BACKGROUND:Obstructive jaundice is a common condition in advanced digestive cancer.Palliative procedures can improve quality of life and allow patients to attempt a systemic treatment.Bilioenteric anastomosis is still...BACKGROUND:Obstructive jaundice is a common condition in advanced digestive cancer.Palliative procedures can improve quality of life and allow patients to attempt a systemic treatment.Bilioenteric anastomosis is still the procedure of choice for patients in many centers.When a surgical bypass is not possible,biliary drainage can be done by placing endoscopic or transparietal stents,which are less durable methods even when an expandable stent is employed. METHODS:A 47-year-old male with an excellent clinical status and a previous cholecystectomy and an exploratory laparotomy for advanced gastric cancer was referred with obstructive jaundice.A preoperative CT scan showed a dilated bile duct and a small mass at the distal hepatic hilum.No other signs of metastasis were found.A surgical bilioenteric anastomosis was indicated.At surgery,a distal choledochal obstruction and a mesenteric retraction by a lymph node mass prevented the jejunum to ascend for a bilioenteric anastomosis. Surgically,an alternative bilioenteric bypass was performed by means of an ileal loop interposition between the bile duct and the jejunum. RESULT:The recovery of the patient was uneventful and his bilirubin levels normalized after one week.The patient was then referred for systemic chemotherapy. CONCLUSIONS:This alternative biliary bypass can be safely and easily performed,and may be a good alternative for patients already referred for surgery because of a better life expectancy and when the jejunum is not an alternative.展开更多
目的:探讨不同浓度胆汁酸盐对人肝胆管癌细胞RBE凋亡的影响。方法:采用0、100μM、500μM、1 m M胆汁酸盐作用于人肝胆管癌细胞后,采用流式细胞术检测细胞的凋亡率,Western-blot法检测细胞Bax、Bcl-2蛋白的表达。结果:胆汁酸盐浓度为0、...目的:探讨不同浓度胆汁酸盐对人肝胆管癌细胞RBE凋亡的影响。方法:采用0、100μM、500μM、1 m M胆汁酸盐作用于人肝胆管癌细胞后,采用流式细胞术检测细胞的凋亡率,Western-blot法检测细胞Bax、Bcl-2蛋白的表达。结果:胆汁酸盐浓度为0、100μM、500μM、1 m M时,人胆管癌细胞的凋亡率分别为(0.7±0.12)%、(0.9±0.15)%、(1.4±0.17)%、(4.8±0.14)%,以1 m M胆汁酸盐所致人胆管癌细胞的凋亡最明显,Bcl-2蛋白表达量逐渐减少,Bax表达量逐渐增多,以1 m M胆汁酸盐时作用最明显,差异具有统计学意义(P<0.05)。1 m M胆汁酸盐处理的人肝胆管癌细胞的形态由原来的梭形变成圆形,细胞核固缩、碎裂。结论:胆汁酸盐可以以浓度依赖性的方式导致人胆管癌细胞凋亡,以1 m M胆汁酸盐的作用最明显。展开更多
AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.METHODS:A total of 186 consecutive patients with unresectable biliary tract cancer,wh...AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.METHODS:A total of 186 consecutive patients with unresectable biliary tract cancer,who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan,were retrospectively analyzed.These patients were divided into three groups based on the year beginning chemotherapy:Group A(2000-2003),Group B(2004-2006),and Group C(2007-2009).The data were fixed at the end of December 2011.Overall survival and time-to-progression were analyzed and compared chronologically.RESULTS:No patient characteristics were significantly different among the three groups.The gallbladder was involved in about half of the patients in each group,and metastatic biliary tract cancer was present in three quarters of the enrollees.In Group A,5-fluorouracilbased chemotherapies were primarily selected as firstline chemotherapy,and only 24% were treated with second-line chemotherapy.In Group B,gemcitabine or S-1 monotherapy was mainly introduced as firstline chemotherapy,and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with monotherapy.In Group C,the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy,and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination therapy.The median timeto-progressions were 4.4 mo,3.5 mo and 5.9 mo in Groups A,B and C,respectively(4.4 mo vs 3.5 mo vs 5.9 mo,P < 0.01).The median overall survivals were 7.1,7.3,and 11.7 mo in Groups A,B and C(7.1 mo vs 7.3 mo vs 11.7 mo,P = 0.03).Induction rates of all three drugs(gemcitabine,platinum analogs,and fluoropyrimidine) in Groups A,B and C were 4%,2% and 27%(4% vs 2% vs 27%,P < 0.01).CONCLUSION:The prognosis of unresectable biliary tract cancer has improved recently.Using three effective drugs(gemcitabine,platinum analogs,and fluoropyrimidine) may improv展开更多
