选择性胆管外引流改善梗阻性黄疸大鼠肝功能的研究

目的 探讨选择性胆管外引流(约占30%肝脏体积)对梗阻性黄疸大鼠肝功能的影响.方法 检测梗阻性黄疸大鼠(梗阻10 d)经选择性胆管外引流组及非选择性(全肝)胆管外引流组引流的0、1、4、7、10 d右叶肝质量/体质量的比率,并通过RT-PCR及Western blot法检测两实验组肝组织胆盐输出泵(bile salt export pump,BSEP)、多药抑制相关蛋白2(multidrug resistance-associated protein 2,MRF2)基因及蛋白的表达.结果 选择性胆管外引流组在开放引流后右叶肝质量/体质量的比率继续增加,而非选择性胆管外引流组逐渐恢复正常,两组比较差异有统计学意义(t=15.569,P<0.05);选择性胆管外引流组开放引流后BSEP、MRP2基因及蛋白的表达始终高于非选择性胆管外引流组,两组比较差异有统计学意义(t=4.485,7.143,9.169,5.178,P<0.05).结论 选择性胆管外引流能够改善梗阻性黄疸大鼠肝功能,与预保留侧肝脏体积代偿性增加和开放引流后预保留侧肝脏单位体积的膜转运蛋白表达增高有关.     

显微外科技术建立稳定的大鼠梗阻性黄疸内引流模型

目的:利用显微外科技术建立一个稳定的大鼠梗阻性黄疸内引流模型。方法:所有操作均在手术显微镜下进行。第1次开腹结扎近端胆总管,往胰腺端胆总管插入引流管约3 mm长,引流管远端封闭,建立黄疸模型;7天后第2次开腹,引流管开放后置入近端扩张的胆总管,实现近端胆管和胰胆管架桥。检测引流前后大鼠营养状况、肝重、肝脏和胰腺生化、肝脏病理和超声弹性成像等,评估新型模型的稳定性。结果:未见肠道返流、胆管堵塞等并发症。建立黄疸模型后第1天,有2例大鼠血清淀粉酶和脂肪酶升高,第4天及以后均未发现胰腺酶谱升高。胆道内引流后血糖和血清白蛋白较快恢复到正常水平;肝重/体重上升;各项生化指标、肝脏超声弹性模量值、肝脏病理改变逐渐恢复到正常水平。结论:采用显微外科技术,成功建立了一个新型稳定的大鼠梗阻性黄疸内引流模型。     

恶性梗阻性黄疸合并胆汁分泌亢进的介入治疗

目的探讨介入治疗恶性梗阻性黄疸合并胆汁分泌亢进的临床效果。方法回顾性分析23例恶性梗阻性黄疸一期经皮肝穿刺胆管外引流(BED)术后并发胆汁分泌亢进患者的临床资料。所有患者均行二期手术治疗,12例行经皮肝穿胆管内外引流术(BIED),7例行胆道支架置入(PTCS),4例行BED联合经鼻空肠营养管胆汁自体回输。二期术后2周用直接胆红素(DBIL)下降程度及临床相关症状(乏力、纳差、口渴等)改善情况评价治疗效果。显效:DBIL下降程度≥50%,临床症状完全改善。有效:DBIL下降程度≥50%,临床症状部分改善。无效:DBIL下降程度<50%,无论临床症状是否改善。结果 18例显效,4例有效,1例无效。1例BIED患者于二期术后第2天出现胰腺炎,1例于二期术后第10天出现引流管堵塞。其余患者住院期间未出现相关并发症,住院时间(25.8±2.7)d。结论介入治疗恶性梗阻性黄疸合并胆汁分泌亢进,疗效确切,具有一定的临床应用价值。     

