Bile Research Articles

Correlation between Alpha Fetoprotein (AFP) Levels and Characteristics of Liver Lesions Using Computed Tomography (CT) scan in Hepatocellular Carcinoma: a Study at Dr. Hasan Sadikin Central General Hospital Bandung 2019

Introduction: Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver which is about 75% - 85%. The diagnosis of HCC is determined based on several factors, including the background of chronic liver disease, tumor markers, and imaging diagnosis. There are three main growth patterns of HCC that can be seen on computed tomography (CT) scan : massive, nodular, and diffuse infiltrative. HCC is locally invasive and tends to invade the portal vein, inferior vena cava and bile duct. Alpha fetoprotein (AFP) is one of the tumor markers used for early diagnosis of KSH and plays an important role in the development and progression of HCC. Objective : To determine the correlation between alpha fetoprotein levels with characteristics of liver lesions using CT scan examination in HCC patients. Methods : This study was an observational analytic study with a cross-sectional design. Sampling was done retrospectively by collecting medical record data and the results of abdominal CT scan readings from January to December 2019. The study was conducted at the Department of Radiology, Department of Clinical Pathology and Installation of Medical Records-SIRS Hospital Dr. Hasan Sadikin Bandung in February - April 2020. Univariable analysis was carried out to see the description of the proportion of each variable to be presented descriptively, which could be explained into descriptive analysis and hypothesis testing. Results : There were 63 subjects, 48 men (76.2%), 15 women (23.8%), with the youngest age of 21 years, the oldest 86 years with an average age of 53.44 years. The highest average AFP levels were found in the group of patients with diffuse infiltrative growth patterns 93064.84 ± 177486,301 and the presence of a thrombus in the portal vein of 78770.98 ± 88358,791. The results of statistical tests using the Mann Whitney Test showed that there were significant differences between the levels of AFP and the growth pattern of liver lesions in HCC patients based on the results of the CT scan with a value of p = 0.040 (p?0.05) and there were significant differences between the levels of AFP and portal vein thrombus in HCC patients based on the results of CT scan examination with a value of p = 0.040 (p?0.05). Conclusion : There is a significant correlation between AFP levels with the characteristics of liver lesions specifically the form of growth patterns and the presence of portal venous thrombus using CT scan examination of HCC patients in dr. Hasan Sadikin General Hospital. Keywords : Hepatocellular carcinoma, Alpha fetoprotein, CT scan

The pivotal predictor of severe postoperative complications of pancreatoduodenectomy: complex links of bacterial contamination from preoperative biliary drainage.

Preoperative biliary drainage (PBD) prior to pancreatoduodenectomy (PD) is controversial. The aim of this study was to clarify how PBD leads to postoperative complications of PD. The subjects of this retrospective study were 230 patients who underwent PD between January, 2008 and January, 2018. We analyzed how PBD was associated with severe postoperative complications (Clavien-Dindo ≥ IIIB) with special reference to its links with bacterial contamination. Preoperative biliary drainage (PBD) was correlated with the contamination of both bile juice collected at surgery (p < 0.001) and ascites collected from the intraperitoneal drain on postoperative day (POD) 3 (p < 0.001). Receiver operating characteristic curve analysis revealed that PBD for longer than 28days was significantly associated with the contamination of bile juice. Multivariate regression analysis revealed that the contamination of ascites on POD3 was independently associated with severe postoperative complications (Clavien-Dindo ≥ IIIB) (odds ratio 3.52, p = 0.03), although PBD and the contaminated bile juice at surgery were not. PBD was associated with the contamination of biliary tract and ascites after surgery. The current study revealed that contaminated ascites on POD 3, not PBD by itself, was independently associated with severe postoperative complications after PD.

Level of total bilirubin in the bile of the future remnant liver of patients with obstructive jaundice undergoing hepatectomy predicts postoperative liver failure.

