title: Applying chemical bile duct embolization to achieve chemical hepatectomy in hepatolithiasis: a further experimental study.
abstract: BACKGROUND
  Hepatolithiasis is the presence of calculi within the bile ducts of the liver. It represents a significant problem for hepatobiliary surgery because of its high recurrence rate and the associated risk for partial hepatectomy. This study was designed to explore the long-term efficacy of chemical biliary duct embolization (CBDE) to treat recurrent hepatolithiasis.
  
  
  METHODS
  A rabbit model of hepatolithiasis was established, and CBDE was achieved using oxybenzene and N-butyl-cyanoacrylate. The short-term (6 wk) and long-term (12 wk) efficacy of CBDE treatment was compared by observing the degree of atrophy, fibrosis, proliferation of collagen fibers, and apoptosis of hepatocytes and hepatic stellate cells in the embolized hepatic lobe. Biochemical measurement of β-glucuronidase was also evaluated to determine the effect of CBDE on stone formation.
  
  
  RESULTS
  Six weeks after CBDE, there was liver cell destruction, collagen accumulation, and bile duct proliferation only in the peripheral part of the target lobe. Twelve weeks after CBDE, "self-cut" chemical hepatectomy was achieved, as manifested by the destruction of almost all the hepatocytes in the target lobe, bile duct proliferation, and collagen fiber accumulation. The β-glucuronidase activity was markedly lower in the embolized lobe than in the nonembolized lobe. In contrast, bax, caspase-3, caspase-9, and α-smooth muscle actin expression was substantially higher in the embolized lobe than in the sham-operation group at 6 wk, but was lower at 12 wk.
  
  
  CONCLUSIONS
  CBDE is a potentially effective therapeutic approach for treating and preventing the recurrence of hepatolithiasis.
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Wen-jie
authors.initials: WJ
authors.lastname: Ma
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Anuj
authors.initials: A
authors.lastname: Shrestha
authors.affiliation: Department of Medicine, West China Hospital of Sichuan University, Chengdu, China. Electronic address: lanfengziye@qq.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Mao
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China. Electronic address: lfy_74@vip.163.com.
authors.forename: Fu-yu
authors.initials: FY
authors.lastname: Li
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Nan-sheng
authors.initials: NS
authors.lastname: Cheng
authors.affiliation: Department of Medicine, The George Washington University, Washington, District of Columbia.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Rui-hua
authors.initials: RH
authors.lastname: Xu
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Yong-qiong
authors.initials: YQ
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Jiang
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Feng
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Han
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D001649:Bile Duct Diseases / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D001663:Bilirubin / Q000097:blood; D053148:Caspase 3 / Q000378:metabolism; D053453:Caspase 9 / Q000378:metabolism; D002769:Cholelithiasis / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D024042:Collagen Type I / Q000378:metabolism; D004195:Disease Models, Animal; D004621:Embolization, Therapeutic / Q000379:methods*; D006498:Hepatectomy; D011817:Rabbits; D055502:Secondary Prevention; D051028:bcl-2-Associated X Protein / Q000378:metabolism
chemical_list: D024042:Collagen Type I; D051028:bcl-2-Associated X Protein; D000410:Alanine Transaminase; D053148:Caspase 3; D053453:Caspase 9; D001663:Bilirubin
keywords: Chemical biliary duct embolization; Chemical hepatectomy; Hepatolithiasis