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Hepatocellular carcinoma with tumor thrombus in bile duct:A proposal of new classification according to resectability of primary lesion

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World Journal of Gastroenterology 2020年第44期26卷 7005-7021页

作者： Di Zhou Gang-Feng Hu Wei-Chen Gao Xiao-Yu Zhang Wen-Bin Guan Jian-Dong Wang Fei Ma Department of General Surgery Xinhua Hospital Affiliated with Shanghai Jiao Tong UniversitySchool of MedicineShanghai 200092China Department of General Surgery Xinhua Hospital Affiliated with Shanghai Jiao Tong UniversitySchool of MedicineChongming BranchShanghai 202150China Department of Pathology Xinhua Hospital Affiliated to Shanghai Jiaotong UniversitySchool of MedicineShanghai 200092China Department of Oncology Xinhua Hospital Affiliated to Shanghai Jiao Tong UniversitySchool of MedicineShanghai 200092China Shanghai Institute for Pediatric Research Shanghai 200092China

BACKGROUND Hepatocellular carcinoma(HCC)with tumor thrombus in the bile duct(BDTT)is easily misdiagnosed or mistreated due to the clinicopathological diversity of the thrombus and its relationship with primary *** To propose a new classification for HCC with BDTT in order to guide its diagnosis and *** A retrospective review of the diagnosis and treatment experience regarding seven typical HCC patients with BDTT between January 2010 and December 2019 was *** BDTT was preoperatively confirmed by computed tomography/magnetic resonance imaging in only four *** patients with recurrent HCC and one patient with first-occurring HCC had no visible intrahepatic tumors;of these,misdiagnosis occurred in two patients,and three patients *** patient was mistreated as having common bile duct stones,and another patient with a history of multiple recurrent HCC was misdiagnosed until obvious biliary dilation could be *** one patient who received hepatectomy accompanied by BDTT extraction exhibited disease-free survival during the follow-up period.A new classification was proposed for HCC with BDTT as follows:HCC with microscopic BDTT(Type Ⅰ);resectable primary or recurrent HCC mass in the liver with BDTT(Type Ⅱ);BDTT without an obvious HCC mass in the liver(Type Ⅲ)and BDTT accompanied with unresectable intra-or extrahepatic HCC lesions(Type Ⅳ).CONCLUSION We herein propose a new classification system for HCC with BDTT to reflect its pathological characteristics and emphasize the significance of primary tumor resectability in its treatment.

关键词： Hepatocellular carcinoma Tumor thrombus bile duct Diagnosis Treatment

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Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

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World Journal of Gastroenterology 2007年第22期13卷 3128-3132页

作者： Da-Bing Zhao Hong Shan Zai-Bo Jiang Ming-Sheng Huang Kang-Shun Zhu Gui-Hua Chen Xiao-Chun Meng Shou-Hai Guan Zheng-Ran Li Jie-Sheng Qian The Third-Affiliated Hospital Sun Yat-sen University Guangzhou 510630 Guangdong Province China The Xiangfan First Hospital Jiefang road 75 Faneheng District Xiangfan 441000 Hubei Province China

AIM： To analyze the clinical manifestations and the effectiveness of therapy in patients with orthotopic liver bansplantation （OLT）-associated hepatic artery stenosis （HAS） and non-anastomosis bile duct stricture.METHODS： Nine cases were diagnosed as HAS and non-anastomosis bile duct stricture. Percutaneous transluminal angioplasty （PTA） was performed in four HAS cases, and expectant treatment in other five HAS cases, percutaneous transhepatic bile drainage, balloon dilation, stent placement were performed in all nine cases.RESULTS： Diffuse intra- and extra-bile duct stricture was observed in nine cases, which was associated with bile mud siltation and biliary infection. Obstruction of the bile duct was improved obviously or removed. Life span/ follow-up period was 13-30 mo after PTA of four HAS cases, 6-23 mo without PTA of other five cases.CONCLUSION： Progressive, non-anastomosis, and diffuse bile duct stricture are the characteristic manifestations of HAS and non-anastomosis bile duct stricture after OLT. These are often associated with bile mud siltation, biliary infection, and ultimate liver failure. Interventional therapy is significantly beneficial.