We investigated whether the daily level of total bilirubin in the bile (LTB) excreted from the future remnant liver (FRL) can predict post-hepatectomy liver failure (PHLF) in patients with obstructive jaundice undergoing hepatectomy. Seventy-four patients who underwent biliary drainage and collection of bile juice from the FRL before undergoing right hepatectomy or right/left trisectionectomy with bile duct resection were included. The LTB from the FRL (mg/d) was calculated as the volume of the bile (dL) per day multiplied by the density of total bilirubin in the bile (mg/dL). We compared patients' characteristics with or without PHLF, which was defined as the total serum bilirubin level remaining >10mg/dL after postoperative day 10. Then, pre- and intraoperative factors related to PHLF were examined. PHLF was observed in six patients. LTB was significantly lower in the PHLF group. The LTB cut-off value for predicting PHLF, as determined using the receiver operating characteristic curve, was 56mg/d. On multivariate analysis, LTB was found to be an independent risk factor for PHLF (P=.01, OR 35.88). LTB may be a potential functional assessment in jaundiced patients before right hepatectomy and right/left trisectionectomy.

The impact of donor’s biliary anatomy variations on the procedure of living donor liver transplantation

Background Anatomical variation of biliary anatomy is the cornerstone for the procedure of living donor liver transplantation (LDLT). Aim The aim was to study the effect of donor’s biliary variant anatomy on the procedure of adult LDLT. Participants and methods A retrospective study was conducted using the data of all donors and recipients of LDLT (June 2013–December 2017) in HPB Department and Liver Transplant Surgery. A total of 120 potential donors were assessed preoperatively by MRCP to evaluate the biliary anatomy of the liver and classified into four types according to Varotti and colleagues. Results Of 120 donors, 13 (10.8%) were excluded from donation before surgery owing to various causes; six (46.1%) of them were excluded owing to donor’s biliary anatomical variation. According to the classification of Varotti and colleagues, biliary variations were seen in 27 (25.2%) of 107 donors (five of type 2, 14 of type 3a, and eight of type 3b); type 1 with short stump was seen in 25 (23.1%) cases. Biliary complications (BCs) occurred in 53 (49.5%) of 107 recipients, including bile leak in 40 (37.5%) cases, biliary strictures in 13 (12.1%) cases, and concomitant biliary stricture and leak in 17 (15.9%) cases. There was a statistically significant correlation between the presence of donor’s right hepatic duct (RTH) duct (type 1 with short stump) and BCs in their recipients (P=0.04). There was a statistically significant between the occurrence of BCs in recipient and hospital stay (P=0.046). BCs presented in eight (7.4%) donors, where six (5.6%) of them had bile leak and two (1.8%) had a biliary stricture. Anatomical biliary variations were a risk factor for potential donor exclusion (P=0.021). Conclusions There was a statistically significant difference between donor’s RTH (type 1 with short stump) and BCs in their recipients, and between the occurrence of BCs in recipient and hospital stay. Donor biliary anatomical variations had a statistically significant effect for potential donor’s exclusion.

Total Laparoscopic Uncut Roux-en-Y for Radical Distal Gastrectomy: An Interim Analysis of a Randomized, Controlled, Clinical Trial.

The traditional Billroth II and Roux-en-Y anastomosis after laparoscopic distal gastrectomy for gastric cancer are associated with bile reflux gastritis and roux stasis syndrome, respectively. The uncut Roux-en-Y gastrojejunostomy can decrease the incidence of these complications by blocking the entry of bile and pancreatic juice into the residual stomach and retaining the impulses originating from the duodenum. The purpose of the present study was to compare the short-term outcomes of uncut Roux-en-Y (URY) and Billroth II combined Braun (BB) anastomosis. In this prospective, multi-center, two-arm randomized controlled trial, 124 patients with advanced distal gastric cancer were randomized into two groups: URY (n = 62) and BB (n = 62) groups. The mean gastric juice pH was significantly lower in the URY group compared with the BB group (3.94 ± 0.71 vs. 5.83 ± 0.91, P < 0.0001). The bile reflux gastritis at 3months (P < 0.0001) and 6months (P = 0.002) was significantly more frequent in the BB group. No recanalization occurred in the URY group, and no significant difference was found between the two groups in terms of mean operative time (P = 0.69), mean time to perform anastomosis (P = 0.86), mean estimated blood loss (P = 0.77), mean number of harvested lymph nodes (P = 0.90), time to first passage of flatus or defecation (P = 0.87), postoperative hospital stay (P = 0.83), and the incidence of postoperative complications (P = 0.70). URY anastomosis is associated with a significantly lower incidence of bile reflux gastritis and roux stasis syndrome compared with BB anastomosis.

