The practical value of applying chemical biliary duct embolization to chemical hepatectomy for treatment of hepatolithiasis.
BACKGROUND
The high recurrence rate of hepatolithiasis, together with the high operative risk of hepatectomy for specifically located stones, has not been effectively settled until now. Thus, the aim of this study was to investigate the feasibility and effectiveness of using chemical biliary duct embolization (CBDE) to achieve chemical hepatectomy in a rabbit model of hepatolithiasis.


METHODS
The animal model of hepatolithiasis was established using the methods of obstruction plus infection. Seven days later, the left hepatic ducts were embolized using phenol plus cyanoacrylate or absolute ethanol plus cyanoacrylate. Subsequently, the influence of CBDE on bile duct, liver, and stone formation was analyzed by histology, RT-PCR for procollagen, biochemistry, and enzymatic histochemistry for beta-glucuronidase (beta-G).


RESULTS
CBDE resulted in the entire ablation of the diseased biliary duct mucosa and the complete occlusion of the diseased biliary duct lumen, thus effectively eradicating chronic proliferative cholangitis and preventing stone formation. More importantly, CBDE also resulted in the complete fibrosis and "self-cut" in the periphery of the embolized lobe, thus achieving chemical hepatectomy. Also of note, the embolized lobe exhibited a much lower level of endogenous beta-G than the nonembolized lobe, indicating an inhibitory effect of CBDE on beta-G. Besides, the mRNA level of procollagen I in the embolized bile duct wall of phenol embolization group was significantly higher than the ethanol embolization group.


CONCLUSIONS
Chemical biliary duct embolization, especially using phenol plus cyanoacrylate, may prevent the recurrence of intrahepatic stone and concurrently achieve the effect of chemical hepatectomy.
Li
Fuyu
F
Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
Cheng
Jingqiu
J
He
Sheng
S
Li
Ning
N
Zhang
Mingming
M
Dong
Jiahong
J
Jiang
Lisheng
L
Cheng
Nansheng
N
Xiong
Xianzhe
X
D000818:Animals; D001653:Bile Ducts, Intrahepatic; D016461:Chemoembolization, Therapeutic; D002758:Cholangiography; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D003487:Cyanoacrylates / Q000627:therapeutic use; D004338:Drug Combinations; D005240:Feasibility Studies; D005355:Fibrosis; D005966:Glucuronidase / Q000378:metabolism; D006498:Hepatectomy / Q000379:methods; D006651:Histocytochemistry / Q000379:methods; D008099:Liver / Q000378:metabolism; D019800:Phenol / Q000627:therapeutic use; D011347:Procollagen / Q000235:genetics; D012333:RNA, Messenger / Q000378:metabolism; D011817:Rabbits; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013194:Staining and Labeling; D013997:Time Factors
D003487:Cyanoacrylates; D004338:Drug Combinations; D011347:Procollagen; D012333:RNA, Messenger; D019800:Phenol; D005966:Glucuronidase