiaoYu

2017, 33(2): 341-343. DOI: 10.3969/j.issn.1001-5256.2017.02.030

Abstract(3044)

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Endoscopic ultrasound- guided celiac plexus neurolysis in treatment of abdominal pain caused by cholangiocarcinoma:a case report

Tong Ting, Jiang XiangWu, Huang Wei

2017, 33(2): 344-345. DOI: 10.3969/j.issn.1001-5256.2017.02.031

Abstract(2327)

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A case of splenic cystiform lymphangioma

Liu ShouLing, Zhang CongGui, Zhou JianPeng, Wang GuangYi

2017, 33(2): 346-347. DOI: 10.3969/j.issn.1001-5256.2017.02.032

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Research advances in idiopathic non- cirrhotic portal hypertension

Liu HaiBo, Zhang BoJing, Lyu Yong, Han GuoHong

2017, 33(2): 348-353. DOI: 10.3969/j.issn.1001-5256.2017.02.033

Abstract(2826)

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Idiopathic non- cirrhotic portal hypertension( INCPH) is a rare disease,which is characterized by portal hypertension in the liver and the absence of liver cirrhosis,other liver diseases,or portal or hepatic vein thrombosis.At present,the research on the etiology of INCPH mainly focuses on the aspects of immune system diseases,chronic infections,exposure to drugs or toxins,genetic predisposition,and prothrombotic conditions or hypercoagulability.The main features of the clinical manifestations of INCPH are portal hypertension,splenomegaly,and hypersplenism,while liver injury,ascites,and hepatic encephalopathy are rare.Currently,there are no clear diagnostic criteria for INCPH,and a diagnosis is often made by exclusion.As for the treatment of INCPH,the therapeutic method recommended in the latest Baveno VI consensus is to follow the current guidelines for the treatment of cirrhotic portal hypertension.Since the majority of INCPH patients have good liver function,they have better prognosis compared with the patients with liver cirrhosis,but some of them may still develop liver failure and need liver transplantation.

Changes in gastrointestinal structure and function caused by cirrhotic portal hypertension and related clinical manifestations

Shang ZhiYin, Yang JingMao, Chen LiPing, Liu Min, Cheng Kai, Li YaoHua, Ai YingChun, Cheng JiLin

2017, 33(2): 354-358. DOI: 10.3969/j.issn.1001-5256.2017.02.034

Abstract(2214)

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In clinical practice,up to 80% of patients with cirrhotic portal hypertension have varying degrees of gastrointestinal symptoms,which are associated with the changes in gastrointestinal structure,gastrointestinal dysfunction,and altered neurohumoral regulation.This article reviews the changes in gastrointestinal structure,gastrointestinal dysfunction,and altered neurohumoral regulation caused by cirrhotic portal hypertension,as well as the gastrointestinal clinical manifestations caused by such changes.It is pointed out that the research on the changes in gastrointestinal structure in cirrhotic patients with portal hypertension helps to effectively prevent and treat the complications of liver cirrhosis and improve gastrointestinal symptoms.In addition,the regulation of gastrointestinal function can improve patients' symptoms and delay the progression of liver cirrhosis.Therefore,it is recommended to regularly evaluate the changes in gastrointestinal mucosa and vessels in patients with liver cirrhosis,in order to provide early treatment and reduce complications.

Mechanism of radiofrequency ablation in treatment of hepatocellular carcinoma

Wang Peng, Ren WeiDong

2017, 33(2): 359-363. DOI: 10.3969/j.issn.1001-5256.2017.02.035

Abstract(2345)

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Hepatocellular carcinoma( HCC) is a malignant tumor with high incidence and mortality rates around the world.Radiofrequency ablation( RFA) is an effective therapy for HCC,especially in patients who experience recurrence after surgery for liver cancer,who are complicated by liver dysfunction and unable to undergo surgical resection,and who have multiple liver tumors and undergo palliative treatment.RFA can significantly improve patients' survival time and quality of life.This article reviews the mechanism of RFA in the treatment of HCC from the aspects of direct and indirect injuries and helps to further understand the role of RFA in local and systemic treatment of HCC,which has a potential value for multidisciplinary treatment of HCC in future.

Research advances in diagnosis and treatment of hepatocellular carcinoma complicated by arterioportal shunt

Yang Yang, Guo WuHua

2017, 33(2): 364-368. DOI: 10.3969/j.issn.1001-5256.2017.02.036

Abstract(2485)

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Hepatocellular carcinoma( HCC) complicated by arterioportal shunt( APS) is commonly seen in clinical practice,with an incidence rate of 28.8%- 63.2%.It is manifested as abdominal pain,diarrhea,and ascites and can also lead to serious complications of portal hypertension including gastrointestinal bleeding.Although there are various therapeutic methods,they tend to have poor clinical effects.APS is one of the most important causes of death in patients with HCC.This article introduces the etiology,typing,clinical manifestation,and therapies of HCC complicated by APS and points out that although there are various therapeutic methods for HCC complicated by APS,interventional treatment remains the most important method.The exploration of interventional treatment helps to improve patients' prognosis.

