Objective To investigate clinical efficacy and prognostic factors of hilar cholangiocarcinoma.Methods The retrospective case-control study was conducted.The clinicopathological data of 322 patients with hilar cholangiocarcinoma who were admitted to the Xiangya Hospital of Central South University between December 2005 and November 2015 were collected.Preoperative staging and classification of tumor and treatment planning were carried out according to the results of laboratory and imaging examinations.Observation indexes:(1) clinical features and results of assisted examinations;(2) treatments and results of pathological examination;(3) followup and survival;(4) prognostic factors analysis:gender,age,preoperative highest total bilirubin (TBil),preoperative carcinoembryonic antigen (CEA),preoperative CA19-9,preoperative CA242,preoperative CA125,treatment methods and TNM staging.The follow-up of outpatient examination and telephone interview was perfornmed to detect patients' survival up to November 2016.Survival curve was drawn using the Kaplan-Meier method.Survival and univariate analyses were done using the Log-rank test,and multivariate analysis was done using the Cox proportional hazard model.Results (1) Clinical features and results of assisted examinations:among the 322 patients,there were 301 patients with a chief complaint of jaundice.Of the 322 patients,the preoperative highest levels of TBil,DBil,ALT and AST in 322 patients were 3.9-785.2 μmol/L,1.6-410.2 μ mol/L,14.8-484.5 U/L and 21.4-539.8 U/L,respectively.Levels of ALP and GGT in 272 patients were 93.8-1 890.0 U/L and 2.0-1 832.8 U/L,respectively.Seventy-seven of 292 patients had an elevated CEA level,272 of 298 patients had an elevated CA19-9 level,153 of 260 patients had an elevated CA242 level and 86 of 260 patients had an elevated CA125 level.According to Bismuth-Corlette type,24 patients were detected in type Ⅰ,115 in type Ⅱ,55 in type Ⅲa,63 in type Ⅲb and 65 in type Ⅳ.(2) Treatments and results of pathological examination:Of the 322 patients,104 patients underwent radical resection,including 79 with hilar bile duct resection (9 combined with vascular resection and reconstruction) and 25 with extended hepatic lobectomy (16 combined with caudate lobectomy),and 218 patients underwent palliative treatments,including 134 with external biliary drainage and 84 with internal biliary drainage.Five patients were dead in the perioperative period,of which 2 died of acute liver failure,1 died of systemic infection and multiple organ failure,1 died of acute renal failure and 1 died of acute suppurative cholangitis,septic shock and disseminated intravascular coagulation.Of 263 patients receiving pathological examination,adenocarcinoma was detected in 253 patients (12 with high-differentiated adenocarcinoma,85 with moderate-differentiated adenocarcinoma,33 with low-differentiated adenocarcinoma and 123 with indefinite differentiation),mucinous adenocarcinoma in 5 patients,cholangiocarcinoma in 3 patients and neuroendocrine carcinoma in 2 patients.TNM staging of 322 patients:stage Ⅰ was detected in 8 patients,stage Ⅱ in 53 patients,stage Ⅲ in 132 patients,stage Ⅳ in 96 patients and indefinite stage in 33 patients.(3) Follow up and survival:among the 322 patients,296 were followed up for 12-132 months,with a median follow-up time of 65 months,including 94 with radical resection and 202 with palliative treatments.Among the 296 patients,the median survival time and 1-,3-,5-year survival rates were 10 months,47.1％,20.2％ and 9.5％,respectively.0f296 patients with follow-up,median survival time and 1-,3-,5-year survival rates were 31 months,84.0％,46.2％,25.0％ in 94 patients receiving radical resection and 7 months,29.9％,8.1％ and 2.3％ in 202 patients receiving palliative treatment,respectively,with a statistically significant difference between the 2 groups (x2=78.777,P＜ 0.05).Among the 94 patients receiving follow-up and radical resection,the median survival time and 1-,3-,5-year survival rates were 31 months,82.1％,45.1％,25.7％ in 73 patients undergoing hilar bile duct resection and 35 months,90.5％,49.8％,22.1％ in 21 patients undergoing hepatic lobectomy,respectively,with no statistically significant difference (x2=0.186,P＞0.05).Among the 73 patients undergoing hilar bile duct resection,median survival time and 1-,3-,5-year survival rates were 16 months,57.1％,0,0 in 7 patients combined with vascular resection and reconstruction and 34 months,84.6％,49.5％,27.5％ in 66 patients undergoing simplex hilar bile duct resection,respectively,showing a statistically significant difference (x2 =11.977,P＜ 0.05).(4) Prognostic factors analysis:results of univariate analysis showed that preoperative highest TBil,preoperative CEA,preoperative CA242,preoperative CA125,treatment methods and TNM staging were related factors affecting prognosis of patients with hilar cholangiocarcinoma (x2=25.009,18.671,9.359,33.628,94.729,77.136,P＜0.05).Multivariate analysis showed that preoperative highest TBil ≥ 342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ and Ⅳ were the independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma (HR =2.270,2.147,3.166,2.351,95％ confidence interval:1.587-3.247,1.446-3.188,2.117-4.734,1.489-3.712,P＜0.05).Conclusions Prognosis of hilar cholangiocarcinoma is still unsatisfactory.The R0 resection is the key in radical surgery.Preoperative highest TBil≥342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ-Ⅳ are independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma.