Perforated duodenal diverticulum successfully treated with a combination of surgical drainage and endoscopic nasobiliary and nasopancreatic drainage: a case report

BackgroundPerforation of a duodenal diverticulum is a rare complication that may become fatal with a delay in appropriate treatment. However, the optimal treatment for perforated duodenal diverticulum remains controversial, ranging from conservative therapy to surgery including pancreatoduodenectomy.Case presentationThe patient was a 60-year-old woman with no particular medical history who visited our hospital with chief complaints of continuous fever and right dorsal pain. Upon arrival, she had tenderness in the right upper quadrant of the abdomen. Laboratory data showed the elevation of inflammatory markers. Computed tomography revealed free air with abscess formation around the duodenum, which was diagnosed as duodenal perforation with abdominal abscess. We decided on emergent surgery, and we identified the perforation site on the dorsal side of the second portion of the duodenum intraoperatively. However, the inflammation around the perforation site was severe, and it was difficult to perform primary closure or dissection of the perforated diverticulum. Therefore, we finished surgery by placing four indwelling intra-abdominal tubes. Since postoperative day (POD) 1, the elevation of inflammation markers appeared to be uncontrollable, owing to the leakage of bile and pancreatic juice. We decided to perform endoscopic retrograde cholangiopancreatography on POD 2, and inserted endoscopic nasobiliary drainage and nasopancreatic drainage tubes. The patient showed a good postoperative course and was discharged on POD 57.ConclusionsEndoscopic nasobiliary and nasopancreatic drainage in combination with surgical drainage may be an effective treatment for perforated duodenal diverticulum.

Hoarseness After Endoscopic Retrograde Cholangiopancreatography

Question: An 84-year-old man presented with obstructive jaundice owing to an ampullary tumor. An endoscopist, with about 1500 endoscopic retrograde cholangiopancreatography (ERCP) experiences, performed ERCP using a duodenoscope (JF260V, Olympus, Tokyo, Japan) under conscious sedation with 3 mg of midazolam and 15 mg of pentazocine. The duodenoscope was inserted into the duodenum without any issues, such as false insertion into the trachea. After cholangiopancreatography, intraductal ultrasound examination of the bile duct, ampullary biopsy, bile and pancreatic juice cytology, and placement of plastic stent in the bile duct were performed.

Changes in the Content and Bioavailability of Onion Quercetin and Grape Resveratrol During In Vitro Human Digestion.

We investigated the effects of in vitro human digestion on the content and bioavailability of onion quercetin and grape resveratrol caused by the composition of saliva or gastric, duodenal, or bile juice. We observed the digestibility of extracted onion quercetin and grape resveratrol, respectively, in the small intestine of the in vitro human digestion system. By liquid chromatography–mass spectroscopy, we found that the degradation of quercetin and resveratrol was influenced by small intestine digestion. Before and after in vitro human digestion, the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activities of homogenized water- and ethanol-extracted grapes were higher than those of onion extracts. DPPH radical scavenging activity in both quercetin and resveratrol was decreased by in vitro digestion. These results will improve our understanding of how human digestion influences the contents and free radical scavenging activities of quercetin and resveratrol.

Absence of BSEP (ABCB11) protects MDR2 (ABCB4) KO mice from cholestatic liver and bile duct injury through modulating the inflammatory signaling

Absence of BSEP (ABCB11) protects MDR2 (ABCB4) KO mice from cholestatic liver and bile duct injury through modulating the inflammatory signaling

Feasibility of Voltage-Applied SERS Measurement of Bile Juice as an Effective Analytical Scheme to Enhance Discrimination between Gall Bladder (GB) Polyp and GB Cancer.