可控性胆道内/外引流及胆道梗阻动物模型的建立

目的：建立一种可控性胆道梗阻及胆道内／外引流动物模型，用于观察不同程度胆道梗阻对胆汁分泌的影响。此慢性动物模型可在清醒状态下，研究不同干预方式对胆汁分泌的影响。方法：选用健康的Wistar大鼠，在适当部位横断胆管，结扎胆管远端，近端插入直径0．8mm的“T”型硅胶管一端，将另一端插入空肠，由此建立经T型管的横臂进行胆道内引流的通路，并通过已建立的皮下隧道，将T型管的T臂引出体外，建立经T型管垂直臂进行外引流的通路。这样建成一种可在体外控制胆汁经体外控制胆汁内、外引流或在体外梗阻的慢性动物模型。测定对照组、假手术组及模型组术后第1周以及胆道内、外引流后1周的肝功能指标及体重的变化。结果：成功建立了可控性大鼠胆道梗阻及胆道内／外引流的动物模型。健康对照组动物、假手术组动物及模型动物的体重、ALT、AST、TBIL以及不同时段胆汁内胆汁酸含量无显著改变。体外阻断T型管的横臂造成胆道梗阻8d，ALT、AST、TBIL均显著增高（P〈0．01），梗阻解除后，肝功能有一定程度恢复。结论：本实验动物模型可在动物清醒状态下控制动物的胆汁内／外引流，能够在体外任意阻断胆道，形成胆道梗阻。该模型对动物影响小，并对肝功能等无明显变化，可以维持有效的胆汁的肝肠循环，对胆酸池无影响。为研究梗阻性黄疸提供了一个简单且可重复使用的研究平台，还可以观察药物对胆汁分泌的影响；对某些药物的胆汁浓度也提供了可靠的检测途径。     

肝动脉结扎对梗阻性黄疸大鼠残肝肝细胞凋亡及再生的影响

目的探讨正常肝脏状态下和梗阻性黄疸状态下,肝固有动脉结扎对大鼠肝细胞凋亡和肝脏再生的影响。方法设计动物实验。80只Wistar雄性大鼠分为4组,每组大鼠20只,即:建立梗阻性黄疸模型后3 d施行70%肝切除+肝固有动脉结扎+胆肠内引流组(A组);建立梗阻性黄疸模型后3 d施行70%肝切除+胆肠内引流(B组);假手术后3 d施行70%肝切除+肝固有动脉结扎(C组)和假手术后3 d施行70%肝切除(D组)。各组分别在肝大部切除模型建立后1、2、3和6 d共4个时间点观察动物生理状态并采集血液及残肝组织标本。记录各组术后大鼠的生理状态及死亡情况;检测血清肝功能指标:胆红素(TB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)及白蛋白(ALB);采用TUNEL法检测残肝组织肝细胞的凋亡;采用Brdu检测残肝再生情况,并进行统计分析。结果 A、B 2组大鼠间及C、D 2组大鼠间术后生存率比较差异无统计学意义(均P0.05)。A组和B组大鼠的术后肝功能差异无统计学意义(P0.05),但术后早期的白蛋白合成A组要弱于B组(术后3 d,P0.05);C组和D组术后肝功能指标差异也无统计学意义(P0.05),但术后早期C组的白蛋白合成要弱于D组(术后1 d和3 d均P0.05)。A、B、C 3个组术后1 d残肝凋亡指数达到最大,而后逐渐下降;而D组残肝凋亡指数在4个时间点上均为最低。术后1 d,C、D 2组肝细胞增殖达到高峰,增殖指数大小为D组C组B组A组,各组之间差异均有统计学意义(均P0.05)。术后6 d,A、B组肝细胞增殖指数无明显增大,C、D组肝细胞增殖指数明显降低,4个组的肝细胞增殖指数均处于较低水平。结论结扎肝动脉将增加残肝肝细胞凋亡,减弱肝细胞再生。但结扎肝动脉并未增加梗阻性黄疸大鼠术后死亡风险。     

梗阻性黄疸SD大鼠肝热缺血再灌注损伤模型的建立

目的构建阻塞性黄疸合并肝热缺血再灌注损伤的SD大鼠模型。 方法选择SD大鼠40只随机分为4组：假手术组（Sham组）、梗阻7天组（7 d组）、梗阻14天组（14 d组）及梗阻21天组（21 d组）,每组10只。通过双重结扎并切断胆总管建立SD大鼠阻塞性黄疸模型,探索最佳梗阻时间。梗阻7 d后另择SD大鼠62只,再随机分为4组：未缺血组（0 min组,10只）、缺血15 min组（15 min组,12只）、缺血30 min组（30 min组,16只）、缺血45 min组（45 min组,24只）,分别行肝门部血管阻断0、15、30、45 min后再灌注,建立后续肝热缺血再灌注损伤模型,观察生化指标、生存率及病理学改变。 结果梗阻7 d时适合下一步建模。建立阻塞性黄疸模型后,随着肝门部血管阻断时间的延长,肝功能进行性下降,大鼠死亡率逐渐升高,各组间的差异具有统计学意义（P<0.05）;随阻断时间的延长,肝脏损害的病理学表现更为严重。其中肝门部血管阻断30 min时24 h死亡率50%,再灌注2 h后病理学上出现严重的肝细胞变性、坏死改变。 结论对于梗阻性黄疸的SD大鼠,在梗阻7 d后行肝门部血管阻断30 min再恢复血流,可有效建立梗阻性黄疸大鼠的肝缺血再灌注损伤模型。     

