68例恶性梗阻性黄疸患者ERCP诊治的分析

目的 探讨经内镜逆行胰胆管造影(ERCP)及其相关技术在恶性梗阻性黄疸患者诊断和治疗中的作用.方法 回顾性分析68例恶性梗阻性黄疸患者的ERCP诊断情况,以及ERCP相关性治疗,包括内镜下鼻胆管引流(ENBD)、内镜下胆管金属支架引流术(EMBD)、塑料支架引流术(ERBD)、超声引导下经皮肝穿刺胆道引流术(PTCD)联合ERCP支架植入术的应用情况,并对患者的预后及并发症进行总结分析.结果 68例患者均经ERCP检查,共成功发现病变显影54例(79.4％),其中壶腹癌(16/18)、乳头癌(10/12)、胆管下段癌(8/l0)、胆囊癌(5/5)、肝癌侵犯胆管(2/2)肝门部胆管癌(6/11)、胰腺癌(6/8).术后7d胆红素及ALP水平较术前均明显下降,大部分患者症状明显缓解.术后并发急性胰腺炎8例(14.8％),电解质紊乱9例(16.7％),并发消化道出血3例.49例接受为期6个月的随访,其中死亡12例(24.5％).结论 ERCP及其相关治疗手段能够减轻黄疸,缓解症状,提高生活质量,延长生存期,是姑息性治疗恶性梗阻性黄疸的重要方法.     

信息荟萃

上海首创新法治疗恶性梗阻性黄疸长期以来被医学界视为难治之症的胆管恶性狭窄，在上海医科大学附属中山医院获得突破。由这家医院放射科王小林教授等组成的课题组，采用自行研制的金属内支架，以微创介入法治疗恶性胆管狭窄，为恶性梗阻性黄疸患者延续生命开辟了新途径。...     

超声内镜介入治疗对梗阻性黄疸疾病的治疗价值

目的：研究超声内镜介入在梗阻性黄疸中的治疗价值。方法回顾210例梗阻性黄疸患者中的治疗效果。结果210例患者内镜检查后均被认为患梗阻性疾病,其中122例患者在检查时确诊为恶性疾病,88例病理检查为阴性,梗阻性黄疸中胆总管恶性的患者超声内镜治疗成功率高达91.8豫。治疗后患者症状均有较好的改善,在复查时肝功能状况也明显有了很大的改善,治疗后高淀粉酶血症6例,轻度胆管炎4例,急性胰腺炎6例,发生并发症的概率为7.62豫。结论超声内镜介入治疗对梗阻性黄疸疾病治疗有效。     

胆道支架放置术治疗恶性梗阻性黄疸的体会

目的探讨胆道支架放置术治疗恶性梗阻性黄疸的安全性和有效性。方法采用自膨式胆道支架放置术治疗恶性梗阻性黄疸78例病人。术前实验室检查血总胆红素为(362.4±106.7)μmol/L,以直接胆红素升高为主[(271.9±74.3)μmol/L]。结果所有病例均成功放置支架,术中、术后无因操作原因致死病例,1～4周黄疸完全消退68例,血胆红素降到正常水平,10例血胆红素平均降至65.2μmol/L;并发症以胆道感染为主。结论胆道支架放置术治疗恶性梗阻性黄疸有效、安全。     

恶性梗阻性黄疸的介入治疗

目的探讨恶性梗阻性黄疸的介入治疗方法及其疗效。方法对256例恶性梗阻性黄疸患者,施用经皮经肝穿刺胆道引流术(PTCD)加金属内支架置入术或结合局部动脉化疗术,共使用256条外引流管和256枚金属内支架。结果 256例患者采用经皮经肝穿刺置入外引流管及支架置入术,均一次置入成功。术后总胆红素、直接胆红素、碱性磷酸酶均明显下降。术后256例患者黄疸消退满意;112例黄疸消退,并于术后4周行局部灌注化疗术。结论经皮经肝穿刺胆道外引流加内支架置入术是姑息性治疗恶性梗阻性黄疸的安全、有效方法,结合局部动脉灌注化疗,能提高患者的生命质量及延长生存期。     

细菌感染性疾病血清学标志物的临床应用研究进展

在各种细菌感染中,脓毒症病情重进展快,早期诊断治疗具有重要意义。寻找快速、简洁、敏感性与特异性高的细菌性感染实验学指标已成为临床实验室长期以来研究的课题。近年来的研究发现了一些敏感性和特异性较高的感染相关生物学标志物,本文现将以下4种能早期诊断细菌性感染的血清学标志物在临床诊疗方面的研究和进展进行综述。     

股骨头缺血性坏死的影像学研究现状及进展

成人股骨头缺血性坏死是常见疾病,早期诊断和疗效评估是其重要的诊疗行为,多种影像学技术的应用为其诊疗提供了重要依据。本文对成人股骨头缺血性坏死不同影像学技术的相关文献进行综述,包括X射线,计算机断层扫描（CT）,核磁共振成像（MRI）技术。分析在股骨头缺血性坏死的诊断中不同影像学技术的优缺点、对临床诊疗的作用以及研究现状和进展。     