A unique surface-enhanced Raman scattering (SERS) measurement scheme to discriminate gall bladder (GB) polyp and GB cancer by analysis of bile juice is proposed. Along with the high sensitivity of SERS, external voltage application during SERS measurement was incorporated to improve sample discriminability. For this purpose, Au nanodendrites were constructed on a screen-printed electrode (referred to as AuND@SPE), and Raman spectra of extracted aqueous phases from raw bile juice samples were acquired using the AuND@SPE at voltages from -300 to 300 mV. The sample spectra resembled that of bilirubin, possessing an open chain tetrapyrrole, showing that bilirubin derivatives in bile juice were mainly responsible for the observed peaks. Discrimination of GB polyp and GB cancer using just the normal SERS spectra was not achieved but became apparent when the spectra were acquired at a voltage of -100 mV. When voltage-applied SERS spectra of bilirubin and urobilinogen (one of bilirubin's derivatives) were examined, a sudden intensity elevation occurring at -100 mV was observed for urobilinogen but not bilirubin. Based on examination of corresponding cyclic voltammograms, the potential-driven strong adsorption of urobilinogen (no faradaic charge transfer) on AuND occurring at -100 mV induced a substantial increase in SERS intensity. It was presumed that the content of urobilinogen in the bile juice of a GB cancer patient would be higher than that of a GB polyp patient, and the contained urobilinogen was sensitively highlighted by applying -100 mV during SERS measurement, allowing clear discrimination of GB cancer against GB polyp.

Effects of cyclosporin A on the pharmacokinetics and toxicities of irinotecan mediated by UGT1A1 in vitro and in vivo.

Irinotecan (CPT-11) is a broad spectrum agent for the treatment of solid tumor malignancies, despite severe diarrhea is limiting its widespread usage. The local effects of SN-38 in the small intestine were considered to be responsible for the irinotecan-induced delayed diarrhea. It was proposed that cyclosporin A (CsA) inhibiting biliary excretion could attenuate this side effect, but in fact, it could not improve the therapeutic index of irinotecan. At present, most studies focused on the inhibition of bile excretion by cyclosporin A through the transporters MRP2 and MDR1 and its effect the irinotecan treatment in vivo. However, UDP glucuronyltransferase-1 polypeptide A1 (UGT1A1) was related to a significantly altered disposition of irinotecan and its metabolites, and was therefore associated with irinotecan-induced toxicity. This study focused on UGT1A1-mediated conversion of SN-38 to SN-38G, and systematically investigated the CsA-irinotecan interactions in vitro and in vivo. After treatment with 10 mg·kg-1 CsA for 7 days, the bile excretion of irinotecan and its metabolites decreased and AUC0-∞ increased significantly. The AUC0-∞ (SN-38G)/AUC0-∞ (SN-38) was significantly reduced when compared with that in vehicle-treated rats. In the liver microsome incubation system, the IC50 of CsA for UGT1A1 enzyme was 9.4 μM. Furthermore, the UGT1A1 mRNA and protein expression levels were significantly reduced. The present study indicated that CsA treatment could enhance the systemic exposure and toxicity of SN-38 by inhibiting the UGT1A1 enzyme. The inhibition of UGT1A1 enzyme might be a critical factor in the failure of CsA improving irinotecan's treatment index.

How Can We Develop Immunity against COVID-19 and Defeat It

We know that Corona Virus develops in animals, birds and humans’ body. Now it is a pandemic and many people are dying with each passing day and the number of patients is increasing every hour. If we do not control it then it is dangerous for humanity. As we know the incubation period for COVID-19 is 1 to 14 days and it’s live in the environment for 12 to 14 hours. The only solution to the spread of the virus is by social distancing. As we know that it affects the person with low immunity so it is advised for all people to have a balanced diet, exercise daily and spend time in meditation for increasing immunity. I want to share a natural method to develop and increase the immunity power by the bile juice of animals, birds and we can try for corona virus too.