关键词： Liver transplantation bile duct Postoperative complication Stricture Interventional therapy

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Rare isolated extra-hepatic bile duct injury: A case report

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World Journal of Clinical Cases 2021年第20期9卷 5661-5667页

作者： Jian Zhao Yan-Li Dang Jia-Ming Lin Chun-Hai Hu Zhi-Yong Yu Department of Hepatobiliary Surgery The Affiliated Hospital of Yunnan University(The Second People's Hospital of Yunnan Province)Kunming 650000Yunnan ProvinceChina Department of Obstetrics The First People's Hospital of Yunnan ProvinceKunming 650000Yunnan ProvinceChina

BACKGROUND Extra-hepatic bile duct injury(EHBDI)is very rare among all blunt abdominal *** to literature statistics,it only accounts for 3%-5%of abdominal injuries,most of which are combined *** EHBDI is more rare,with a special injury mechanism,clinical presentation and treatment strategy,so missed diagnosis easily *** SUMMARY We report a case of unexplained abdominal effusion and jaundice following blunt abdominal trauma in our *** which,surgical exploration of the case was performed and a large amount of bile leakage in the abdominal cavity was *** obvious abdominal organ damage or bile duct rupture was *** was terminated after the common bile duct indwelled with a T *** 2 wk,a T-tube angiography revealed the lesion in the common bile duct pancreatic segment,confirming isolated *** 2 mo later,the T tube was pulled out with re-examined magnetic resonance cholangiopancreatography,indicating narrowing of the common bile duct injury,with no special treatment due to no clinical symptoms and no abnormality in the current *** This case was featured by intraoperative bile leakage and no *** type of rare isolated EHBDI is prone to missed and delayed diagnosis due to its atypical clinical manifestations and imaging *** is still the main treatment,and the indications and principles of bile duct injury repair must be followed.

关键词： bile duct Injury Blunt Abdominal trauma Diagnosis Case report

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Diseases of bile duct in children

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World Journal of Gastroenterology 2024年第9期30卷 1043-1072页

作者： Sutha Eiamkulbutr Chomchanat Tubjareon Anapat Sanpavat Teerasak Phewplung Nimmita Srisan Palittiya Sintusek Department of Pediatrics King Chulalongkorn Memorial HospitalBangkok 10330Thailand Department of Pediatrics Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkok 10330Thailand Department of Pathology Chulalongkorn UniversityBangkok 10330Thailand Department of Radiology Chulalongkorn UniversityBangkok 10330Thailand Department of Surgery Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkok 10330Thailand Center of Excellence in Thai Pediatric Gastroenterology Hepatology and ImmunologyDivision of GastroenterologyDepartment of PediatricsKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand

Several diseases originate from bile duct *** studies on these diseases,certain etiologies of some of them still cannot be *** most common disease of the bile duct in newborns is biliary atresia,whose prognosis varies according to the age of surgical *** diseases such as Alagille syndrome,inspissated bile duct syndrome,and choledochal cysts are also time-sensitive because they can cause severe liver damage due to *** majority of these diseases present with cholestatic jaundice in the newborn or infant period,which is quite difficult to differentiate regarding clinical acumen and initial *** cholangiography is potentially necessary to make an accurate diagnosis,and further treatment will be performed synchronously or planned as findings *** article provides a concise review of bile duct diseases,with interesting cases.

关键词： bile duct Cholestasis Biliary atresia Biliary hypoplasia Biliary imaging Inspissated bile syndrome Choledochal cyst

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Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes

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World Journal of Gastroenterology 2014年第22期20卷 6924-6931页

作者： Young Ook Eum Joo Kyung Park Jaeyoung Chun Sang-Hyub Lee Ji Kon Ryu Yong-Tae Kim Yong-Bum Yoon Chang Jin Yoon Ho-Seong Han Jin-Hyeok Hwang Department of Internal medicine Cheongju St. Mary's HospitalChungcheongbuk-do 360-568South Korea Department of Internal Medicine Seoul National University Hospital Seoul National University College of Medicine Seoul 110-744South Korea Department of Internal Medicine Seoul National University College of Medicine Seoul National University Bundang Hospital Gyeonggi-do 463-707South Korea Department of Radiology Seoul National University Bundang HospitalGyeonggi-do 463-707South Korea Department of Surgery Seoul National University Bundang HospitalGyeonggi-do 463-707South Korea

AIM: To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs).

关键词： Endoscopic retrograde cholangiography Percutaneous transhepatic cholangiography Percutaneous transhepatic biliary drainage bile duct Biliary stricture.