脂肪乳剂对梗阻性黄疸病人术后脂代谢的影响

目的　研究不同浓度脂肪乳剂对梗阻性黄疸病人术后脂肪代谢的影响。方法　23例梗阻性黄疸病人随机分成两组,分别给予10%、20%的脂肪乳剂约1g/(kg·d),行术后短期(5天)全胃肠外营养支持,观察营养支持前后血脂质、动脉血酮体比及肝肾功能变化情况。结果　两组病人血甘油三酯、总胆固醇呈下降趋势,肝、胃功能有所改善。结论　梗阻性黄疸病人术后短期应用脂肪乳剂,没有加重肝功能损害和脂代谢紊乱,有利于肝脏的能量代谢。     

大鼠梗阻性黄疸后不同时间行胆道引流对肝脏功能及组织病理的影响

目的 观察大鼠梗阻性黄疸后不同时间行胆道引流前后肝脏的生化指标和组织病理,探讨其在减黄前后的变化规律。方法 55只健康成年SD雄性大鼠,建立胆道梗阻及引流模型,分为梗阻3、7、14、21、28 d外引流组以及对照组。分别于不同时段测定血清总胆红素（TBIL）、直接胆红素（DBIL）、丙氨酸 氨基转移酶（ALT）、碱性磷酸酶（ALP）、血清前白蛋白（PA）以及凝血酶原时间（PT）,并观察肝脏组织病理变化。结果 大鼠胆道梗阻3 d以内,ALP在引流后能够恢复正常,3 d以上恢复较困难;梗阻7 d以内,TBIL、DBIL、ALT和PT在引流后能够恢复正常,7 d以上恢复较困难;梗阻14 d以内,PA和肝脏组织病理损伤在引流后能够恢复正常,14 d以上恢复较困难。结论 胆道梗阻时间的长短是影响肝脏损伤程度以及梗阻解除后恢复速度的重要因素。在大鼠梗阻性黄疸后不同时间行胆道引流,其肝脏功能和组织病理的恢复速度有很大差异。梗阻时间达到一定程度后,即使解除梗阻,其肝脏损伤也可能难以逆转。本研究的结果表明大鼠胆道梗阻14 d以内胆道引流的效果较好,梗阻时间超过14 d胆道引流的效果较差。     