Rupture of hepatic artery pseudoaneurysm after liver transplantation: a report of three patients

Objective To report on 3 patients who presented with rupture of hepatic artery pseudoaneurysm after liver transplantation. Methods From April 2010 to April 2019, 3 patients with hepatic artery pseudoaneurysm rupture after liver transplantation treated at the Department of Hepatobiliary and Pancreatic Surgery, Henan Provincial People's Hospital were studied. The possible causes, clinical manifestations, diagnosis and treatment were retrospectively analyzed. Results Rupture of hepatic artery pseudoaneurysm occurred on the19th, 28th and 63th days after transplantation. The 3 patients all presented with hematochezia and abdominal pain, while 2 patients presented with hematemesis. Two patients had bile leakage and abdominal infection. All the 3 patients presented with fever. Patient 1 who was diagnosed by laparotomy died of liver failure. Patient 2 underwent interventional embolization of hepatic artery and died of liver failure also. Patient 3 underwent surgical resection of the pseudoaneurysm followed by hepatic artery reconstruction, but died of repeat abdominal hemorrhage. Conclusion Hepatic artery pseudoaneurysm after liver transplantation has a long latent period and is difficult to diagnose at an early stage. Early detection of this life-threatening complication is the key to improve survival. Early treatment of biliary leakage, abdominal infection and other complications help to prevent development of pseudoaneurysms. Key words: Liver transplantation; Pseudoaneurysm; Abdominal infection

Effect and mechanism of gdolinium chloride on hepatic ischemia/reperfusion injury in Sprague Dawley rats

Objective To analyze the effect and mechanism of gadolinium chloride on hepatic ischemia-reperfusion injury (HIRI) in Sprague Dawley (SD) rats. Methods Thirty six eight weeks special pathogen free SD rats, were included in the project. The body weight ranged from 200 to 250 g. Thirty six rats were randomly divided into sham operation group, model group and gadolinium chloride group with 12 rats/group. Model of ischemia-reperfusion injury was generated in the rats of model group; In the gadolinium chloride group, preoperative intraperitoneal injection of gadolinium chloride was performed before the model of HIRI was established; In the sham operation group, only the abdomen was opened and closed and the hilum was dissected. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected in the three groups. The relative expression of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-1 β (IL-1β) mRNA were detected by Q-PCR. Western blot was used to detect the expression of markers involved in the Toll like receptor 2/myeloid differentiation factor 88 (MyD88) signaling pathway. Immunohistochemistry staining was used to detect the expression of Fas and Fas ligands in hilar bile duct epithelial cells. Results ALT and AST were (55±8) U/L, (92±22) U/L in sham operation group, lower than those in model group (1 247±62) U/L, (1 117±60) U/L, respectively, and ALT and AST in gadolinium chloride group were (622±50) U/L and (552±41) U/L, lower than those in model group (all P<0.05). Compared with the sham operation group, the relative expression of TNF-α, IL-1 β, IL-6 mRNA in the model group was significantly higher (all P<0.05), but the expression of those markers were higher than gadolinium chloride group (all P<0.05). Gadolinium chloride down-regulated the expression of Toll like receptor 2/MyD88 signaling pathway in rat with liver ischemia-reperfusion. The percentage of Fas protein positive cells in model group was (40.2±3.8)%, and the percentage of Fas ligand positive cells was (36.9±2.9)%, which was higher than those in gadolinium chloride group (29.7±2.3)% and (23.6±2.1)% with statistically significant differences (all P<0.05). Conclusion Gadolinium chloride can reduce the injury of liver function and inhibit the expression of inflammatory factors in liver tissue of SD rats with hepatic ischemia-reperfusion, which may play a protective role by down regulating the expression of relative protein in Toll like receptor 2/MyD88 signaling pathway. Key words: Reperfusion injury; Gdolinium chloride; Liver; Toll-like receptor 2; Myeloid differentiation factor 88