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Contrast-enhanced ultrasound of a traumatic neuroma of the extrahepatic bile duct:A case report and review of literature

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World Journal of Gastroenterology 2022年第30期28卷 4211-4220页

作者： Zhi-Qiang Yuan Hua-Lin Yan Jia-Wu Li Yan Luo Department of Medical Ultrasound West China Hospital of Sichuan UniversityChengdu 610041Sichuan ProvinceChina

BACKGROUND Traumatic neuromas result from nerve injury after trauma or surgery but rarely occur in the bile ***,it is challenging to diagnose traumatic neuromas correctly *** some previous reports have described the imaging features of traumatic neuroma in the bile duct,no features of traumatic neuromas in the bile duct have been identified by using contrast-enhanced ultrasound(CEUS)imaging *** SUMMARY A 55-year-old male patient presented to our hospital with a 3-mo history of abdominal distension and anorexia and history of cholecystectomy 4 years *** ultrasound demonstrated mild to moderate intrahepatic bile duct ***,a hyperechoic nodule was found in the upper extrahepatic bile *** lesion approximately 0.8 cm×0.6 cm with a regular shape and clear *** nodule of the bile duct showed slight hyperenhancement in the arterial phase and isoenhancement in the venous phase on *** tests showed that alanine aminotransferase and aspartate aminotransferase were increased significantly,while the tumor marker carbohydrate antigen 19-9 was increased ***,hilar bile duct resection and end-to-end bile ductal anastomosis were *** histological examination revealed traumatic neuroma of the extrahepatic bile *** patient had an uneventful recovery after *** The current report will help enhance the current knowledge regarding identifying traumatic neuromas by CEUS imaging and review the related literature.

关键词： Traumatic neuroma bile duct Contrast-enhanced ultrasound Enhancement Cholangiocarcinoma Case report

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Sequential embolization of the branches of the bile duct and portal vein to the targeted hepatic lobe in rats

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Hepatobiliary & Pancreatic Diseases International 2014年第1期13卷 55-59页

作者： Anuj Shrestha Yong Zhou Hui Mao Fu-Yu Li Wen-Jie Ma Nan-Sheng Cheng Ri-Hua Xu Yong-Qiong Zhang Ting Jiang Huan Feng Wen Li Qiang Han Department of Hepatobiliary Surgery West China Hospital of Sichuan University Department of Medicine West China Hospital of Sichuan University

BACKGROUND: The high recurrence rate of hepatolithiasis and the high operative risk of right posterior, caudate or multiple lobe hepatectomy are the unsettled problems in hepatobiliary surgery. The present study was to investigate the efficacy of chemical hepatectomy performed via applying sequential embolization of the branches of the bile duct and portal vein to the targeted hepatic lobe. METHODS: The bile duct and portal vein branches of the median hepatic lobe of rats were treated with: 1) bile duct embolization followed by portal vein ligation(BDE+PVL) and 2) portal vein ligation followed by bile duct embolization(PVL+BDE). The efficacy of chemical hepatectomy in BDE+PVL and PVL+BDE groups was compared with that of sole BDE by histology and Western blotting analysis of collagen I expression. RESULTS: After six weeks of the chemical hepatectomy, rats in the BDE group showed hepatocyte damages, fibrosis and 'selfcut' only in the periphery of the embolized lobe. In contrast, rats in the PVL+BDE and BDE+PVL groups exhibited complete necrosis of hepatocytes and replacement with proliferative ductules and collagen fibers, leading to complete fibrosis and 'self-cut' phenomenon in the whole targeted lobe. Collagen I expression in the PVL+BDE group was slightly higher than that in the BDE+PVL group; however, no statistically significant difference was noted. CONCLUSION: The sequential embolization of the bile duct and portal vein branches to the targeted hepatic lobe may bea feasible and effective approach to acheive the ideal effect of chemical hepatectomy in a short period of time.