不同引流方式对梗阻性黄疸大鼠部分肝切除术后肝再生的影响

目的探讨不同引流方式对梗阻性黄疸大鼠部分肝切除术后肝再生的影响。方法建立梗阻性黄疸70％部分肝切除sD大鼠模型。随后将120只sD大鼠按照随机数字表法分为对照组：行肝中、左叶切除;内引流组：于扩张胆管和十二指肠间置管引流;外引流组：于扩张胆管置管,导管另-端从腹腔引出。每组40只大鼠。内引流组和外引流组引流7d后行肝中、左叶切除,于术后0、1、2、4、12、24、48、72h收集3组大鼠血液及肝脏组织标本,测定肝再生率、有丝分裂指数。采用免疫组织化学染色法观察肝脏组织增殖细胞核抗原（PCNA）及信号传导与转录激活因子3（STAT3）的表达,ELISA法检测血清TNF．OL、IL-6水平,RT．PCR测定肝脏组织TNF—OLmRNA和IL-6mRNA的表达。组间比较采用单因素方差分析,两两比较采用SNK检验。结果部分肝切除术后72h内引流组sD大鼠肝再生率为94．86％±12．72％,显著高于外引流组的62．39％±8．01％和对照组的45．77％±5．41％（F=33．62,P〈0．05）。3组大鼠肝脏组织有丝分裂指数和PCNA水平均于12h明显升高,内引流组有丝分裂指数和PCNA水平均于24h达到高峰,分别为24．47％±4．01％和88．1％±9．2％,对照组和外引流组于48h达到高峰,分别为15．80％±1．08％和58．3％±5．8％、18．40％±1．12％和70．2％±6．9％。内引流组有丝分裂指数和PCNA水平峰值显著高于对照组和外引流组（P〈0．05）。内引流组STAT3表达于术后4h达到高峰,为42．6％±3．6％,对照组和外引流组分别于术后12h达到高峰,分别为22．9％±2．0％和29．2％±3．7％。内引流组STAT3表达峰值显著高于对照组和外引流组（P〈0．05）。内引流组TNF—d和IL-6水平均于术后12h达到高峰,分别为（227±23）U／L和（256±32）U／L;对照组和外引流组TNF—d和IL-6水平均于术后24h达到高峰,分别为（309±41）U／L和（388±40）U／L、（287±30）U／L和（346±33）U／L,内引流组术后0、1、2、4、12、24、48、72hTNF-0l和IL-6水平显著低于相同时相点对照组和外引流组（P〈0．05）。对照组、内引流组和外引流组大鼠肝组织TNF-dmRNA表达均于术后4h达到高峰,分别为0．92±0．14、0．39±0．05、0．80±0．15,IL-6mRNA于术后12h达到高峰,分别为0．79±0．07、0．38±0．06、0．63±0．10,内引流组术后0、1、2、4、12、24、48、72hTNF—dmRNA和IL-6mRNA表达显著低于相同时相点对照组和外引流组（P〈0．05）。结论内、外引流均可改善梗阻性黄疸大鼠剩余肝脏的再生能力,但内引流效果更明显。内引流术可能通过降低TNF-α和IL-6水平,影响STAT3表达而改善梗阻性黄疸大鼠剩余肝脏的再生能力。     

门静脉动脉化对实验性梗阻性黄疸大鼠肝脏微血管的影响

肝门部胆管癌 ,有血管、神经浸润时最理想的根治性手术是肝十二指肠韧带的整块切除[1] 。为此我们提出了用门静脉动脉化的方法[2 ] 来解决整块切除时肝脏供血、门静脉回流和术后肝脏血管重建的问题。结合肝外胆管癌多伴有梗阻性黄疸 ,我们建立了梗阻性黄疸时门静脉动脉化的动物模型 ,并通过对该模型肝脏的组织学检查和血管铸型扫描电子显微镜观察对此加以研究。1.实验材料和方法 :(1)实验动物及分组 :雄性Ｓｐｒａｇｕｅ Ｄａｗｌｅｙ(ＳＤ)大鼠 ,体重 2 5 0～ 30 0ｇ。本实验共分 4组 ,每组 5只大鼠 ,除第 2组为梗阻性黄疸 5ｄ后处死外 ,其…     

Decrease in regeneration capacity of rat liver after external biliary drainage.

In order to discover the effect of external biliary drainage on liver regeneration, we have produced a model system carrying cannula in the common bile duct of rat liver and examined the regeneration capacity of liver after partial hepatectomy under various conditions. Previously we have shown that hepatic cells proliferate by obstructive jaundice alone without partial hepatectomy [Terasaki et al; Jpn J Cancer Res 1991;82:170-175]. In the present study, we showed that DNA polymerase-alpha was induced by partial hepatectomy of rats suffering from obstructive jaundice and the induced level was similar to that of the normal regenerating liver. The level of DNA polymerase-alpha activity corresponded well to the liver regeneration capacity estimated by mitotic index. Contrary to our expectation, external biliary drainage for obstructive jaundice markedly suppressed the regeneration capacity of the remaining liver which was estimated by DNA polymerase-alpha activity, mitotic index and [3H]thymidine incorporation. The suppression may be due to the external biliary drainage itself because the liver regeneration of normal rats without jaundice was also suppressed by the biliary drainage. These results suggest that the external biliary drainage seriously suppresses the regeneration capacity of liver at least at the early stage of obstructive jaundice.     

Therapeutic Effect of Plasma Exchange with the Biliary Drainage in the Treatment of Obstructive Jaundice

The effect of therapeutic plasmapheresis combined with biliary drainage was evaluated in obstructive jaundice animal models. Plasma exchange (PE) using fresh-frozen plasma was carried out with biliary drainage (BD) on a canine jaundice model created by the ligation and resection of bile duct. Routine biochemical analyses were done following PE and BD. The result was compared with that of a BD only group. Plasma bilirubin level abruptly dropped after PE and was kept at a lower level, whereas the bilirubin level of the drainage alone group decreased gradually. Decreased plasma mitochondrial GOT level in the PE group suggests improvement of liver cell damage in obstructive jaundice. Mitochondrial function of liver tissue was evaluated following partial hepatectomy, which was carried out 2 days after PE along with BD in jaundice rat. Mitochondrial respiratory control ratio and ADP/O ratio following hepatectomy were improved in the PE group. The results suggest the improvement of hepatic functional reservoir by a single PE treatment in addition to BD treatment. These results show that PE can shorten the icteric period and may improve the hepatic functions after the treatment of malignant obstructive lesion in the biliary tract.     

