胆囊癌组织中NDPK／nm23的表达及意义

作者用免疫组化ＡＢＣ法对４１例胆囊癌标本核苷二磷酸激酶（ＮＤＰＫ，下同）／ｎｍ２３表达进行了测定，结果发现：ｎｍ２３在恶性肿瘤中的表达率明显高于良性病变（Ｐ＜０．０５）。ＮＤＰＫ／ｎｍ２３表达与胆囊癌组织的分化、局部浸润及淋巴转移密切相关（Ｐ＜０．０１）。ＮＤＰＫ／ｎｍ２３阳性患者生存中位数１２．２５个月，阴性患者６．５个月，两者存在显著差异（Ｐ＜０．０１），提示ｎｍ２３检测对预后有重要价值。     

腹腔镜胆囊切除术中处理胆囊颈管结石的体会

目的 :探讨腹腔镜胆囊切除术 (LC)中处理胆囊颈及胆囊管结石的方法。方法 :回顾分析 2 0 0 0年 4月至 2 0 0 4年 6月 2 9例胆囊颈部结石及胆囊管结石患者行LC时 ,采用胆囊管纵行切开取石 ,圈套器结扎 ,多钛夹阶梯施夹 ,胆囊管残端丝线结扎或缝扎等方法处理胆囊颈、管结石。结果 :2 9例用上述方法治疗均获成功 ,3例置腹腔引流管引流 ,分别于术后第 2、3天拔管 ,均痊愈出院。结论 :在LC术中只要合理处理胆囊颈、胆囊管结石 ,不会出现胆漏、胆管损伤等严重并发症。     

Diagnosis of gallbladder perforation in acute acalculous cholecystitis in critically ill patients

In the presence of ascites ultrasound is not appropriate to distinguish between gallbladder perforation and acute acalculous cholecystitis. However, the correct and early diagnosis of gallbladder perforation is important for the treatment and prognosis. We report 4 critically ill patients with ascites. All patients had evidence of gallbladder perforation by ultrasound and underwent cholecystectomy: 2 patients had gallbladder perforation, but 2 had acalculous cholecystitis without perforation. markedly elevated serum alkaline phosphatase was the only discriminating finding indicating gallbladder perforation.     

胆汁胆固醇对胆囊收缩素受体表达的影响

目的：探讨胆汁胆固醇对胆囊收缩素受体（CCK－R）表达的影响。方法 采用放射免疫分析法和受体放射配基结合法检测对照组、高胆固醇组、自然恢复组及治疗组豚鼠门静脉血CCK水平、胆囊CCK－R的最大结合容量（Bmax）和亲和力（Kd），同时观察空腹胆囊体积（FV）、胆囊胆汁量（FB）和餐后胆囊体积（RV）、胆囊胆汁量（RB）及胆囊收缩率（E％）、胆汁胆固醇浓度的变化。结果 与对照组比较，高胆固醇组豚鼠FV、FB增大（P＜0.05），RV、RB也增大，胆囊收缩率下降（P＜0.01），胆汁胆固醇浓度升高（P＜0.05），门静脉血CCK水平及CCK－R的Kd无改变，而CCK－R的Bmax下降（P＜0.01）；治疗组上述各项指标正常。结论 胆汁中的高胆固醇通过下调胆囊CCK－R表达而导致胆囊收缩功能障碍，降低胆汁高胆固醇浓度可以促进胆囊动力功能的恢复。     

Abdominal ultrasonography in the diagnostic work-up in children with recurrent abdominal pain

We report on our experience with routine abdominal ultrasonography in 120 children (aged 3–15 years) with recurrent abdominal pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities: gallbladder stone (n = 2), splenomegaly (n = 1) and urogenital abnormalities (n = 5). The recurrent abdominal pain could be explained by these findings in only two (may be three) cases. Conclusion The diagnostic value of abdominal ultra‐sonography in unselected children with recurrent abdominal pain is low. However, the direct visualization of the abdominal structures as being normal may be helpful to the parents and the child in their understanding and acceptance of the benign nature of recurrent abdominal pain. Received: 19 March 1996 / Accepted: 29 January 1997     

Dynamic MRI of the gallbladder lesions: Differentiation of benign from malignant

Forty-nine pathologically proven gallbladder lesions were evaluated in 45 patients using dynamic MRI with a spoiled gradient pulse sequence (SPGR), to access the ability of this technique to differentiate benign from malignant gallbladder lesions. The studies were reviewed retrospectively. Signal intensity of the lesions were measured. Twenty-one malignant and 28 benign lesions were classified into three categories: polypoid, diffuse wall thickening, and exophytic. Early and delayed enhancement patterns were evaluated. For the polypoid masses, malignant lesions (n = 9) demonstrated early and prolonged enhancements, whereas benign lesions (n = 14) had early enhancement with subsequent washout (P < .05). For diffuse gallbladder wall thickening, malignant lesions (n = 6) demonstrated early and prolonged enhancement and benign lesions (n = 14) showed relatively slow, prolonged enhancement (P < .05). The exophytic masses (n = 6) all were malignant and demonstrated early and prolonged enhancement. Dynamic MRI can help differentiate benign from malignant gallbladder lesions.     

