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New trends in diagnosis and management of gallbladder carcinoma

World Journal of Gastrointestinal Oncology 2024年第1期16卷 13-29页

作者： Efstathios T Pavlidis Ioannis N Galanis Theodoros E Pavlidis ^(nd)Propedeutic Department of surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Gallbladder(GB)carcinoma,although relatively rare,is the most common biliary tree cholangiocarcinoma with aggressiveness and poor *** is closely associated with cholelithiasis and long-standing large(>3 cm)gallstones in up to 90%of *** other main predisposing factors for GB carcinoma include molecular factors such as mutated genes,GB wall calcification(porcelain)or mainly mucosal microcalcifications,and GB polyps≥1 cm in *** is made by ultrasound,computed tomography(CT),and,more precisely,magnetic resonance imaging(MRI).Preoperative staging is of great importance in decisionmaking regarding therapeutic *** staging is based on MRI findings,the leading technique for liver metastasis imaging,enhanced three-phase CT angiography,or magnetic resonance angiography for major vessel *** is also necessary to use positron emission tomography(PET)-CT or ^(18)F-FDG PET-MRI to more accurately detect metastases and any other occult deposits with active metabolic *** laparoscopy may detect dissemination not otherwise found in 20%-28.6%of *** treatment is needed,including surgical resection,targeted therapy by biological agents according to molecular testing gene mapping,chemotherapy,radiation therapy,and *** is of great importance to understand the updated guidelines and current treatment *** extent of surgical intervention depends on the disease stage,ranging from simple cholecystectomy(T1a)to extended resections and including extended cholecystectomy(T1b),with wide lymph node resection in every case or IV-V segmentectomy(T2),hepatic trisegmentectomy or major hepatectomy accompanied by hepaticojejunostomy Roux-Y,and adjacent organ resection if necessary(T3).Laparoscopic or robotic surgery shows fewer postoperative complications and equivalent oncological outcomes when compared to open surgery,but much attention must be paid to avoiding *** addition to surgery,novel targe

关键词： biliary tract neoplasms Extrahepatic cholangiocarcinoma Gallbladder carcinoma Gallbladder diseases biliary tree diseases Gastrointestinal malignancies

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Intraoperative cholangio-ultrasonography(IOCUS)during hepatectomy with resection of the biliary confluence:An effective alternative to intraoperative cholangiography

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Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 417-420页

作者： Daniele Del Fabbro Fabio Procopio Jacopo Galvanin Guido Costa Simone Famularo Angela Palmisano Matteo Donadon Guido Torzilli Division of Hepatobiliary surgery Department of SurgeryIRCCS Humanitas Research HospitalVia A.Manzoni 56Rozzano 20089MilanItaly Department of Biomedical Sciences Humanitas UniversityVia Rita Levi Montalcini 4Pieve Emanuele 20072MilanItaly

Intraoperative ultrasonography(IOUS)in hepatobiliary surgery is well known as an essential tool for radical and safe hepatectomies,allowing to perform parenchymal sparing surgery and,as consequence,to expand the surgical indications for patients otherwise considered ***,since many years,despite its effectiveness in the study of vascular anatomy of the liver,the gold standard for the assessment of biliary anatomy during surgery is intraoperative cholangiography(IOC),which is used for the validation of preoperative imaging as well as for guiding reconstruction in case of bile duct injury or resection.

关键词： anatomy biliary ultrasonography

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Oesophageal and gastric varices:historical aspects,classification and grading:everything in one place

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Gastroenterology Report 2016年第3期4卷 186-195,I0001页

作者： Cyriac Abby Philips Amrish Sahney Department of Hepatology Institute of Liver and Biliary SciencesNew DelhiDelhiIndia

Variceal disease and its management are of the utmost importance in the treatment of portal *** guidelines are universal for management of variceal disease in portal *** and grading systems are numerous and differ according to geographical *** this exhaustive review,the historical aspects of variceal disease,its classification and the grading systems in use are discussed,with self-explanatory tables and timelines.A better and clear understanding of the evolution of portal hypertension and variceal disease is provided.

