Reversibility of leukocyte dysfunction in rats with obstructive jaundice

BACKGROUND: The role of leukocytes in obstructive jaundice is obscure and the effect of relieving cholestasis on leukocyte function is unclear. We postulated that cholestasis affects systemic polymorphonuclear leukocyte function by deranging phagocytosis and hydrogen peroxide release and the leukocyte dysfunction is reversible by internal and external biliary drainage. MATERIALS AND METHODS: Sixty male Sprague Dawley rats were randomly assigned to four groups: obstructive jaundice (OJ), sham operation (SH), OJ with internal drainage (ID), and OJ with external drainage (ED). The phagocytic functions of neutrophils and monocytes in whole blood were measured with flow cytometry using fluorescent microspheres. Intracellular hydrogen peroxide production by leukocytes was assessed with flow cytometry using dihydrorhodamine-123 as probes. RESULTS: Leukocyte count and percentage of monocytes in rats with OJ was significantly increased compared with SH rats (P < 0.001). These elevations could be reversed by both ID and ED method (P < 0.001). The phagocytic function of neutrophils and monocytes was significantly depressed in OJ rats compared with that in SH rats (P < 0.001). After relief of the OJ, the suppressed phagocytic function of neutrophils and monocytes was completely improved in ID rats (ID versus OJ, P < 0.001), but only partially reversed in ED rats. The hydrogen peroxide production by monocytes and lymphocytes was significantly increased in OJ rats (P < 0.05). ID reversed the increased hydrogen peroxide generation (P < 0.05), but ED only partially did. CONCLUSIONS: In our rodent model of biliary obstruction, deranged phagocytosis, and hydrogen peroxide generation by leukocytes was found. Internal drainage is superior to external drainage for reversal of the distorted leukocyte function.     

胆道梗阻大鼠肝切除术后胆汁内引流和外引流对肝功能及肝再生的影响

目的:比较胆汁内引流和外引流对胆道梗阻大鼠肝切除术后肝功能及肝再生的影响。方法:将SD大鼠随机分为胆汁内引流组(ID组)、胆汁外引流组(ED组)、对照组,ID组和ED组均行胆总管结扎,对照组行假手术,各组均于术后72 h行部分(70%)肝切除,ID组和ED组同时分别行胆汁内引流与胆汁外引流。分别在肝切除术后0、1、2、3、7 d收集大鼠血清与残余肝组织,检测肝功能指标、肝组织有丝分裂细胞数以及增殖细胞核抗原(PCNA)的表达,并计算各组肝切除术后7 d残肝质量/体质量比值。结果:与对照组比较,ID组和ED组肝切除术后各时间点,血清总胆红素(TBIL)与谷草转氨酶(AST)均明显升高,而白蛋白(ALB)水平明显降低(均P0.05);ID组与ED组间比较,除TBIL水平无统计学差异外(均P0.05),其他两项指标ID组均优于ED组(均P0.05)。与对照组比较,ID组和ED组核分裂细胞数在肝切除术后大多数时间点均明显降低(均P0.05),但ID组核分裂细胞数多于ED组,在肝切除术后2、3 d差异有统计学意义(均P0.05)。肝切除术后,ID组和ED组肝组织PCNA表达量升高的速度与幅度均低于对照组(均P0.05),ID组升高的程度与衰退的速度大于ED组(均P0.05)。与对照组比较,ID组和ED组在肝切除术后7 d的残肝质量/体质量比值均降低(均P0.05),ID组的残肝质量/体重比值明显高于ED组(P0.05)。结论:胆道梗阻的大鼠部分肝切除术后,胆汁内引流可以改善术后肝功能,促进残余肝脏再生。     