Objective To determine the possible mechanism for chronic pancreatitis causing pancreatic duct stones. Methods A total of 172 patients with chronic pancreatitis (n=67) , pan-creatic duct stones (n=62) , and pancreatic injury (n=43) , admitted to from August 2000 to October 2008, preoperatively diagnosed by endoscopic retrograde cholangiopancreatograpby (ERCP) or computed tomography (CT) , and intraoperatively confirmed by exploration and biopsy, were divid-ed into 3 groups. Pancreatic fluid was drawn to test the concentrations of pancreatic stone protein (PSP), lactoferrin (LF) and Ca2+. Results The chronic pancreatitis (the CP group) presented hard consistency, shrinkage and nodular fibrosis of the pancreas; besides the above symptoms, the pancreatic duct stones (the PS group) presented dilatation of the pancreatic ductal system with vari-ous stones ; pancreatic injury (the PI group) presented broken pancreas of different grades with fluid or blood. Compared with that of the PI group, PSP concentration of both the PS group and the CP group was elevated (P<0.05), and was more apparent in the CP group. Concentrations of LF and Ca2+ were also elevated (P<0.05) , which were more obvious in the PS group. Conclusion De-creased concentrations of PSP and increased concentrations of LF and Ca2+ may play very important roles in chronic pancreatitis causing pancreatic stones.

Objective To summarize our experience in the prevention and treatment of iatrogenic vascular(trauma).Methods The clinical data of 24 different types of iatrogenic vascular trauma committed from 2003 to 2006 were retrospectively analyzed.Results The 24 cases included 7 cases of superior mesenteric(arteriovenous) trauma,3 cases of portal venous trauma,4 cases of carotid arterial trauma,6 cases of iliac and femoral arterial trauma,and each one of trauma of popliteal artery,axillary artery,renal artery,left gastric artery,respectively.Treated method: Six cases underwent vascular repair,5 cases had vascular anastomosis,2 cases had vascular replacement,3 cases had vascular ligation,2 cases had covered stent implantation under intervention,and other methods included thrombectomy,thrombolysis and packing.Among the 24 cases,22 were cured completely,one patient died from massive hemorrhage 24 hours after operation,and the other died 5 days after operation.Conclusions Iatrogenic vascular trauma can be prevented and its incidence reduced by increased vigilance,clear identification of the anatomy,and accurate and careful operation.Once iatrogenic vascular trauma has occurred,its cause must be determined and then different treatment methods can be(chosen),based on the cicumstaces. When effective treatment technique is not at hand,one should promptly seek outside support or transfer the patient to an advanced hostipal.

Objective To investigate the effect of expression of pituitary tumor transforming gene(PTTG) on the expression of inhibitory of vascular endothelial growth factor(VEGF).Methods The constructed(recomibinant) vector,pcDNA3.1-PTTGas that contained full-length antisense PTTG,was transfected into the cholangiocarcinoma cell line QBC939 in different quantity.After 48h incubation,the variation of expressions of PTTG and VEGF mRNAs and proteins were observed by RT-PCP and Western-blot method.Results(After) successful transfecting the recomibinant vector into QBC939,the mRNAs and proteins of PTTG and VEGF were all inhibited.Linear correlation analysis showed positive correlation between descendent extents of PTTG and VEGF(P