关键词： oesophageal varices gastric varices classification portal hypertension

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Potent antiviral therapy improves survival in acute on chronic liver failure due to hepatitis B virus reactivation

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World Journal of Gastroenterology 2014年第43期20卷 16037-16052页

作者： Cyriac Abby Philips Shiv Kumar Sarin Department of Hepatology Institute of Liver and Biliary SciencesNew Delhi 110070India

Acute on chronic liver failure(ACLF)is a disease entity with a high mortality *** acute event arises from drugs and toxins,viral infections,bacterial sepsis,interventions(both surgical and non-surgical)and vascular events on top of a known or occult chronic liver *** secondary to reactivation of chronic hepatitis B virus is a distinct condition;the high mortality of which can be managed in the wake of new potent antiviral *** example,lamivudine and entecavir use has shown definite short-term survival benefits,even though drug resistance is a concern in the *** renoprotective effects of telbivudine have been shown in a few studies to be useful in the presence of renal *** with newer agents such as tenofovir and a combination of nucleos(t)ides is promising for improving survival in this special group of liver disease *** review describes the current status of potent antiviral therapy in patient with acute on chronic liver failure due to reactivation of chronic hepatitis B,thereby providing an algorithm in management of such patients.

关键词： Acute on chronic liver failure Chronic hepatitis B infection Reactivation of hepatitis B Flare of hepatitis B Anti-viral therapy Nucleoside analogue Nucleotide analogue

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Surgical vs percutaneous radiofrequency ablation for hepatocellular carcinoma in dangerous locations

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World Journal of Gastroenterology 2011年第1期17卷 123-129页

作者： Ji-Wei Huang Roberto Hernandez-Alejandro Kristopher P Croome Lu-Nan Yan Hong Wu Zhe-Yu Chen Pankaj Prasoon Yong Zeng Department of Hepato-biliary-Pancreatic surgery Division of Liver Transplantation West China Hospital Sichuan University Chengdu 610041 Sichuan Province China Department of surgery University of Western Ontario Hepatobiliary and Liver Transplant Surgery London Health Sciences Centre London Ontario N6A 4S2 Canada

AIM:To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation(RFA) for hepatocellular carcinoma(HCC) in dangerous ***:One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this *** patients were divided into percutaneous RFA group and surgical RFA *** the patients were regularly followed up for a long time,their curative rate,hospital stay time,postoperative complications and 5-year local tumor progression were compared and ***:No significant difference was observed in curative rate between the two groups(91.3% vs 96.8%,P = 0.841).The hospital stay time was longer and more analgesics were required while the incidence of bile duct injury and RFA-related hemorrhage was lower in surgical RFA group than in percutaneous RFA group(P < 0.05).The local progression rate of HCC in dangerous locations was significantly lower in surgical RFA group than in percutaneous RFA group(P = 0.05).The relative risk of local tumor progression was 14.315 in percutaneous RFA ***:The incidence of severe postoperative complications and local tumor progression is lower after surgical RFA than after percutaneous RFA.

关键词： Hepatocellular carcinoma Radiofrequency ablation liver cirrhosis Recurrence Local therapy

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Day-of-surgery rejection of donors in living donor liver transplantation

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World Journal of Hepatology 2012年第11期4卷 299-304页

作者： Bassem Hegab Mohamed Rabei Abdelfattah Ayman Azzam Hazem Mohamed Waleed Al Hamoudi Faisal Aba Alkhail Hamad Al Bahili Hatem Khalaf Mohammed Al Sofayan Mohammed Al Sebayel Department of liver Trans-plantation and Hepatobiliary-Pancreatic surgery King Faisal Specialist Hospital and Research Center Riyadh 11211 Saudi Arabia Department of Hepato-biliary-Pancreatic surgery and liver Transplantation National Liver Institute University of Menoufiya Menoufiya 32714 Egypt Department of Hepato-biliary and Pancreatic surgery University of Alexan-dria Alexandria 21131 Egypt