胆总管一期缝合经胆囊管胆道置管外引流与T管引流的对比分析

目的对比分析胆总管一期缝合经胆囊管胆道置管外引流与T管引流的临床疗效。方法回顾性分析2013年2月至2016年9月丹阳市人民医院112例腹腔镜治疗胆囊结石合并胆总管结石患者的临床资料。根据手术方法不同,患者分为两组:腹腔镜胆总管切开一期缝合经胆囊管胆道置管外引流组(A组,59例),腹腔镜胆总管切开T管引流组(B组,53例)。比较两组患者的手术时间、术后引流量、术后住院时间、术后恢复正常生活时间、术后并发症等情况。结果两组患者均顺利完成手术。与T管引流组比,经胆囊管胆道置管外引流组术后恢复正常生活时间明显缩短[(7.25±1.27)d vs(46.47±3.86)d,P0.05],但手术时间[(133.75±14.51)min vs(132.21±12.71)min]、术后住院时间[(7.15±1.23)d vs(6.94±0.95)d],两组比较差异均无统计学意义(P0.05)。两组患者引流量前2 d对比差异无统计学意义(P0.05),2 d后经胆囊管胆道置管引流量较T管引流量明显减少(P0.05)。两组患者均随访2~29个月,平均10个月,B超检查无胆管狭窄,肝功能均正常。结论经胆囊管胆道置管外引流较T管引流简易、微创,并有利于胆汁排入十二指肠,值得临床推广。     

选择性胆道引流在肝门部胆管癌联合肝切除术中的临床价值

目的:探讨选择性胆道引流是否能够降低行联合肝切除的肝门部胆管癌患者术后的并发症以及病死率。方法:回顾山东大学齐鲁医院2007年1月—2012年1月116例血清总胆红素(TB)在85μmol/L以上行联合肝切除的肝门部胆管癌病人的临床资料,分析选择性胆道引流对肝功能以及术后并发症、病死率的影响。结果:直接手术组54例,引流组62例,平均引流9 d,引流组术前的TB下降为(214±115)μmol/L,与引流前的(290±100)μmol/L相比差异有统计学意义。选择性胆道引流可降低天冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、丙氨酸转氨酶(ALP)、总胆红素(TB)、直接胆红素(DB)水平。术后并发症总发生率为55.2%(64/116),引流组为58.1%(36/62),手术组为51.9%(28/54),2组之间差异无统计学意义,单个并发症总发生率2组之间差异亦无统计学意义。引流组死亡6例(9.7%),手术组死亡6例(11.1%),2组病死率比较差异无统计学意义(P=0.859)。结论:选择性胆道引流可以有效降低胆红素水平及改善肝门部胆管癌手术切除病人术前的肝功能,但不能降低术后并发症以及病死率。     

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.     

肝硬化病人胆道探查术后螺旋型鼻肠管的临床应用

目的: 探讨螺旋型鼻肠管在胆道探查术后回输胆汁的可行性及其对肝硬化病人术后康复的影响. 方法: 胆总管结石并梗阻性黄疸行胆总管切开探查病例中合并肝硬化61例,随机分为A、B两组,A组病人术前按常规留置螺旋型鼻肠管,术后经螺旋型鼻肠管将每日外引流的胆汁回输,B组病人术后嘱病人每日将外引流的胆汁分次口服.术后1 d、3 d、6 d、9 d和12 d分别抽取外周静脉血送实验室检测TBIL、DBIL、AST及ALT,并对病人的饮食恢复情况、术后精神状态评估等进行统计学处理. 结果: A组病人术后TBIL、DBIL、AST、ALT恢复正常的时间较B组病人明显缩短,差异有显著性(P<0.05),饮食恢复情况、术后精神状态评估等亦存在显著意义. 结论: 螺旋型鼻肠管在胆道探查术后胆汁回输中的应用是可行的,螺旋型鼻肠管对机体刺激性小(患者遵嘱率高),对病人术后各项康复指标均有明显促进作用.     