恶性梗阻性黄疸患者梗阻解除前后血清铜水平与血清IgG、IgA、IgM含量相关性

恶性梗阻性黄疸患者梗阻解除前后血清铜水平与血清ＩｇＧ、ＩｇＡ、ＩｇＭ含量相关性李金明张思森本研究对３０例恶性梗阻性黄疸患者梗阻解除手术前后血清铜水平及血清ＩｇＧ、ＩｇＡ、ＩｇＭ含量进行了测定，用火焰原子吸收法测定Ｃｕ（ｐｐｍ），用彩色单扩散测定球蛋白...     

经直肠超声弹性成像在前列腺癌中应用进展

早期前列腺癌预后较好,前列腺癌的早期诊断至关重要。超声弹性成像技术是应用于前列腺癌的筛查和诊断一种无创的新兴影像学检查技术。文章就弹性成像技术的基本原理、在前列腺癌诊断中的应用、在前列腺治疗中的应用和进展做一综述,展望弹性成像随着多模态成像技术的发展,在诊断鉴别前列腺良恶性病变、预测癌灶的病理分化程度、评估监测前列腺癌治疗中发挥诊治作用。     

超声显像在颈部良恶性淋巴结鉴别诊断中的应用进展

目的 总结超声显像对颈部良恶性淋巴结的诊断进展。方法 查阅近年来国内外关于超声诊断颈部良恶性淋巴结的相关文献,进行总结分析。结果 超声显像可以从颈部淋巴结的二维灰阶超声、彩色多普勒、超声弹性成像及超声造影等不同的检查方法对其良恶性进行鉴别,从而为临床治疗提供有价值的信息。结论 超声显像能够早期并较好的对颈部淋巴结良恶性进行鉴别诊断。超声引导下活检准确性将更高。     

术前胆道引流对恶性阻塞性黄疸患者免疫和炎症状况的影响

目的探讨术前胆道引流对恶性阻塞性黄疸患者免疫和炎症状况的影响。方法选择于我院就诊的31例恶性阻塞性黄疸患者作为研究对象,对患者进行术前胆道引流,比较引流前后患者的免疫和炎症状况。结果引流后患者的IL-6、IL-8、CRP、CD4+、CD8+与引流前比较,差异均无统计学意义(P0.05);引流后患者的TNF-α明显低于引流前,差异有统计学意义(P0.05)。结论术前胆道引流能够明显改善患者的TNF-α水平,TNF-α是恶性阻塞性黄疸患者免疫、炎症的敏感因子。     

早期慢性阻塞性肺疾病诊断与防治研究

慢性阻塞性肺疾病（COPD）是以持续气流受阻进行性发展为特征的一种可预防和治疗的疾病。COPD发病率、致残率较高,严重威胁人类健康安全。目前,早发现、早诊断、早治疗是我国COPD防治的重要手段。我国早期COPD病例数量大,不同患者症状存在明显差异性。研究早期COPD诊治情况,有望探索对患者进行个体化治疗的方法,进一步促进临床治疗策略的制定,提高慢性阻塞性肺疾的临床诊治研究水平。本文现就COPD早期的诊治研究进行综述,以期为临床诊治慢性阻塞性肺疾提供理论参考依据。     

富阳地区2008年～2012年新生儿听力筛查结果分析

目的分析富阳市2008～2012年间新生儿听力筛查情况，以便旱期诊断、治疗、干预。方法采用耳声发射仪（OAE）对新生儿进行初筛，未通过者42天进行复筛，复筛仍未通过者采用脑干听觉诱发电位（AABR）进行确诊。结果初筛率AK2008年的97．54％上升至2012年100．00％，通过率88．05％；未通过初筛者召回率为99．88％，通过率89．74％，复筛召回率平均99．88％，确诊听力障碍54例，发病率1．52‰。结论新生儿听力筛查是早期诊断新生儿听力障碍的可行性方法，提高筛查率、复筛率，做到早期诊断与治疗，减少残疾儿童的发生。     

Two cases of chronic pancreatitis with pseudocyst complicated by obstructive jaundice

We recently treated two cases of chronic pancreatitis with obstructive jaundice due to compression of the common bile duct by pancreatic pseudocyst. The two cases were males admitted with the complaint of icteric skin color. The first, a 46-year-old male, admitted with the complaint of icteric skin color. He was treated by operative cystojejunostomy after percutaneous drainage of the pseudocyst and percutaneous transhepatic biliary drainage. The other case was a 58 year-old male who admitted with the complaint of icteric skin color. He had an infected pseudocyst in the pancreas and was endoscopically treated. Both of them were discharged with favorable clinical course and normal laboratory findings after the treatment. The former patient remained well 11 months after treatment, but the latter patient died from necrotizing pancreatitis and septic shock 6 months after treatment. Most cases of obstructive jaundice associated with pseudocysts appear to be due to fibrotic stricture of the intrapancreatic portion of the common bile duct rather than due to compression of the bile duct by the pseudocyst. In a patient with secondary pancreatic infection or obstructive jaundice following pancreatic disease, differentiating between these two conditions is an important aspect of accurate diagnosis and therapy. Herein we report two unusual cases of chronic pancreatitis with pseudocyst complicated by obstructive jaundice.     