文摘BACKGROUND:Obstructive jaundice is a common condition in advanced digestive cancer.Palliative procedures can improve quality of life and allow patients to attempt a systemic treatment.Bilioenteric anastomosis is still the procedure of choice for patients in many centers.When a surgical bypass is not possible,biliary drainage can be done by placing endoscopic or transparietal stents,which are less durable methods even when an expandable stent is employed. METHODS:A 47-year-old male with an excellent clinical status and a previous cholecystectomy and an exploratory laparotomy for advanced gastric cancer was referred with obstructive jaundice.A preoperative CT scan showed a dilated bile duct and a small mass at the distal hepatic hilum.No other signs of metastasis were found.A surgical bilioenteric anastomosis was indicated.At surgery,a distal choledochal obstruction and a mesenteric retraction by a lymph node mass prevented the jejunum to ascend for a bilioenteric anastomosis. Surgically,an alternative bilioenteric bypass was performed by means of an ileal loop interposition between the bile duct and the jejunum. RESULT:The recovery of the patient was uneventful and his bilirubin levels normalized after one week.The patient was then referred for systemic chemotherapy. CONCLUSIONS:This alternative biliary bypass can be safely and easily performed,and may be a good alternative for patients already referred for surgery because of a better life expectancy and when the jejunum is not an alternative.
文摘目的:探讨不同浓度胆汁酸盐对人肝胆管癌细胞RBE凋亡的影响。方法:采用0、100μM、500μM、1 m M胆汁酸盐作用于人肝胆管癌细胞后,采用流式细胞术检测细胞的凋亡率,Western-blot法检测细胞Bax、Bcl-2蛋白的表达。结果:胆汁酸盐浓度为0、100μM、500μM、1 m M时,人胆管癌细胞的凋亡率分别为(0.7±0.12)%、(0.9±0.15)%、(1.4±0.17)%、(4.8±0.14)%,以1 m M胆汁酸盐所致人胆管癌细胞的凋亡最明显,Bcl-2蛋白表达量逐渐减少,Bax表达量逐渐增多,以1 m M胆汁酸盐时作用最明显,差异具有统计学意义(P<0.05)。1 m M胆汁酸盐处理的人肝胆管癌细胞的形态由原来的梭形变成圆形,细胞核固缩、碎裂。结论:胆汁酸盐可以以浓度依赖性的方式导致人胆管癌细胞凋亡,以1 m M胆汁酸盐的作用最明显。
文摘AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.METHODS:A total of 186 consecutive patients with unresectable biliary tract cancer,who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan,were retrospectively analyzed.These patients were divided into three groups based on the year beginning chemotherapy:Group A(2000-2003),Group B(2004-2006),and Group C(2007-2009).The data were fixed at the end of December 2011.Overall survival and time-to-progression were analyzed and compared chronologically.RESULTS:No patient characteristics were significantly different among the three groups.The gallbladder was involved in about half of the patients in each group,and metastatic biliary tract cancer was present in three quarters of the enrollees.In Group A,5-fluorouracilbased chemotherapies were primarily selected as firstline chemotherapy,and only 24% were treated with second-line chemotherapy.In Group B,gemcitabine or S-1 monotherapy was mainly introduced as firstline chemotherapy,and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with monotherapy.In Group C,the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy,and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination therapy.The median timeto-progressions were 4.4 mo,3.5 mo and 5.9 mo in Groups A,B and C,respectively(4.4 mo vs 3.5 mo vs 5.9 mo,P < 0.01).The median overall survivals were 7.1,7.3,and 11.7 mo in Groups A,B and C(7.1 mo vs 7.3 mo vs 11.7 mo,P = 0.03).Induction rates of all three drugs(gemcitabine,platinum analogs,and fluoropyrimidine) in Groups A,B and C were 4%,2% and 27%(4% vs 2% vs 27%,P < 0.01).CONCLUSION:The prognosis of unresectable biliary tract cancer has improved recently.Using three effective drugs(gemcitabine,platinum analogs,and fluoropyrimidine) may improv