AIM: To study diagnostic laparoscopy as a tool for excluding donors on the day of surgery in living donor liver transplantation (LDLT).METHODS: This study analyzed prospectively collected data from all potential donors for LDLT. All of the donors were subjected to a three-step donor evaluation protocol at our institution. Step one consisted of a clinical and social evaluation, including a liver profile, hepatitis markers, a renal profile, a complete blood count, and an abdominal ultrasound with Doppler. Step two involved tests to exclude liver diseases and to evaluate the donor’s serological status. This step also included a radiological evaluation of the biliary anatomy and liver vascular anatomy using magnetic resonance cholan-giopanc reatography and a computed tomography (CT) angiogram, respectively. A CT volumetric study was used to calculate the volume of the liver parenchyma. Step three included an ultrasound-guided liver biopsy. Between November 2002 and May 2009, sixty-nine potential living donors were assessed by open exploration prior to harvesting the planned part of the liver. Between the end of May 2009 and October 2010, 30 potential living donors were assessed laparoscopically to determine whether to proceed with the abdominal incision to harvest part of the liver for donation. RESULTS: Ninety-nine living donor liver transplants were attempted at our center between November 2002 and October 2010. Twelve of these procedures were aborted on the day of surgery (12.1%) due to donor findings, and eighty-seven were completed (87.9%). These 87 liver transplants were divided into the following groups: Group A, which included 65 transplants that were performed between November 2002 and May 2009, and Group B, which included 22 transplants that were performed between the end of May 2009 and October 2010. The demographic data for the two groups of donors were found to match; moreover, no significant difference was observed between the two groups of donors with res

关键词： Live donor Laparoscopic assessment Re-jected donors Day of surgery Fatty liver

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Prevention and Treatment of Recurrent Hepatitis B after liver Transplantation

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Journal of Clinical and Translational Hepatology 2016年第1期4卷 54-65页

作者： Rakhi Maiwall Manoj Kumar Hepatology and liver Transplantation Institute of Liver and Biliary Sciences New Delhi India

Chronic hepatitis B is a global health problem that leads to development of various complications,such as cirrhosis,liver cancer,and liver failure requiring liver *** recurrence of hepatitis B virus (HBV) post-liver transplantation is a major cause of allograft dysfunction,cirrhosis of the allograft,and graft *** with high viral load at the time of transplantation,hepatitis B e antigen (HBeAg)positivity,or those with a history of anti-viral drug resistance are considered as high-risk for recurrent HBV post-liver transplantation,while patients with low viral load,including HBeAg negative status,acute liver failure,and hepatitis D virus (HDV) co-infection are considered to be at low-risk for recurrent HBV post-liver *** for patients awaiting liver transplantation(LT) cause suppression of HBV replication and reduce the risk of recurrent HBV infection of the allograft and,therefore,all HBV patients with decompensated cirrhosis should be treated with potent antivirals with high genetic barrier to resistance (entecavir or tenofovir) prior to liver *** of post-liver transplantation recurrence should be done using a combination of hepatitis B immunoglobulin (HBIG) and antivirals in patients at high risk of *** dose HBIG,HBIG-free protocols,and monoprophylaxis with high potency antivirals can still be considered in patients at low risk of ***,marginal grafts from anti-HBc positive donors can be safely used in hepatitis B surface antigen (HBsAg) negative,preferably in anti-hepatitis B core (HBc)/anti-hepatitis B surface (HBs) positive *** this article,we aim to review the mechanisms and risk factors of HBV recurrence post-LT in addition to the various treatment strategies proposed for the prevention of recurrent HBV infection

关键词： Hepatitis B Recurrent liver transplant

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STUDY OF THE MECHANISM OF ARTEMISINE CAPILLARIES AND RADIX CURCUMAE PREVENTING GALLSTONE FORMATION INDUCED BY HIGH CHOLESTEROL DIET IN GUINEA PIGS

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Journal of Pharmaceutical Analysis 1999年第1期13卷 62-65页

作者：石景森任斌马庆久孟清翠汪涛田和平韩梅荣卢云刘绍浩吴谨光 dept. of Hepatal-biliary surgery First Affiliated Hospital Xi'an Medical University Xi'an 710061 China