经T管窦道生物蛋白胶植入协助治疗拔T管后胆漏

目的 研究经腹腔镜胆总管切开取石T管引流术（LCTD）后,拔除T管出现胆漏的处理办法;在临床常规方法的基础上,探讨生物蛋白胶封堵T管窦道漏口的可行性。方法 研究对象为LCTD术后,拔除T管出现胆漏的患者36例,按照随机分组原则分为2组。对照组18例,拔除T管出现胆漏后,行禁食水、胃肠减压、抑酸、抑酶、抗感染治疗,同时经胆道镜T管窦道尿管置入或经十二指肠镜鼻胆管引流;研究组18例,拔除T管出现胆漏后,除禁食水、胃肠减压、抑酸、抑酶、抗感染治疗、经胆道镜T管窦道尿管置入或经十二指肠镜鼻胆管引流外,经胆道镜从T管窦道置入生物蛋白胶堵漏,封闭窦道撕裂或未完全愈合处。统计、对比两组患者的病情恢复情况。结果 对照组单纯使用T管窦道尿管置入或鼻胆管引流,腹膜炎体征恢复慢,治疗时间长,费用高,其中2例患者行二次手术;研究组在使用T管窦道尿管置入或鼻胆管引流的基础上,加用生物蛋白胶封堵窦道漏口,腹膜炎体征恢复快,治疗时间短,费用低,无二次手术患者。两组比较,各指标差异有统计学意义（P＜0.05）。结论 对于拔除T管后出现胆漏的患者,除禁食水、胃肠减压、抑酸、抑酶、抗感染、再次T管窦道置入尿管引流或鼻胆管引流外,联合胆道镜植入生物蛋白胶堵漏治疗拔T管后胆漏,较单纯使用尿管引流或鼻胆管引流效果更好,恢复快,费用低,值得推广。     

肝门部胆管癌根治术前经内镜鼻胆管引流和经皮经肝胆管造影引流术的临床效果观察

目的对比经内镜鼻胆管引流术(endoscopic nasobiliary drainage,ENBD)和经皮经肝胆管造影引流术(percutaneous transhepatic cholangiography and drainage,PTCD)作为术前减黄对肝门部胆管癌根治术的不同效果。方法回顾性分析2008年1月至2016年8月,首都医科大学附属北京佑安医院普通外科中心20例行ENBD并完成肝门部胆管癌根治术病人的临床资料,与同期31例行PTCD并完成肝门部胆管根治术病人的临床资料进行比较。比较两组以下指标的差异:病人减黄时间,减黄前及术前、术后肝功能指标(血总胆红素、血直接胆红素、天冬氨酸转氨酶、丙氨酸转氨酶、白蛋白水平),术中情况(手术时间、出血量、输血量),术后并发症。结果 ENBD组与PTCD组均能够显著降低胆红素水平(P0.05);PTCD组除了能够降低胆红素水平外,肝功能酶学水平也显著降低(P0.05);ENBD组肝功能酶学减黄前后差异无统计学意义(P0.05);术中两组手术时间、术中出血量及术后血总胆红素、血直接胆红素、天冬氨酸转氨酶、丙氨酸转氨酶、术后住院时间、住院总费用比较,差异均无统计学意义(均P0.05);PTCD组与ENBD组围手术期并发症发生率比较差异无统计学意义(74.2%比60.0%,P0.05),其中PTCD组术后胆管炎发生率更高(48.4%比20.0%),差异有统计学意义(P=0.036)。结论 ENBD和PTCD均能够有效降低术前胆红素水平,PTCD引流更充分,减黄时间更短,肝功能恢复效果更好,ENBD术后胆管炎并发症更低;肝门部胆管癌术前应结合病人的具体情况选择合适引流方式,从而增加手术安全性,减少术后并发症发生率。     

内镜下胆汁内引流术治疗胰头癌胆道梗阻的临床研究

目的 评价内镜下胆汁内引流术(ERBD)治疗胰头癌胆道梗阻的临床疗效.方法 46例胰头癌胆道梗阻患者进行ERBD治疗(塑料支架或金属支架).结果 46例患者置入支架39例成功.术后患者血清总胆红素(104.67±15.49)μmol/L较术前(371.37±49.23)μmol/L明显降低(P<0.01),肝功能改善[...     

腹腔镜胆总管切开取石T管引流术210例报告

目的 探讨腹腔镜治疗肝内外胆管结石效果。方法 在腹腔镜下切开胆总管用纤维胆道镜取石,胆总管内置入T管,缝合胆总管切口。结果 210例腹腔镜手术全部成功,手术时间80～230min。术后腹腔引流管引流出胆汁6例,十二指肠损伤1例,腹腔残石致引流管口形成脓肿1例,胆道残石10例,术后经T管窦道纤维胆道镜取石后治愈,从T管引流出钛夹2例。术后第2天进流质饮食并下床活动,平均住院5天,带T管出院。结论 该手术扩大了腹腔镜胆囊切除术适应证,具有创伤小、恢复快、住院短等优点,是治疗胆囊结石并胆总管结石尤其是胆总管大结石的有效方法。     