Objective To investigate the indication and value of metallic stent in the management of patients with malignant obstructive jaundice(OJ). Method The clinical data of 15 patients with malignant OJ treated in our hospital were analysed retrospectively. All the 15 patients were treated with metallic stent including cholangiocarcinoma in 8 cases, carcinoma of gallbladder in 3 cases, pancreatic carcinoma in 2 cases, porta hepatis metastasis of gastric carcinoma after radical gastrectomy in 2 cases. Result All the patients' jaundice disappeared 11-38 days after the stent placement. No severe complications or death occurred in this series. One patient had cholimia 5 days after the stent placement, which was cured by non-operative method. All cases were followed up periodically, the survival time was 30-384 days(averag 180.5 days). Conclusions Installing stent of Titanium-Nickel metallic alloy for the patient with unresectable malignant OJ is an ideal palliative therapy which is simple and less discomfortable.and less complications.The effect of reducing jaundice is satisfactory. This method may offer a new alternative method in the management of malignant OJ.

Objective To investigate the possible mechanism of pancreaticobiliary maljunction(PBM) on development of congenital choledochal cyst(CCC).Methods Tweenty-one patients with choledochal cysts initially diagnosed by ultrasonography,then underwent ERCP.The concentrations of amylase(AMS) and C-reactive protein(CRP) in bile removed through selective biliary catheterization was analyzed.Results Each of 21 cases of PBM(including 13 cases of C-P type and 8 cases of P-C type) had significantly higher concentrations of AMS and CRP compared with control group(P

Objective To detect the effect of exogenous IL-6 on the proliferation of cholangiocarcinoma cell line QBC939.Methods MTT was used to observe the proliferation of cell line QBC939 treated with exogenous IL-6.Following the annexin V/FITC and PI staining,FCM was used to detect the apoptosis of QBC939 treated with exogenous IL-6.Results The proliferation of cell line QBC939 was increased after treatment with IL-6 and was positively related with the concentration of IL-6(P

Objecctive To study the expression and significance of CD44V6 and E-Cd in gallbladder carcinoma. Methods The expression of CD44V6 and E-Cd was detected by immunohistochemical technique in 48 cases of gallbladder carcinoma, 29 cases of gallbladder adenomal polypi and 25 cases of chronic calculous cholecytitis. The association of CD44V6 and E-Cd expression with the clinical and pathologic parameters was analyzed. Results E-Cd expressed in 21 of 48 cases of gallbladder carcinoma(43 75%), 21 of 29 cases of gallbladder adenomal polypi(72 42%) and 24 of 25 cases of chronic calculous cholecytitis(96 00%), while CD44V6 expressed in 31 of 48 cases of gallbladder carcinoma(64 58%), 9 of 29 cases of gallbladder adenomal polypi(31 03%) and 1 of 25 cases of chronic calculous cholecytitis(4 00%). The expression rates of CD44V6 and E-Cd in the three kinds of tissues were significantly different(P

Objective To investigate the relationship between the expression of the Smad4,TGF-?_1 and T?R II and the possible mechanisms in the development of cholangiocarcinoma. Methods Immunohistochemical SABC method was used to examine the expression of Smad4,TGF-?_1 and T?R II in 49 cases of cholangiocarcinoma and 8 nomal common bile duct.Results The expression rates of Smad4,TGF-?_1 and T?R II in cholangiocarcinoma were (40.82)%(20/49),71.43%(35/49) and 36.73%(18/49) respectively; in normal common bile duct tissues were 87.50(7/8),12.50%(1/8) and 100%(8/8) respectively. There was a significant relationship between the (expression) of TGF-?_1 and clinical stage, and tumor metastasis (P

Objective To evaluate the therapeutic effect of segmental hepatectomy for intrahepatic bile duct stones.Methods In this study, 414 patients suffering from intrahepatic bile duct stones underwent hepatectomy from Jan 1981 to Dec 2001. Stones distribution, operation modality,postoperative complication and therapeutic effect were evaluated. Results Postoperative complications occurred in 72 cases(17.4%), mortality was 0.7%. A follow up of 2 to 22 years was achieved in 305 patients (73.7%), with excellent or good result in 88.9%, residual stone in 15.7%,and stone recurrence in 4.6%.Conclusion Appropriate use of hepatectomy is effective for the treatment of intrahepatic bile duct stones.