Surgery is the only effective treatment for congenital choledochal cysts, as it allows for the resection of the cysts, the complete relief of cholangitis, and the prevention of canceration of cysts. The key elements of surgery for central choledochal cysts involve the cysts resection, bile-intestinal anastomosis, and biliopancreatic diversion. The difficulty in operating on central choledochal cysts lies in the rational decision making and effective management of cysts in the hilar and pancreatic regions. Depending on the type of central choledochal cysts with different anatomical patterns, a reasonable and feasible individualized surgical management strategy can be established to effectively avoid adverse therapeutic consequences such as postoperative biliary leakage, cholangio-intestinal anastomotic stricture, residual choledochal cysts and its carcinogenesis.
A complex mechanism of reduced number of bile duct innervating ganglion cells, smooth muscle distribution, foregut duplications, and abnormal pancreaticobiliary duct junction, which occurs during embryonic development and after birth in a genetic context, can lead to pathological congenital biliary dilatation. As a precancerous lesion of the biliary system, irrational treatment of congenital biliary dilatation will further increase the risk of malignancy in patients. By understanding the causes, pathological features, and limitations of early detection techniques of malignant tumor secondary to congenital biliary dilatation is helpful to clarify the key points in the management of congenital biliary dilatation, reduce the incidence of postoperative adverse treatment events and avoid the medical risk of secondary malignancy.
Objective To systematically review the correlation between epidermal growth factor (EGF) 61A/G polymorphism and the risk of esophageal carcinoma. Methods Such databases as PubMed, EMbase, CJFD, CBM, CNKI, VIP and WanFang Data were electronically searched from inception to January 1st, 2013, to collect case-control studies on the correlation between epidermal growth factor (EGF) 61A/G polymorphism and the risk of esophageal carcinoma. Two reviewers independently identified the literature according to inclusion and exclusion criteria, extracted data, and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 and Stata 12.0 software. Results A total of six studies involving 1 448 cases and 1 728 control subjects were included. The results of meta-analysis showed that, there was no significant association between EGF 61A/G polymorphism and the risk of esophageal carcinoma (dominant model: AG+GG vs. AA: OR=1.22, 95%CI 0.91 to 1.65; and recessive model: GG vs. AG+AA: OR=1.35, 95%CI 0.94 to 1.94; AG vs. AA: OR=1.12, 95%CI 0.93 to 1.35; GG vs. AA: OR=1.43, 95%CI 0.83 to 2.47). The results of subgroup analysis grouped by ethnicity showed that, EGF 61A/G polymorphism increased the risk of esophageal carcinoma of the White population (dominant model: AG+GG vs. AA: OR=1.39, 95%CI 1.14 to 1.71; and recessive model: GG vs. AG+AA: OR=1.75, 95%CI 1.37 to 2.25; GG vs. AA: OR=1.93, 95%CI 1.47 to 2.55). However, it had no correlation to the risk of esophageal carcinoma of Asian population. Conclusion Current studies showed that, EGF 61A/G polymorphism is not associated with susceptibility to esophageal carcinoma , but it may increase the risk of esophageal carcinoma in White population. Due to limited quality and quantity of the included studies, the above conclusion needs to be verified by more studies with large sample size.
Objective To compare proton pump inhibitors (PPI) and H2 receptor antagonists (H2RA) for both the prevention of bleeding and the healing of ulcer after endoscopic submucosal dissection (ESD), so as to provide best evidence for treating ESD-induced ulcer in clinic. Methods Databases including PubMed, CENTRAL, EMbase, ISI Web of Knowledge, VIP, CNKI, CBM and WanFang Data were searched from the date of their establishment to October 26, 2012 to collect the randomized controlled trials (RCTs) about comparison of PPI and H2RA on the prevention of bleeding and the healing of ulcer after ESD. Meanwhile the references of the included studies were also retrieved manually. According to the inclusion and exclusion criteria, literature selection, data extraction and quality assessment were performed by four reviewers independently, and meta-analysis was performed using RevMan 5.1 software. Results A total of 6 studies involving 616 patients were included finally. The results of meta-analysis showed that: for the prevention of ulcer bleeding after ESD, PPI preceded H2RA apparently (OR=0.51, 95%CI 0.29 to 0.89, P=0.02), especially when the treatment course was 8-week (OR=0.43, 95%CI 0.22 to 0.82, P=0.01); but among the merged, 8-week and 4-week groups, there were no significant differences between PPI and H2RA in the healing of ESD-induced ulcer (OR=0.85, 95%CI 0.39 to 1.86, P=0.69; OR=1.33, 95%CI 0.28 to 6.27, P=0.72; OR=0.75, 95%CI 0.31 to 1.79, P=0.52). Conclusion PPI is superior to H2RA for the prevention of ulcer bleeding induced by ESD, but there is no significant difference between them in the healing of ulcer, so PPI is recommended to prevent ESD-induced ulcer bleeding in clinic. Due to the limitation of quantity and quality of the included studies, the safety of PPI has to be further proved by conducting more high quality, large scale and multicenter RCTs.
【Abstract】Objective To investigate prophylactic measures for nontraumatic complications of laparoscopic cholecystectomy (LC).Methods The data of 13 000 patients who underwent LC in Kunming general hospital of PLA over 13 years(1991-2004) were retrospectively reviewed. Results Nine malignant tumors and 47 common bile duct stones were missed at LC. The 9 malignant tumors included hepatic cancer (n=1), gastric cancer (n=1), gallbladder cancer (n=2), pancreatic cancer (n=2) and right colon cancer (n=3). Of all the carcinomas, 3 patients with right colon cancer underwent colectomy, the other 6 patients couldn’t be cured radically. All the 47 patients with choledocholithiasis were cured successfully, among them 31 patients were performed with ERCP and 16 were reoperated on with cholangiotomy. Conclusion This study emphasizes the necessity to analyze carefully patients’ symptoms before operation and pay attention to pathological changes of gallbladder and intraabdominal situation intraoperatively. If necessary, laparoscopic ultrosonography can be used to avoid missing malignant tumors and biliary stones.