Intraoperative real-time imaging-guided laparoscopic liver resection

In recent years, laparoscopic hepatectomy has developed rapidly, but new challenges are posed to surgeons because of this surgical approach. The disadvantages of laparoscopic surgery can be effectively solved by using intraoperative real-time imaging guidance technology. Laparoscopic ultrasound can be used to discover and diagnose the nature of lesions, mark the important pipeline structure, determine the cutting edge, and guide puncture. ICG fluorescence imaging can be applied to the identification, localization, characterization of intraoperative lesions, the marking of specific liver segments and the prevention of postoperative bile leakage. These two technologies are the only two real-time imaging guidance technologies in laparoscopic hepatectomy at present, which truly make up for the shortcomings of laparoscopic liver surgery such as the inability to palpate and limited exploration exposure. Key words: Laparoscopy; Hepatectomy; Surgery, image-guided

Prevention of bile leakage after laparoscopic primary suturing of common bile duct by transabdominal placement of nasal bile duct

Objective To study the advantages of laparoscopic primary suturing of common bile duct plus transabdominal nasobiliary drainage in reducing the rate of bile leakage. Methods The clinical data of laparoscopic primary suturing of common bile duct with or without nasal bile duct drainage in Second People's Hospital of Chengdu were analyzed retrospectively. Results During laparoscopic common bile duct exploration, 286 patients were treated by primary suturing without nasobiliary drainage (group without drainage), including 32 (11.2%) patients with bile leakage; 350 patients were treated by primary suturing with transabdominal nasobiliary drainage (group with drainage), including 11 (3.1%) patients with bile leakage. The incidences of bile leakage of the two groups were significantly different (P 0.05). Conclusions The choice after laparoscopic primary suturing of common bile duct between with or without nasobiliary drainage should be determined according to the diameter of common bile duct. When a common bile duct diameter of less than 11.0 mm, nasobiliary drainage is recommended to reduce the rate of bile leakage. Key words: Choledocholithiasis; Laparoscope; Choledochoscope; Nasobiliary duct

Comparative analysis of bile components in patients with different types of gallstones

Objective To study the relationship among bile components and different gallstone types through comparing and analyzing gallbladder bile contents in patients with different types of gallstones. Methods A retrospective study of 542 consecutive patients with gallstones or gallbladder polyps was conducted. The stone composition type and 14 kinds of bile components from these patients were analyzed. The bile parameters consisted of potassium (K+ ), sodium (Na+ ), chlorine (Cl-), calcium (Ca2+ ), bicarbonate (HCO3-), magnesium (Mg2+ ), aspartate aminotransferase (AST), glutamyltranspeptidase (GGT), alkaline phosphatase (ALP), total bilirubin (TBIL), total bile acid (TBA), cholesterol (CHO), lactate dehydrogenase (LDH) and pH. Finally, the content of these bile components among the different types of stones and gallbladder polyps were compared. According to the composition determined by Fourier transform infrared spectroscopy (FTIR), the gallstone patients were divided into five groups. Results Compared with other groups, the content of K+ , GGT, ALP, TBIL, TBA and CHO in the calcium carbonate stone group were lower (P 0.05). In addition, there was no difference in bile contents among the pigment gallstone group, mixed stone group and polyp group (P>0.05). Conclusions In gallstone patients, the bile components of patients with calcium carbonate stones is significantly different. The high cholesterol content in bile is the main feature of cholesterol stone patients, and there is no significant difference in bile composition between patients with pigment stones and mixed stones. Key words: Cholecystolithiasis; Bile; Gallbladder polyps; Cholesterol; Bile acid; Calcium carbonate stones

Effects of bile acids and their related nuclear receptors on intestinal mucosal barrier

Bile acids are the end product of cholesterol metabolism, which is the main component of bile. Bile acids can not only promote the absorption of fat and fat-soluble vitamins but also be used as the important signal molecules to activate nuclear receptors. It regulates metabolism of bile acids and intestinal homeostasis. The bile acids’ effect on intestinal mucosal barrier function has been controversial until now. Bile acids is both hydrophilic and hydrophobic simultaneously. Hydrophilic bile acid can promote cell proli-feration, while hydrophobic bile acid can promote cell apoptosis. The stronger the hydrophobicity is, the greater the cellular damage effect will be. The activation of nuclear receptor by bile acids can protect intestinal mucosal barrier. New research progress of the bile acid regulation in intestinal mucosal barrier function is reviewed in this article. Key words: Bile acids and salt; Intestinal mucosal barrier; Nuclear receptors

