EST+胆胰管引流治疗急性胆源性胰腺炎

目的 探讨内镜下乳头奥迪氏扩约肌切开(endoscopic sphincterotomy,EST) 胆胰管引流技术在急性胆源性胰腺炎(acute biliary pancreatitis,ABP)诊治中的应用价值.方法 将入选的315例ABP患者随机分为EST治疗组(n=132)和非EST对照组(n=183),并根据APACHEⅡ评分,将每组再进一步分为重症组和轻症组.两组患者均给予中西医结合治疗.EST治疗组在入院后24 h内行ERCP(endoscopic retrograde cholangiopancreatography) EST,如发现胆管或胆胰共同通道有结石,则行网篮气囊取石或碎石器碎石取石,如结石多、结石直径大,结石难以一次取尽则急诊不强行取石术.如ERCP证实胰管狭窄或胰管有结石,则行胰管支架植入或鼻胰管引流.所有患者EST术后均行鼻胆管引流术(endoscopic naso-billiary drainage ENBD).结果 对重症ABP,EST治疗组的并发症发生率、转开腹手术率、住院天数及住院费用均明显低于非EST对照组(X12=7.12,X22=5.64,t1=2.57,t2=2.28,P＜0.05);而两组轻症之间无显著差异.结论 早期应用EST技术治疗ABP是可行的、有效的和安全的.     

不同临床和病理分型对肝门部胆管癌切除术预后的影响

目的 研究临床和病理分型与肝门部胆管癌切除术疗效的关系。方法总结1993年至2004年在解放军总医院肝胆外科手术切除的肝门部胆管癌198例病例资料。结果临床分型Ⅰ型34例，Ⅱ型60例，Ⅲa型27例，Ⅲb型33例，Ⅳ型19例，Ⅴa型6例。Ⅴb型19例。病理高分化腺癌35例，中分化腺癌52例，低分化腺癌54例，三者的中位生存期分别为29．5、11、5．5个月；病理切缘阴性者与切缘阳性者生存率有显著性差异（P 〈0．05）。手术并发症出现率41．4％，围手术期死亡1例。结论肝门部胆管癌根据临床分型进行相应的手术治疗；病理切缘阴性是影响预后的主要因素之一；围手术期正确处理，是减少手术并发症，提高患者生活质量和延长生存期的关键。     

原发性肝癌破裂出血的临床分析(附76例报告)

目的探讨原发性肝癌破裂出血的诊疗。方法回顾性分析1990-2004年我院76例资料完整的原发性肝癌破裂出血患者的诊断和治疗。结果76例患者均有急性上腹部疼痛和急性腹膜炎表现，影像学检查和腹腔穿刺均阳性。76例中非手术治疗34例，占44．7％，12例死亡（占非手术治疗的35．3％）；手术治疗42例，占54．3％。6例死亡（占手术治疗的14．3％）。结论病史、影像学检查和腹腔穿刺在原发性肝癌破裂出血的诊断中起重要作用。治疗根据患者的具体情况而采取保守治疗或缝扎止血、手术肝切除、肝动脉结扎等手术治疗方法。     

支气管肺癌伴其它部位多原发癌的影像诊断(附25例报告)

经病理确诊的527例原发性支气管肺癌(PBC)(1972～1987)中,PBC伴其它部位多原发癌(MPC)25例(4.7％)。其中双原发肺癌(DPBC)、12例(2.3％),PBC伴消化道癌6例(1.14％)。25例中共有原发癌灶52个,其中2例为3原发癌;同期组6例(其中DPBC 4例),后期组19例(其中14例间隔3年以上,内2例分别间隔14年及25年)。组织类型相同者8例,不同者4例。 25例MPC特点如下:1.55岁以上20例(80％);2.24例(96％)第2原发癌为1980年后发现;3.第2原发癌为肺癌者23例(92％);4.双原发肺癌12例(48％)。上述特点说明80年代老年人中MPC,尤其是肺癌发病率增高。 本文着重对第2原发肺癌的影像学表现和鉴别诊断进行讨论。     

99Tcm-EHIDA肝胆动态显像判断肝硬化患者胆囊运动功能

目的研究^99Tc^m-二乙基乙酰苯胺亚氨二醋酸（EHIDA）肝胆动态显像在判断肝硬化患者胆囊运动功能中的作用.方法研究对象分为正常对照组和肝硬化组,其中肝硬化组分为胆石组和非胆石组.受试者均行^99Tc^m-EHIDA肝胆动态显像.获得图像后应用胆囊感兴趣区（ROI）技术,由计算机自动绘制胆囊时间-放射性曲线,并计算潜伏期（LP）、排胆期（EP）、排胆分数（GBEF）和排胆率（ER）.结果肝硬化组患者GBEF和ER明显低于正常对照组（t值均为2.767,P均＜0.01）,但其LP高于正常对照组（Z=-1.989,P＜0.05）.肝硬化胆石组胆囊运动异常率（x^2=4.538,P=0.033）、胆囊壁厚度（t=-2.386,P=0.02）和血清总胆汁酸（t=-2.442,P=0.018）明显高于非胆石组.结论肝硬化患者胆囊运动功能减弱.^99Tc^m-EHIDA肝胆动态显像可作为检查胆囊运动功能的一种无创、准确的方法.     