关键词： hepatolithiasis bile duct portal vein sequential embolization chemical hepatectomy

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Extrahepatic intraductal ectopic hepatocellular carcinoma:bile duct filling defect

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Hepatobiliary & Pancreatic Diseases International 2009年第6期8卷 650-652页

作者： Moritz Schmelzle Hanno Matthaei Nadja Lehwald Andreas Raffel Roy Y.Tustas Natalia Pomjanski Petra Reinecke Marcus Schmitt Jan Schulte am Esch Wolfram T.Knoefel Claus F.Eisenberger Department of General Visceral and Pediatric Surgery Heinrich-Heine-University Düsseldorf Institute of Cytopathology Heinrich-Heine-University Düsseldorf Institute of Pathology Heinrich-Heine-University Düsseldorf Department of Gastroenterology Hepatology and Infectious Diseases Heinrich-Heine-University Düsseldorf

BACKGROUND:Obstructive jaundice caused by an intraductal hepatocellular carcinoma is a rare initial *** report a rare case of an extrahepatic icteric type hepatocellular ***:A 75-year-old patient was admitted to our hospital because of obstructive jaundice 3 months after resection of multilocular hepatocellular carcinoma.A postoperative bile leakage was treated by placement of a decompressing stent in the common bile *** retrograde choledochoscopy showed extended blood clots filling the bile duct system and computed tomography revealed a local swelling in the common extrahepatic bile *** level of alpha-fetoprotein(AFP)was only slightly elevated but that of CA19-9 was dramatically *** showed an intraductal filling defect typical of a cholangiocellular ***:bile duct brushing cytology showed no cholangiocellular carcinoma but hepatocellular carcinoma cells in the extrahepatic bile *** extrahepatic bile duct resection was *** examination confirmed the diagnosis of extrahepatic intraductal growth of hepatocellular ***:Ectopic hepatocellular carcinoma is a rare but important differentially diagnosed of extrahepatic bile duct filling defect.

关键词： hepatocellular carcinoma cholangiocellular carcinoma bile duct obstructive jaundice

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EXPRESSION AND SIGNIFICANCE OF MYOFIBROBLAST IN HEALING PROCESS OF bile duct

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Academic Journal of Xi'an Jiaotong University 2001年第1期13卷 -页

作者：耿智敏向国安牛新捷韩庆刘效恭陈明霞刘青光潘承恩 Department of Hepatobiliary Surgery First Hosp. Xi'an Jiaotong Univ. Xi'an 710061 China

Objective To observe the expression and distribution of myofibroblasts in the healing process of bile duct and discuss its function and significance in the process of iatrogenic biliary stricture formation. Methods A model of trauma-repair of bile duct in the dog was made. The anastomosis tissues on week 1, 3 and month 3,6 after operation were studied with TEM and immunohistochemical SP staining of SMA. Results Myofibroblasts functioned actively and lasted for the whole process, extracellular matrix overdeposited. SMA staining was observed in myofi- broblasts and highly expressed from 1 week to 6 months after operation. The consequence easily leaded to scar con- tracture and anastomoctic stenosis. Conclusion Myofibroblast is the main cause or scar contracture of bile duct.

关键词： myofibroblast wound healing bile duct

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Feasibility and effectiveness of chemical bile duct embolization for chemical hepatectomy: a preliminary study

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Hepatobiliary & Pancreatic Diseases International 2006年第4期5卷 570-573页

作者： Fu-Yu Li, Ning Li, Li-Sheng Jiang, Jing-Qiu Cheng, Nan-Sheng Cheng, Xing-Wu Wu and Sheng HeAuthor Affiliations: Department of Hepatobiliary Surgery Key Laboratory of Transplantation Engineering and Immunology , West China Hospital, Sichuan University, Chengdu 610041, China Department of Hepatobiliary Surgery West China Hospital Sichuan University Chengdu 610041 China.

BACKGROUND: The high operative risk of hepatectomy for specially located intrahepatic stones is still a problem to be solved. This study was undertaken to investigate the feasibility and effectiveness of chemical bile duct embolization for chemical hepatectomy. METHODS: Oxybenzene or absolute ethanol plus N-butyl-cyanoacrylate was employed for embolization. The feasibility, effectiveness and mechanism of chemical hepatectomy were preliminarily analyzed histologically or by Fas, TIMP-1, TGF-β1, and collagen Ⅰ. RESULTS: Oxybenzene plus cyanonacrylate can preferably destroy and embolize the intrahepatic biliary duct, leading to the disappearance of hepatocytes in the periphery of embolized lobe and the achievement of effective chemical hepatectomy. The expressions of Fas, TIMP-1 and TGF-β1 in oxybenzene embolism group (88.90±38.10, 619.43± 183.42, 185.22±70.39) and ethanol embolism group (72.39± 29.51, 407.55±134.74, 163.56±51.75) were higher than those of biliary duct-ligated group (26.31±12.07, 195.31±107.67, 74.84±40.73) (Pbile duct embolization.

关键词： bile duct embolization hepatectomy hepatolithiasis

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