To study the effect of chinese herbal medicine preventing gallstone formation, morphology of livers and gallbladders as well as conjugated bile acids of the bile. 58 female guinea pigs were randomly divided into three groups. The control group was fed on normal diet; the lithogenous groups was high cholesterol diet (HCD) and the antilithic group was high cholesterol and the chinese herbal medicine capsule (13 5 g/kg). 8 weeks later the guinea pigs were killed. liver and gallbladder were removed for light and electroscope observation. Gallbladder bile were withdrawn and gallbladder were collected. The minute construction of gallstones were observed by scanning electron microscope and gallstone components were quantified by Fourier Transform Infrand Spectros Copy (FT IR). The morphology of liver and gallbladder were observed by light microscope and transmission electron microscope. Conjugated bile acid of biles were determined by Thin layer Chromatograph. The effect of chinese herbal medicine preventing gallstone formation, morphololgy of livers and gallbladders as well as conjugated bile acids of the bile were also observed. We measured conjugated bile acids in all groups and found that decreased in lithogenic group and increased notably in antilithic group (P<0 01) . The gallstone formation rate was 100% when the animals were fed on HCD in lithogenic group. The rate decreased to 5 3% when the animals were fed on HCD and Chinese herbal medicine capsule inantilithic group. It indicates that changes in diet is an important factor in the process of gallstone formation and the chinese herbal medicine can prevent gallstone formation effectively.

关键词： artemisiae capillaris radix curcumae gallstone conjugated bile acid

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Impact of open hepatectomy on postoperative bile leakage in patients with biliary tract cancer

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World Journal of Gastrointestinal surgery 2024年第1期16卷 67-75页

作者： Gang Wu Wen-Ying Li Yu-Xing Gong Feng Lin Chen Sun General surgery Department The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150000Heilongjiang ProvinceChina

BACKGROUND Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract *** To evaluate the incidence,risk factors,and management of bile leakage after open hepatectomy in patients with biliary tract *** We retrospectively analyzed 120 patients who underwent open hepatectomy for biliary tract cancer from February 2018 to February *** leak was defined as bile drainage from the surgical site or drain or the presence of a biloma on *** incidence,severity,timing,location,and treatment of the bile leaks were *** risk factors for bile leakage were analyzed using univariate and multivariate logistic regression *** The incidence of bile leak was 16.7%(20/120),and most cases were grade A(75%,15/20)according to the International Study Group of liver surgery *** median time of onset was 5 d(range,1-14 d),and the median duration was 7 d(range,2-28 d).The most common location of bile leakage was the cut surface of the liver(70%,14/20),followed by the anastomosis site(25%,5/20)and the cystic duct stump(5%,1/20).Most bile leaks were treated conservatively with drainage,antibiotics,and nutritional support(85%,17/20),whereas some required endoscopic retrograde cholangiopancreatography with stenting(10%,2/20)or percutaneous transhepatic cholangiography with drainage(5%,1/20).Risk factors for bile leakage include male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood *** Bile leakage is a frequent complication of open hepatectomy for biliary tract ***,most cases are mild and can be conservatively *** sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion were associated with an increased risk of bile leak.

关键词： Open hepatectomy Bile leak biliary tract cancer Risk factors Management Complication

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Risk factors for combined hepatocellular-cholangiocarcinoma:A hospital-based case-control study

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World Journal of Gastroenterology 2014年第35期20卷 12615-12620页

作者： Yan-Ming Zhou Xiao-Feng Zhang Lu-Peng Wu Cheng-Jun Sui Jia-Mei Yang Department of Hepato-biliary-Pancreato-Vascular surgery the First Affiliated Hospital of Xiamen University Department of Special Treatment and liver Transplantation Eastern Hepa-tobiliary Surgery HospitalSecond Military Medical University

AIM: To identify risk factors contributing to the development of combined hepatocellular-cholangiocarcinoma (CHC) in China.

关键词： Risk factors Combined hepatocellular-cholangiocarcinoma Hepatitis B virus Alcohol consumption Epidemiology

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