Lack of intestinal bile results in delayed liver regeneration of normal rat liver after hepatectomy accompanied by impaired cyclin E-associated kinase activity

BACKGROUND: The importance of bile in liver regeneration after hepatectomy is unknown, although we have recently shown that preoperative internal biliary drainage is superior to external biliary drainage for liver regeneration in obstructive jaundiced rats. This study examined the hypothesis that the presence or absence of bile in the intestinal tract modulates cyclins and cyclin-dependent kinases after hepatectomy in rats. METHODS: In male Wistar rats, bile was drained externally (ED group) or into the duodenum (ID group) for 7 days before 70% hepatectomy. Relative liver weight, DNA synthesis rate, and proliferating cell nuclear antigen labeling index were determined at the time of hepatectomy (day 0) and on days 1, 3, and 7 after hepatectomy. Posthepatectomy expressions of cyclin D1 and E and of cyclin D1- and E-associated kinases were serially analyzed. Hepatic function tests were performed. RESULTS: No significant difference in liver function was found between the 2 groups at hepatectomy except for the lower albumin level in the ED group. The relative liver weight was lower in the ED group than in the ID group on day 3 after hepatectomy (ED, 2.58% +/- 0.06%; ID, 2.84% +/- 0.08%; P <.05). Both the DNA synthesis rate and proliferating cell nuclear antigen labeling index in the ED group (77 +/- 36 disintegrations per minute/microg DNA and 8.3% +/- 1.9%, respectively) were lower than those in the ID group (262 +/- 50 disintegrations per minute/microg DNA and 21.6% +/- 5.6%, respectively) on day 1 after hepatectomy (P <.05, respectively). Cyclin D1-associated kinase activity and cyclin D1 expression were not significantly different between the 2 groups. Cyclin E-associated kinase activity was lower in the ED group than in the ID group at 18 hours after hepatectomy (ED, 84% +/- 17%; ID, 146% +/- 28% of the value at 0 hour in the ID group; P <.05), although expressions of cyclin E and p27 binding to cyclin E were not significantly different between the 2 groups. CONCLUSIONS: These results suggest that the absence of bile in the intestine delays liver regeneration associated with cyclin E-associated kinase inactivation after hepatectomy.     

低位胆管恶性梗阻的经皮肝穿刺胆管引流方式探讨

目的探讨经皮肝穿刺胆管引流方式在减少低位胆管恶性梗阻患者术后胆管感染中的作用。方法 56例接受经皮肝穿刺胆管引流术的低位胆管恶性梗阻患者纳入本研究,所有患者均无肠梗阻及肠道手术史,将其随机分为试验组(n=31)和对照组(n=25)。先行外引流术(BED),再行内外引流术(BIED),试验组术后即关闭外引流,仅作单纯内引流;对照组内外引流同时开放。检测BED术前、BED术后、BIED术后30天内的血白细胞计数,并进行统计学分析。结果两组患者均成功完成引流。试验组、对照组BED术后的血白细胞计数分别为(6.75±1.06)×109/L和(6.98±1.04)×109/L,无统计学差异(t=0.83,P>0.05);而BIED术后试验组血白细胞计数[(7.23±2.19)×109/L]低于对照组[(10.74±5.21)×109/L,t=3.16,P<0.05]。结论对于低位胆管恶性梗阻,在单纯外引流的基础上择期置入内外引流管,术毕即关闭外口,仅作单纯内引流,可明显减少术后胆管感染的发生率。     