Regulatory effect of abnormal expression of hypoxia- inducible factor- 1α on angiogenesis in hepatocellular carcinoma

Wang Li, Shi Wei, Xue Jun, Pan CuiRan, Yao Min, Yao DengFu

2017, 33(2): 369-374. DOI: 10.3969/j.issn.1001-5256.2017.02.037

Abstract(2056)

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Hepatocellular carcinoma( HCC) is a common malignant tumor in China with abundant blood supply.Conventional therapies may easily cause tolerance and patients tend to have poor prognosis.Combined with the hypoxia response elements of over a hundred of downstream target genes,hypoxia- inducible factor- 1α( HIF- 1α) in liver tissue participates in many processes including angiogenesis and glucose metabolism,inhibits the differentiation and apoptosis of tumor cells,and promotes the proliferation of tumor cells.High expression of HIF- 1α and its regulatory effect on angiogenesis- related factors are closely associated with patients' tolerance to radiotherapy and chemoradiotherapy,tumor invasion,metastasis,and prognosis.This article reviews the regulatory effect of abnormal expression of HIF- 1α in HCC cells on angiogenesis- related factors and their interrelation.

Research advances in drug- induced liver injury

Yuan Ling, Yang YongGeng, Shen YouXiu, Ma YingCai

2017, 33(2): 375-378. DOI: 10.3969/j.issn.1001-5256.2017.02.038

Abstract(2504)

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With the continuous development of new drugs and their clinical application,the incidence of drug- induced liver injury continues to increase.In order to enhance the knowledge of drug- induced liver injury and provide a reference for clinical prevention,this article reviews the drugs causing drug- induced liver injury and the pathogenesis,diagnosis,typing,treatment,and prevention of drug- induced liver injury.

Research progress in genetic susceptibility to alcoholic liver disease

Yang FuNing, Huang Jing

2017, 33(2): 379-383. DOI: 10.3969/j.issn.1001-5256.2017.02.039

Abstract(1841)

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Alcoholic liver disease( ALD) is one of the most common chronic liver diseases in clinical practice with a complicated pathogenesis.Genetic factors play an important role in the pathogenesis of ALD and might be the potential targets for the treatment of ALD.This article reviews the susceptibility genes associated with ALD in recent years and points out that the exploration of the mechanisms of action of these genes in the development and progression of ALD can provide a theoretical basis for effective evaluation,diagnosis,and prevention and treatment of ALD in clinical practice.

Mechanism of action of gut microbiota in hepatobiliary diseases

Han MeiLin, Gong ZhenHua

2017, 33(2): 384-388. DOI: 10.3969/j.issn.1001-5256.2017.02.040

Abstract(1994)

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As the largest microbial community in human body,gut microbiota is involved in many important physiological processes,and gut microbiota dysbiosis is associated with various diseases in humans.Due to the interaction and mutual effect between the liver and the gastrointestinal tract,gut microbiota plays an important role in the development and progression of hepatobiliary diseases.Metagenomic studies can achieve a comprehensive understanding of the features of gut microbiota and its effect on human health and diseases.This article introduces the research advances in the changes of gut microbiota among patients with nonalcoholic fatty liver disease,liver cirrhosis,hepatocellular carcinoma,and autoimmune liver diseases and related mechanisms of action.

Application status of three- dimensional CT reconstruction in hepatobiliary surgery

Jiang Chao, Wang HaiJiu, Ren Li, Yang DanCaiRang, Hou LiChao, Zhou Ying, Wen Hao, Fan HaiNing

2017, 33(2): 389-393. DOI: 10.3969/j.issn.1001-5256.2017.02.041

Abstract(2179)

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With the development of imaging technology,three- dimensional CT reconstruction has been widely used in hepatobiliary surgery.Three- dimensional CT reconstruction can divide and reconstruct two- dimensional images into three- dimensional images and clearly show the location of lesion and its relationship with the intrahepatic bile duct system.It has an important value in the preoperative assessment of liver volume,diagnosis and treatment decision- making process,intraoperative precise operation,and postoperative individualized management,and promotes the constant development of hepatobiliary surgery and minimally invasive technology,and therefore,it holds promise for clinical application.

Risk factors for recurrence after surgery for common bile duct stones

Qian Rui, Chen XiaoPeng

2017, 33(2): 394-399. DOI: 10.3969/j.issn.1001-5256.2017.02.042

Abstract(1992)

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Recurrence after surgery for common bile duct stones has not been solved properly,and recurrence of calculi often requires reoperation,which brings patients great pain and economic burden.Various risk factors may mediate the recurrence of common bile duct stones,including biliary tract infection,bile duct stenosis,cholangiectasis,cholestasis,Oddi sphincter dysfunction,abnormal bile composition,and surgical procedure.These risk factors are analyzed and related preventive measures are summarized.Current research findings show that prevention and treatment of risk factors for recurrence of calculi can reduce the recurrence rate of calculi and play an important role in preventing the recurrence of common bile duct stones.

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