Development and reversibility of T lymphocyte dysfunction in experimental obstructive jaundice

This study evaluates the effect of experimental biliary obstruction by bile duct ligation (BDL) and biliary drainage on cell-mediated immunity in Wistar rats. Immune status has been assessed by a mitogen stimulation test of T lymphocytes with phytohaemagglutinin. Animals were followed for up to 35 days after BDL. Regression analysis showed a significant negative correlation between lymphocyte function and the period of jaundice (correlation coefficient -0.57, P less than 0.001). Following BDL for 21 days, groups of animals had internal biliary drainage for 7, 14 and 28 days, and external drainage for 14 days. Compared with obstructed animals, 14 days internal drainage was required to improve lymphocyte function (P less than 0.05). Animals which had 14 days of external drainage had significantly lower lymphocyte stimulation than internal drainage animals (P less than 0.05). The results demonstrate that obstructive jaundice produces a progressive reduction of T lymphocyte function. This can be reversed by biliary drainage, internal drainage being more effective than external drainage.     

Impaired specific cell-mediated immunity in experimental biliary obstruction and its reversibility by internal biliary drainage

Little is known of the effect of cholestasis on host immunity. This study evaluates lymphocytic responsiveness to PHA and LPS mitogen and to allogeneic F344 antigen in Sprague-Dawley rats 21 days following bile duct ligation and 31 days following relief of jaundice by internal biliary drainage. Serum bilirubin level was significantly elevated in the bile duct ligated animals at Day 21 (P less than 0.001) and thereafter returned to preoperative levels following internal biliary drainage. Results demonstrate depressed responsiveness to PHA (P less than 0.001) and allogeneic F344 antigen in vivo (P less than 0.04) and in vitro (P less than 0.02) in bile duct ligated animals as compared to sham, sham pair-fed, and normal control rats. The observed deficiency in responsiveness to T-cell-dependent mitogen and antigen cannot be explained on the basis of complicating nutritional, renal, or infective factors. Subsequent internal biliary drainage results in some improvement in T-cell responsiveness in the bile duct ligated group although recovery is not complete. B-Lymphocytic response to LPS mitogen is not affected by bile duct ligation. We conclude that cholestasis subsequent to extrahepatic biliary obstruction per se results in impairment of cell-mediated immunity in vivo. This impairment is partly reversible by internal biliary drainage. In vitro B-cell function does not appear to be affected in this model. Further study of impaired cell-mediated immunity in extrahepatic biliary obstruction will improve our understanding of the immunological status of patients with obstructive jaundice and cholestatic liver diseases.     

Bacterial translocation in obstructive jaundice in rats: role of mucosal lacteals.

OBJECTIVE: To study the ultrastructure of the ileal wall in rats with obstructive jaundice alone and after passive external biliary drainage to see if we could discover the reason for the increased risk of infective complications and multisystem failure in the presence of obstructive jaundice and after external biliary drainage. DESIGN: Histological examination of the wall of the terminal ileum using light microscopy, as well as scanning and transmission electron microscopy (EM). SETTING: Experimental laboratory, Republic of Georgia. ANIMALS: 56 adult male Wistar rats. Interventions: Rats were divided into 7 groups: controls (not operated on, n = 6); sham-operated and studied after 6 and 12 days (n = 6 in each); bile duct ligation alone studied after 6 and 12 days (n = 10 in each); and bile duct ligation followed 6 and 12 days later by one-day of external biliary drainage (n = 9 in each). MAIN OUTCOME MEASURES: Percentage of destroyed villi. RESULTS: The extent of oedema of villi, necrosis of neurons, and disturbances in the secretory capacity of enterocytes correlated well with the duration of cholestasis. After 6 and 12 days ligation alone 7.2% and 17.3%, respectively, of villi were found to be destroyed; their connective tissue framework including lymphatics was in direct contact with the intestinal contents. The changes were not reversed by one day of external biliary drainage. CONCLUSION: The gaps in the ileal mucosa caused by obstructive jaundice (and not relieved by one day of external biliary drainage) may enable gut bacteria and their endotoxin to reach the systemic circulation through the lymphatic-system. This could increase the risk of infective complications.     