ERBD+LCBDE与ENBD+ERCP/EST在胆总管结石合并中重度急性胆管炎中的近期疗效对比

目的 比较内镜下胆道支架引流(ERBD)+腹腔镜下胆总管探查(LCBDE)与内镜下鼻胆管引流(ENBD)+经内镜逆行胰胆管造影(ERCP)/内镜下乳头括约肌切开(EST)治疗在胆总管结石合并中重度急性胆管炎中的应用效果,探索理想的治疗组合方式。方法 回顾性分析华东师范大学附属芜湖医院2020年1月至2021年6月收治的44例胆总管结石合并中重度急性胆管炎患者的临床资料。其中19例经ERBD引流后二期行LCBDE,作为研究组(n=19);25例经ENBD引流后二期行ERCP/EST取石治疗,作为对照组(n=25)。比较两种治疗方案的近期疗效差异。结果 两组患者一般资料比较差异无统计学意义(P>0.05)。胆道引流前后,两组肝功能(TBIL、ALT、γ-GTP、ALP)及感染性指标(WBC、CRP、PCT),组间比较均无统计学差异(P>0.05);组内比较,引流后两组肝功能和感染性指标均较引流前明显下降,差异具有统计学意义(P<0.05)。两组住院总时间、住院总费用、取石成功率均无统计学差异(P>0.05)。研究组一次性结石取净率高于对照组[94.74%(18/19...     

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.     

<Emphasis Type="Bold">Obstructive Jaundice in Rats: Cause of Spatial Memory Deficits with Recovery after Biliary Decompression</Emphasis>

Children with end-stage liver disease have been found to have cognitive deficits. The aim of this study was to examine whether cholestatic jaundice causes spatial deficits in rats and if these cognitive deficits are reversed by biliary drainage. Rats were randomly divided into three groups. In the first group, the bile duct was ligated for 3 weeks (BDL group); in the second group, the proximal bile duct was ligated with a Broviac CV catheter for 2 weeks followed by a tube bilioduodenostomy (TBD group); in the third group, a sham operation was performed (SHAM group). All the surviving rats were assessed for spatial learning and memory (a major cognitive function in rats) by the Morris water maze task about 3 weeks after the first operation. Blood was aspirated by cardiocentesis and assayed for total bilirubin, albumin, ammonia, and hemoglobin levels on the day following the water maze task. During the four consecutive acquisition trial days of the Morris water maze, jaundiced rats (BDL group) had a significant longer latency to escape than the SHAM group (p < 0.05). Rats that underwent biliary decompression for 1 week (TBD group) showed improved status of the spatial deficit, as they required less time to reach the escape platform, approaching the performance of the SHAM group. The BDL group had a significantly higher serum ammonia level, higher bilirubin level, and lower hemoglobin level than the other two groups. After biliary decompression for 1 week, the serum albumin concentration in the TBD group still did not return to the level of the SHAM group. The results of this study suggest that long-term cholestasis results in spatial memory deficits in rats that correlate with anemia and hyperbilirubinemia encephalopathy. Early biliary decompression of obstructive jaundice improves spatial memory deficits, possibly related to the recovery of the serum ammonia and hemoglobin levels.     

Impact of internal biliary drainage after pancreaticoduodenectomy

Background  Bile acid has an important role in protecting immune systems related to gut-associated lymphoid tissue. This study was designed to evaluate the effects of internal biliary drainage after a pancreaticoduodenectomy (PD) on postoperative nutrition and complications in a randomized study. Methods  The authors compared the morbidity, mortality, and postoperative nutritional status of 46 patients who had a hepaticojejunostomy (HJ) with a stented external biliary drainage (group E) or with a non-stented internal biliary drainage (group I) after a PD. Results  Systemic infection was recognized in four patients in group E, while no patients in group I. Transthyretin at postoperative 28 days in group I was 15.6 ± 6.2, higher than that in group E. Retinol-binding protein at postoperative 28 days in group I was 2.6 ± 1.0 and also higher than that in group E. Conclusion  HJ with no-stented internal biliary drainage was not associated with systemic infections and mortality, but showed the possibility of improving nutritional status.     