胆囊结石及癌变过程中肿瘤坏死因子可溶性受体的变化

目的　探讨可容性肿瘤坏死因子受体 (sTNFR)在胆囊结石及癌变过程中的变化。方法　用双抗体夹心酶联免疫法对 5 3例胆囊结石 ,9例胆囊癌及 11例正常对照者血清及胆法中的sTNFR水平进行检测。结果　血清及胆汁中sTNFR水平胆囊癌组为 (2 .63± 0 .5 6) μg/L、(10 .0 2± 3 .2 3 ) μg/L较胆石症组 (1.2 5± 0 .3 6) μg/L、(2 .81± 0 .93 ) μg/L及对照组 (0 .95± 0 .19)μg/L、(1.83± 0 .5 4) μg/L均显著升高 (P <0 .0 1)。胆囊黏膜从典型增生、非典型增生到胆囊癌的发展过程中sTNFR在血清 (1.11± 0 .2 8、1.5 3± 0 .3 2、2 .63± 0 .5 6)及胆汁中 (2 .5 0± 0 .81、3 .42±0 .87、10 .0 2± 3 .2 3 )逐级增高 (各组间P <0 .0 5 )。胆汁中sTNFR水平在胆囊癌Ⅰ～Ⅲ期 (8.3 6±2 .60 )与Ⅳ～Ⅴ期 (13 .3 3± 4.46)间差异有显著性 (P <0 .0 0 1) ,肿瘤直径≥ 2cm组 (12 .10± 2 .3 2 )与 <2cm组 (7.42± 2 .10 )间差异有显著性 (P <0 .0 5 )。胆汁中TNFR水平明显高于其对应的血清水平 ,两者之间呈正直线相关 (r =0 .875 ,P <0 .0 0 1)。胆囊癌术后血清sTNFR水平显著下降。结论　sTNFR参与胆囊结石致癌的过程 ,与胆囊癌的临床生物学特点密切相关。     

原发性胆囊癌CD44v6和bcl-2的表达及其与临床病理的关系

目的　探讨CD44v6和bcl 2蛋白在原发性胆囊癌组织中的表达及其与癌组织类型、病理分级和转移状况的关系 ,以及CD44v6表达与bcl 2表达的相关性。方法　应用免疫组织化学方法检测 50例原发性胆囊癌、2 0例胆囊腺瘤和 1 0例慢性胆囊炎组织中CD44v6和bcl 2蛋白的表达。结果　胆囊癌组织中CD44v6和bcl 2表达阳性率分别为82 .0 %和 60 .0 % ,均明显高于胆囊腺瘤 (分别为 45 .0 %和 30 .0 % ,P<0 .0 5) ,并随着胆囊癌细胞分化程度的减低、病理分级的增高和转移而明显增高 (P<0 .0 5)。同时 ,CD44v6的表达与bcl 2表达呈正相关 (r =0 .36 ,P<0 .0 5)。结论　CD44v6和bcl 2均是胆囊癌高度恶性和预后不良的重要指标。胆囊癌CD44v6表达与bcl 2蛋白表达可能具有相互协同作用。     

经肝动脉介入治疗并发胆囊坏死(2例报告并文献复习)

目的 :探讨经肝动脉介入治疗并发胆囊坏死的发生原因和防治措施。方法 :报告 2例经肝动脉介入治疗并发胆囊坏死的病例 ,均经手术病理证实。并结合文献资料分析这一并发症发生的机率、原因 ,以及为了减少并发症的发生需要注意的一些问题。结果 :近 8年来我院共做经肝动脉介入治疗 6 80例次 ,并发胆囊坏死 2例 (0 3% )。其发生原因是多方面的。超选择插管不到位是该并发症发生的主要原因。结论 :胆囊坏死是经肝动脉介入治疗比较常见的严重并发症之一 ,在今后工作中应引起足够的重视 ,尤其对肝血管瘤的介入治疗更应慎重 ,使这一并发症的发生率降至最低限度。