Cholangiocarcinoma(CCA)is a particularly aggressive and challenging type of cancer,known for its poor prognosis,which is worsened by the complex interplay of various biological and environmental factors that contribut...Cholangiocarcinoma(CCA)is a particularly aggressive and challenging type of cancer,known for its poor prognosis,which is worsened by the complex interplay of various biological and environmental factors that contribute to its development.Recently,researchers have increasingly focused on the significant role of the biliary-enteric communication of liver-gut axis in the pathogenesis of CCA,highlighting a complex relationship that has not been thoroughly explored before.This review aims to summarize the key concepts related to the biliary-enteric communication of liver-gut axis and investigate its potential mechanisms that may lead to the onset and progression of CCA,a disease that presents substantial treatment challenges.Important areas of focus will include the microbiome's profound influence,which interacts with host physiology in ways that may worsen cancer development;changes in bile acid metabolism that can create toxic environments favorable for tumor growth;the regulation of inflammatory processes that may either promote or inhibit tumor progression;the immune system's involvement,which is crucial in the body's response to cancer;and the complex interactions within metabolic pathways that can affect cellular behavior and tumor dynamics.By integrating recent research findings from various studies,we aim to explore the multifaceted roles of the biliary-enteric communication of liver-gut axis in CCA,providing new insights and perspectives for future research while identifying promising therapeutic targets that could lead to innovative treatment strategies aimed at improving patient outcomes in this challenging disease.展开更多
Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis ...Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis model in mongrel dogs(n=32). Magnetic anastomosis(group A, n=16) and traditional suture anastomosis(group B, n=16) were performed to reconstruct the biliary-enteric continuity in one stage. Half of the dogs in each group were euthanized on the 30 th postoperative day, and the other half on the 90 th postoperative day to harvest the stoma region. The healing conditions of the stoma after the 2 anastomotic approaches were observed with naked eyes, under light microscope and scanning electron microscope. Results The stoma leakage rate(50% versus 0% on the 30 th postoperative day, 37.5% versus 12.5% on the 90 th postoperative day, both P<0.05) and stenosis degree(13.9%±0.3% versus 7.1%±0.3% on the 30 th postoperative day, 17.2%±0.4% versus 9.4%±0.4% on the 90 th postoperative day, both P<0.01) were significantly higher in group B than in group A. Compared with traditional manual anastomoses, the histological analysis under light and electron microscope showed a more continuous stoma with more regular epithelium proliferation and collagen arrangement, less inflammation in group A. Conclusions Magnetic anastomosis stent ensures better healing of the stoma even under the circumstance of severe inflammation.展开更多
Background: A cholecystoenteric stula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ...Background: A cholecystoenteric stula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ileus, along with their surgical outcomes. Methods: From 2015 to 2018, 3245 consecutive patients underwent cholecystectomy for gallbladder disease at our institution, of which 15 were diagnosed with a CEF. All electronic medical records were retrospectively reviewed. Results: Fifteen patients presented with CEF. Ten patients presented cholecystoduodenal stula, four pa- tients cholecystocolonic, and one patient cholecystogastric counterparts. Twelve patients were female. The median patient age was 61 years (range 33 86 years). Five patients presented with gallstone ileus treated by laparotomy and enterolithotomy. In ten patients, a laparoscopic approach was attempted, but conversion to open surgery was necessary for eight of them. The median operative time was 140 min (range 60 240 min), and the median operative blood loss was 50 mL (range 10600mL). The procedure-related morbidity and mortality rates were 13.3% and 6.7%, respectively. Conclusions: There is no consensus on the best treatment modality for a CEF, as the treatment outcome is mostly dependent on the surgeon’s expertise and the patient’s condition. Not all CEFs are accompanied by gallstone ileus. For such case, the main purpose is to resolve the intestinal obstruction and, unless necessary, avoidance of the gallbladder area.展开更多
文摘Cholangiocarcinoma(CCA)is a particularly aggressive and challenging type of cancer,known for its poor prognosis,which is worsened by the complex interplay of various biological and environmental factors that contribute to its development.Recently,researchers have increasingly focused on the significant role of the biliary-enteric communication of liver-gut axis in the pathogenesis of CCA,highlighting a complex relationship that has not been thoroughly explored before.This review aims to summarize the key concepts related to the biliary-enteric communication of liver-gut axis and investigate its potential mechanisms that may lead to the onset and progression of CCA,a disease that presents substantial treatment challenges.Important areas of focus will include the microbiome's profound influence,which interacts with host physiology in ways that may worsen cancer development;changes in bile acid metabolism that can create toxic environments favorable for tumor growth;the regulation of inflammatory processes that may either promote or inhibit tumor progression;the immune system's involvement,which is crucial in the body's response to cancer;and the complex interactions within metabolic pathways that can affect cellular behavior and tumor dynamics.By integrating recent research findings from various studies,we aim to explore the multifaceted roles of the biliary-enteric communication of liver-gut axis in CCA,providing new insights and perspectives for future research while identifying promising therapeutic targets that could lead to innovative treatment strategies aimed at improving patient outcomes in this challenging disease.
基金Supported by the National Natural Science Foundation of China(30830099)China Postdoctoral Science Foundation(20100481341)Scienceand Technology Research and Development Project of Shaanxi Province(2009K14-01)
文摘Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis model in mongrel dogs(n=32). Magnetic anastomosis(group A, n=16) and traditional suture anastomosis(group B, n=16) were performed to reconstruct the biliary-enteric continuity in one stage. Half of the dogs in each group were euthanized on the 30 th postoperative day, and the other half on the 90 th postoperative day to harvest the stoma region. The healing conditions of the stoma after the 2 anastomotic approaches were observed with naked eyes, under light microscope and scanning electron microscope. Results The stoma leakage rate(50% versus 0% on the 30 th postoperative day, 37.5% versus 12.5% on the 90 th postoperative day, both P<0.05) and stenosis degree(13.9%±0.3% versus 7.1%±0.3% on the 30 th postoperative day, 17.2%±0.4% versus 9.4%±0.4% on the 90 th postoperative day, both P<0.01) were significantly higher in group B than in group A. Compared with traditional manual anastomoses, the histological analysis under light and electron microscope showed a more continuous stoma with more regular epithelium proliferation and collagen arrangement, less inflammation in group A. Conclusions Magnetic anastomosis stent ensures better healing of the stoma even under the circumstance of severe inflammation.
文摘Background: A cholecystoenteric stula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ileus, along with their surgical outcomes. Methods: From 2015 to 2018, 3245 consecutive patients underwent cholecystectomy for gallbladder disease at our institution, of which 15 were diagnosed with a CEF. All electronic medical records were retrospectively reviewed. Results: Fifteen patients presented with CEF. Ten patients presented cholecystoduodenal stula, four pa- tients cholecystocolonic, and one patient cholecystogastric counterparts. Twelve patients were female. The median patient age was 61 years (range 33 86 years). Five patients presented with gallstone ileus treated by laparotomy and enterolithotomy. In ten patients, a laparoscopic approach was attempted, but conversion to open surgery was necessary for eight of them. The median operative time was 140 min (range 60 240 min), and the median operative blood loss was 50 mL (range 10600mL). The procedure-related morbidity and mortality rates were 13.3% and 6.7%, respectively. Conclusions: There is no consensus on the best treatment modality for a CEF, as the treatment outcome is mostly dependent on the surgeon’s expertise and the patient’s condition. Not all CEFs are accompanied by gallstone ileus. For such case, the main purpose is to resolve the intestinal obstruction and, unless necessary, avoidance of the gallbladder area.