胆汁酸在梗阻性黄疸小鼠肝部分切除术后肝再生中作用的研究

目的：探讨胆汁酸（CA）在梗阻性黄疸（OJ）小鼠肝部分切除术后肝再生中的作用及机制。 方法：180只健康雄性小鼠随机均分为6组,分别行假手术（对照组）、胆总管结扎（OJ组）、胆总管结扎并于7 d加行外引流（ED组）、胆总管结扎+0.2%CA灌胃并7 d后加行外引流（ED+0.2%CA组）、胆总管结扎+1%CA灌胃并于7 d后加行外引流（ED+1%CA组）、胆总管结扎并于7 d后加行内引流（ID组）,各组分别于实验第14天行70%肝切除,且各外引流组改行内引流。检测各组肝切除术后不同时间点肝再生率与肝组织增殖细胞核抗原Ki-67表达、叉状头盒M1b基因（Foxm1b）mRNA相对表达、成纤维细胞生长因子受体4（FGFR4）蛋白表达,并观察部分组肝细胞原位凋亡情况。 结果：除对照组外,肝再生率、肝组织Ki-67阳性表达率、Foxm1b mRNA及FGFR4蛋白表达在其余各组均由高到低依次为：ID组>ED+0.2%CA组>ED组>OJ组>ED+1%CA组,组间差异均有统计学意义（均P<0.05）;ID组与对照组间各指标差异均无统计学意义（均P>0.05）;肝细胞凋亡率由高到低依次为：ED+1%C组>ED组>ED+0.2%CA组>对照组,组间差异均有统计学意义（均P<0.05）。 结论：内引流通过减少内源性CA的丢失有利于肝切除后肝再生;外源性低浓度CA可以恢复外引流引起的肝再生障碍,可能与其上调Foxm1b与FGFR4的表达从而促进肝再生有关。     

Preoperative biliary drainage for hilar cholangiocarcinoma

Hilar cholangiocarcinomas grow slowly, and metastases occur late in the natural history. Surgical cure and long-term survival have been demonstrated, when resection margins are clear. Preoperative biliary drainage has been proposed as a way to improve liver function before surgery, and to reduce post-surgical complications. Percutaneous transhepatic biliary drainage (PTBD) with multiple drains was previously the preferred method for the preoperative relief of obstructive jaundice. However, the introduction of percutaneous transhepatic portal vein embolization (PTPE) and wider resection has changed preoperative drainage strategies. Drainage is currently performed only for liver lobes that will remain after resection, and for areas of segmental cholangitis. Endoscopic biliary drainage (EBD) is less invasive than PTBD. Among EBD techniques, endoscopic nasobiliary drainage (ENBD) is preferable to endoscopic biliary stenting (EBS), because secondary cholangitis (due to the retrograde flow of duodenal fluid into the biliary tree) does not occur. ENBD needs to be converted to PTBD in patients with segmental cholangitis, those with a prolonged need for drainage, or when the extent of longitudinal tumor extension is not sufficiently well characterized.     

术中放置鼻胆管在胆总管切开取石探查后一期缝合的研究

目的探讨术中放置鼻胆管在胆总管切开取石探查后一期缝合术与传统胆总管探查T管引流术疗效的对比。方法对我院2005年6月至2007年3月126例胆石症患者行手术治疗进行回顾性分析,其中65例术中采用T管引流（T管组）,61例采用鼻胆管引流（鼻胆管组）,两组术后均经胆道造影证实通畅。结果鼻胆管组与T管组比较,后者术后拔管及胆汁引流时间明显缩短,（P〈0.05）;术后住院天数明显缩短（P〈0.05）;术后与引流相关的并发症发生率低（P〈0.05）。结论胆道外科术后采用鼻胆管引流能够缩短患者住院时间,可避免胆汁大量丢失,并发症少,避免了长期带T管的痛苦,是一种较为理想的引流方式。     

胆胰恶性肿瘤放疗前胆道引流的方式

目的:选择合理、有效的胆道引流方式,辅助胆胰恶性肿瘤的放射治疗,以延长中晚期病人的生存期,减轻其痛苦。方法:对852例胆胰恶性肿瘤伴阻塞性黄疸病人,分别经内镜放置胆道塑料、金属支架引流,鼻胆管持续负压引流,或经超声介入经皮肝穿刺肝内胆管置管引流,48h后,实施CT定位下γ-刀治疗。结果:胆胰恶性肿瘤放疗加胆道引流,优良率89.1%。鼻胆管组和经皮肝穿组疗效优于塑料支架组和金属支架组(P0.05)。结论:病人"黄疸"越深,年龄越大,引流意义越大;病情越重,引流越早越好。放疗前的介入引流,以简便、微创、安全、尽快缓解病情、减轻病人痛苦为治疗原则。