腹腔镜下经皮胆总管穿刺置管引流五例报告

目的探讨腹腔镜下经皮胆总管穿刺置管引流治疗恶性肿瘤梗阻性黄疽临床应用价值。方法 5例不能手术切除恶性梗阻性黄疸病人,其中3例胰头癌,2例壶腹部癌,均采用腹腔镜下经皮胆总管穿刺置管引流术治疗。术后7~10d复查病人血生化指标。结果穿刺成功率为100%;术后7~10d总胆红素平均下降95.8μmol/L;未出现出血、胆汁性腹膜炎、胆漏等并发症。结论此方法创伤小,并发症少,操作简单,引流可靠有效,是晚期恶性肿瘤梗阻性黄疸较好的引流方法。     

Experimental study on therapeutic plasmapheresis with the biliary decompression in the treatment of obstructive jaundice

The effectiveness of therapeutic plasmapheresis with the biliary decompression was evaluated using animal model in the treatment of obstructive jaundice. Plasma exchange (PE) using fresh frozen plasma was carried out with biliary decompression on canine jaundice model made by means of ligation and resection of bile duct. Routine biochemical analysis was performed following the PE and biliary drainage and the result was compared with the external biliary drainage group. Plasma level of total bilirubin decreased after PE and kept lower level while plasma level of bilirubin in external biliary drainage group decreased slowly. M-GOT and GOT level, those are the indicators of liver cell injury, was lower in PE group. Mitochondrial function of liver cell was evaluated following partial hepatectomy carried out two days after PE with biliary decompression on jaundiced rat. Mitochondrial respiratory control ratio and ADP/O ratio was improved in PE group. The effectiveness of PE is speculated as the combined mechanism of the removal of hepatotoxic factors in the jaundiced plasma and the addition of hepatotrophic factors within the fresh frozen plasma. These results support the effectiveness of PE to shorten the biliary drainage period and to improve the hepatic function for perioperative management.     

Differences in biliary lipid excretion after major hepatectomy in obstructive jaundiced rats with preoperative internal,external, or no biliary drainage

Necessity of preoperative biliary drainage for patients with obstructive jaundice is still controversial. We recently reported that liver regeneration after major hepatectomy was better restored in a rat model of obstructive jaundice with preoperative internal biliary drainage than that without biliary drainage or with external biliary drainage. The aim of this study was to investigate the differences in biliary lipid excretion after hepatectomy in obstructive jaundiced rats with or without preoperative internal or external biliary drainage. After bile duct ligation for 7 days, rats were randomly divided into the three groups; obstructive jaundice-hepatectomy (OJ-Hx), internal biliary drainage-hepatectomy (ID-Hx), and external biliary drainage-hepatectomy (ED-Hx) groups. 70% hepatectomy and internal biliary drainage were carried out 7 days after biliary decompression in the latter two groups and without biliary decompression in the OJ-Hx group. On the day of and on days 1, 2, 3 and 7 after hepatectomy, the liver weight, DNA synthesis rate, biliary lipids excretion rates, and bile acid composition were determined. In the ID-Hx group, the DNA synthesis rate and relative liver weight were significantly higher than those of the OJ-Hx and ED-Hx groups. The excretion rates of biliary lipids were disturbed in the ED-Hx group compared with those in the ID-Hx group and the values in the OJ-Hx group were in-between the ID-Hx and ED-Hx group. The liver regeneration rate was significantly correlated with bile flow and excretion rates of biliary lipids. The maintenance of enterohepatic circulation of biliary lipids before hepatectomy may be important for the liver regeneration.     

PTCD治疗梗阻性黄疸137例分析

目的PTCD技术应用及临床价值,旨在提高成功率,减少并发症。方法对患胆结石、胆囊癌、胆管癌、肝转移癌引起的阻塞性黄疸137例患者在彩超引导下行PTCD,置管147根,合适胆管选择左肝高于右肝。结果1次穿刺成功率98．58％,2次成功率100％。引导管放置时间3—186d,发生并发症6例,占4．4％。结论彩超引导下PTCD是目前最为简便、安全、实用的胆道减压方法。