Primary malignant melanoma: a rare cause of mediastinal mass

A case of primary malignant melanoma in the mediastinum presenting as recurrent laryngeal nerve palsy is reported. Tissue biopsy at mediastinotomy yielded a diagnosis of malignant melanoma. The mass was fixed to the left aspect of the trachea and to the upper border of the left main bronchus and could not be removed surgically. Further extensive clinical and radiological investigations revealed no evidence of tumor elsewhere in the body.     

福建省原发性肝癌遗传因素分析

为了探讨遗传因素与福建省原发性肝癌的关系,应用多种对照配对的病例对照研究方法,对100个原发性肝癌和200个对照家系进行了遗传流行病学分析。结果显示,原发性肝癌先证者一、二级亲属患病率明显高于对照组患病率,分离比为0.04146～0.08654,遗传度加权均值为63.52±4.22％。提示原发性肝癌系多基因遗传病,遗传易感性是原发性肝癌的危险因素之一,原发性肝癌的发生是遗传和环境多种因素共同作用的结果。     

Spontaneous gallbladder perforation—An unusual presentation of carcinoma of the pancreas

A 50 year old man with a two month history of upper abdominal pain and a one month history of anorexia and weight loss, presented with icterus and evidence of peritonitis. Laparotomy revealed biliary peritonitis which had been caused by a rupture of the fundus of the gallbladder. The common bile duct was dilated and there was a large growth in the head of the pancreas with multiple hepatic metastases. A cholecysto-jejunostomy and gastrojejunostomy were done and the patient had an uneventful recovery.     

血清Ⅲ型原胶原含量与肝纤维化的关系（附102例肝活检分析）

为进一步研究血清Ⅲ型原胶原（ＰＣⅢ）含量与肝纤维化的关系，对肝炎患者血清ＰＣⅢ含量与肝炎组织学变化进行对比分析．方法：用ＲＩＡ法测定６１６例急、慢性肝炎及肝硬化患者的血清ＰＣⅢ含量，其中１０２例同时做肝活检，按照Ｋｎｏｄｅｌｌ肝组织炎症活动性指数标准记分．结果：急、慢性肝炎及肝硬化患者血清ＰＣⅢ含量明显高于正常人，差异有显著性（Ｐ＜ｏ．０５～０．０１）．其升高的血清ＰＣⅢ含量与肝细胞坏死范围及门管区炎症程度无相关性（ｒ＝０．４９４，Ｐ＞０．０５），而与肝纤维化程度呈正相关（ｒ＝０．６６８，Ｐ＜０．０１）．结论：血清ＰＣⅢ测定是判断慢性肝炎及肝硬化时肝纤维化程度的有用指标．     

A novel cognition enhancer NS-105 modulates adenylate cyclase activity through metabotropic glutamate receptors in primary neuronal culture

The effect of (+)-5-oxo-D-prolinepiperidinamide monohydrate (NS-105), a novel cognition enhancer, on adenylate cyclase activity was investigated in cultured neurons of the mouse cerebral cortex. NS-105 (10^–7 and 10^–6 M) inhibited forskolin-stimulated cyclic AMP formation, an action that was dependent on pertussis toxin-sensitive G proteins. Conversely, in pertussis toxin-pretreated neurons, NS-105 (10^–7 –10^–5 M) significantly enhanced the forskolin-stimulated cyclic AMP formation, and this action was completely reversed by cholera toxin. A metabotropic glutamate receptor agonist (1S, 3R)-1-aminocyclopentane-1, 3-dicarboxylic acid (1S, 3R-ACPD) produced similar bi-directional actions on the cyclic AMP formation. Both of these inhibitory and facilitatory actions of NS-105 and 1S, 3R-ACPD were blocked by L(+)-2-amino-3-phosphopropinoic acid (L-AP3). NS-105 (10^–6 M) and 1S, 3R-ACPD (10^–4 M) significantly enhanced isoproterenol- and adenosine-stimulated cyclic AMP formation. The enhancement of such Gs-coupled receptor agonists-stimulated cyclic AMP formation was also produced by quisqualate but not by L(+)-2-amino-4-phosphonobutanoate (L-AP4). The phosphoinositides hydrolysis was enhanced by 1S, 3R-ACPD (10^–4 M) but not by NS-105 (10^–6 M), however, 1S, 3R-ACPD-induced increase in phosphoinositides turnover was attenuated by NS-105. These findings suggest that NS-105 stimulates metabotropic glutamate receptor subclasses that are coupled both negatively and positively to adenylate cyclase, but it acts as an antagonist at the receptor subclasses that are linked to phosphoinositides hydrolysis. Received: 3 February 1997 / Accepted: 25 April 1997