急性胆源性胰腺炎的临床治疗探讨

目的:探讨提高急性胆源性胰腺炎(acute biliary pancreatitis,ABP)疗效的治疗方法.方法:本组共48例ABP患者,其中胆道梗阻性11例、非梗阻性37例.对梗阻性ABP患者采取早期急诊手术治疗,手术方式为胆囊切除、胆总管切开取石、T管引流,胰腺包膜切开引流、胰腺坏死组织和感染灶清除;对非梗阻性ABP患者早期采取非手术治疗.结果:非梗阻性ABP 37例,其中34例经非手术治疗痊愈;3例出现体温升高、病情恶化者急诊手术,2例痊愈,1例死于多器官功能衰竭.11例梗阻性ABP行急诊手术治疗,发生并发症5例,均治愈.结论:急性胆源性胰腺炎的治疗应遵循个体化原则,对伴有胆道梗阻者早期宜行急诊手术,其它类型的急性胆源性胰腺炎早期宜非手术治疗.选择正确的治疗方法,把握恰当的手术时机,可提高治愈率,降低病死率.     

Cholestasis caused by a choledochal botryoid rhabdomyosarcoma in a 22-month-old boy

Botrioid rhabdomyosarcoma of the extrahepatic bile ducts is a rare cause of jaundice in children. It has a very poor prognosis and is rarely diagnosed preoperatively. We report a choledochal botrioid rhabdomyosarcoma in a 22-month-old boy who developed an obstructive jaundice. Radiographic explorations suggested cystic lymphangioma. The gallbladder, the cystic duct, the common bile duct and the pancreatic head were resected. The diagnosis was made on pathological examination; adjuvant chemotherapy followed. The patient was disease free 20 months following treatment.     

Myeloid sarcoma of the extrahepatic bile ducts presenting as obstructive jaundice

We report a rare case of myeloid sarcoma (MS) of the extrahepatic bile ducts presenting as obstructive jaundice in a patient without leukemia at time of diagnosis. A 75-year-old female presented with a one-month history of abdominal pain and jaundice. Computerized tomography scan of the abdomen showed stenosis of the extrahepatic bile ducts. Endoscopic retrograde cholangiography disclosed an irregular narrowing of the common biliary duct, suggestive of a cholangiocarcinoma, and resection was performed. Histologic examination showed diffuse transmural infiltration of malignant cells. These cells exhibited medium-sized round nuclei with central nucleoli and eosinophilic cytoplasm, and were strongly positive for myeloperoxidase, CD68, lysozyme, CD45, CD117 (c-kit protein) and CD43. Eight months following surgery the patient presented with multiple cutaneous nodules and bone marrow trephine biopsy showed acute myelomonocytic leukemia. A literature search identified two previously reported cases of MS of the extrahepatic biliary duct. MS should be taken into consideration in the differential diagnosis of a patient with obstructive jaundice. Immunohistochemistry is essential for a correct diagnosis.     

胆管神经内分泌癌的诊断和治疗

目的 提高对胆管神经内分泌肿瘤的认识。方法 报道国内首例肝总管神经内分泌癌合并肝脏转移，结合国内已经报道的8例未发生转移病例，总结该病的诊断和治疗。结果 男性3例，女性6例，8例以梗阻性黄疸起病，2例合并类癌综合征，梗阻部位胆总管下段2例，肝总管6例，胆总管中段1例，手术前均未能确诊；采取探查性手术，5例行根治性切除胆管空肠吻合术，2例行Whipple手术，1例行姑息切除＋肝动脉插管化疗，1例外引流，手术后病理确诊。结论 胆管神经内分泌癌是一种少见的胆道恶性肿瘤，梗阻性黄疸是常见的症状，NSE、Cg-A、SYP等免疫组化染色是诊断的要点；手术切除率高，根治性切除是治疗的首选，如果肿瘤转移，姑息性切除＋肝动脉化疗是比较好的选择。     

Echosonography and retrograde cholangiopancreatography in selecting surgical tactics in mechanical jaundice

The results of the diagnosis and treatment of 134 patients with obstructive jaundice are analyzed. The diagnostic potentialities of the ultrasonic method and endoscopic retrograde cholangiopancreatography (ERCPG) are compared. ERCPG has been found more effective for the diagnosis of the causes, localization, and severity of the bile duct obstruction in patients with mechanical jaundice. Endoscopic papillosphincterotomy is an effective treatment modality that helps eliminate or reduce the jaundice, remove the concrements from the duct, and reduce the scope of abdominal cavity surgery in cholelithiasis.