The ultrasonic navigation technique in percutaneous transhepatic one-step biliary fistulation with rigid cholangioscopic lithotripsy for complicated hepatolithiasis

Objective To study the efficacy and safety of percutaneous transhepatic one-step biliary fistulation (PTOBF) with rigid cholangioscopic lithotripsy for treatment of complicated hepatolithiasis under the ultrasonic navigation technique. Methods In this retrospective study, PTOBF lithotripsy surgery was performed in 94 patients with hepatolithiasis under general anesthesia with tracheal intubation, and with percutaneous transhepatic puncture of targeted bile duct under ultrasonic navigation in The First Affiliated Hospital of Guangzhou Medical University. Biliary expanders were used along a guidewire to expand the sinus gradually until 14Fr to establish a fistulous channel. Lithotripsy was then performed through the channel by rigid cholangioscopy. The operation-related data were collected and analyzed, including puncture and fistula establishment success ratio, complication rate, intraoperative blood loss, residual and recurrence hepatolithiasis rates. Results 94 patients (total 122 patient-times) underwent PTOBF lithotripsy. There was no perioperative mortality. The overall puncture success rate was 100%, and the fistula/puncture rate was 97.5% (119/122). In 118 patients success was achieved in 2 time (96.7%). The complication rate was 9.6% (9/94). The average intraoperation blood loss were (24.9±21.3)ml. The residual calculus rate after therapy was 13.8%(13/94). All patients were followed-up for a period that ranged between 18 and 30 months. The recurrence rate was 14.9%(14/94). Conclusions Ultrasonic navigation technique plays an important role in bile duct puncture, sinus expansion and rigid cholangioscopic lithotripsy for treatment of complicated hepatolithiasis. PTOBF lithotripsy is a safe and effective procedure, which provides a new way in mini-invasive treatment for hepatolithiasis. It is worth generalizing. Key words: Ultrasound; Navigation; Percutaneous transhepatic puncture; Hepatolithiasis; Rigid cholangioscope

One-stage laparoscopic versus two-stage endoscopic followed by laparoscopic treatment for cholecystolithiasis complicated with choledocholithiasis

Objective To compare the clinical efficacy of one-stage laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with primary suture (PS) versus two-stage endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy(EST) followed by LC in treatment of cholecystolithiasis complicated with choledocholithiasis. Methods The clinical data of 171 patients with cholecystolithiasis complicated with choledocholithiasis, who underwent minimally invasive surgical treatment from January 2016 to December 2017, were retrospectively analyzed. Of these patients, 90 underwent one-stage LC+ LCBDE+ PS (the one-stage group), and 81 underwent two-stage ERCP/EST followed by LC (the two-stage group). The main clinical variables between the two groups of patients were compared. Results The surgical success rates (94.4% vs. 95.1%), residual stone rates (3.3% vs. 4.9%) and incidences of postoperative complications (6.7% vs.8.6%) showed no significant difference (all P>0.05) between the one-stage and two-stage groups. Compared with the two-stage group, the operative time was shorter (110.4 vs. 135.7 min), the length of postoperative hospital stay was shorter (3.3 vs. 7.1 d) and the total hospitalization cost was reduced (22 756.2 vs. 31 429.3 yuan) in the one-stage group. The incidence of long-term complications (2.2% vs.9.9%) in the one-stage group was also lower than that in the two-stage group (both P<0.05). Conclusions Both one-stage LC+ LCBDE+ PS and two-stage ERCP/EST+ LC are safe and effective in the treatment of cholecystolithiasis complicated with choledocholithiasis. One-stage LC+ LCBDE+ PS shows obvious advantages in hospitalization stay, hospitalization cost and in the preservation of function of the Oddi sphincter, and therefore should be the first choice in most cases. Key words: Cholecystolithiasis; Choledocholithiasis; Cholecystectomy, Laparoscopic; Cholangiopancreatography, endoscopic retrograde