lactulose和glutamine对梗阻性黄疸大鼠空肠黏膜的影响

目的:研究梗阻性黄疸时空肠黏膜的变化及lactulose和glutamine对梗阻性黄疸大鼠空肠黏膜的影响．方法:Wistar大鼠84只,随机分为4组．通过手术结扎切断大鼠胆总管得到梗阻性黄疸模型．对梗阻性黄疸大鼠分别经胃灌注lactulose和glutamine药物,比较给药前及给药后5,10 d各组大鼠空肠黏膜绒毛高度变化,同时与未行胆管结扎的假手术对照组进行比较．结果:无论胆总管结扎与否,给药前各组空肠黏膜的绒毛高度无明显差异．胆总管结扎后大鼠空肠黏膜高度减低(5 d:q=4．32,P<0．01;10 d:q=11．03,P<0．01);应用生理盐水组大鼠的空肠黏膜绒毛高度明显低于应用lactulose和glutamine组大鼠的空肠黏膜绒毛高度,且应用glutamine组与胆总管未结扎组相近(5 d:q= 3．62,P>0．05;10 d:q=3．83,P>0．05);而应用lactulose和glutamine的2组大鼠空肠黏膜绒毛高度无明显差异(P>0．05)．结论:结扎大鼠胆总管可导致其空肠黏膜萎缩．经胃肠道应用lactulose或glutamine对胆道梗阻所致的大鼠空肠黏膜萎缩均具有保护作用,且二者对肠黏膜的保护作用无明显差异．     

梗阻性黄疸与肠源性内毒素血症的临床研究

以梗阻性黄疸 (OJ)和胆囊结石患者为实验组和对照组 ,探讨梗阻性黄疸是否影响消化道粘膜屏障功能造成肠源性内毒素血症。分光光度法监测外周血中二胺氧化酶 (DAO)和内毒素 (ET)的活性。与正常组比较 ,术前梗阻性黄疸组的DAO活性明显升高 (t=3.176 ,P <0 0 0 1) ;而术前胆囊结石组与正常人DAO活性差异无显著性(t=0 .0 0 77,P >0 0 5 )。梗黄组术前DAO活性明显高于术后 (t=3.86 2 3,P =0 .0 114 )。梗黄组和胆囊结石组术前、术后的DAO、ET活性分别比较 ,差异有显著性 ,但梗黄组的ET含量术后较术前升高 (P <0 0 5 )。相关分析表明梗黄组术前的DAO与ET相关 ,相关系数为r=0 .74 7,P <0 0 1。梗阻性黄疸所致的消化道粘膜屏障功能异常可能与肠源性内毒素血症密切相关。     

谷氨酰胺对良性梗阻性黄疸患者术后免疫功能的影响

目的探讨谷氨酰胺对梗阻性黄疸免疫功能的影响。方法收集48例良性梗阻性黄疸患者的临床资料,并对患者血清的内毒素(ET)、可溶性白细胞介素2受体(sIL-2R)、T淋巴细胞亚群、免疫球蛋白等进行检验。结果谷氨酰胺干预组和梗阻性黄疸对照组相比,谷氨酰胺干预组血清中的sIL-2R较梗阻性黄疸对照组下降明显;两组T淋巴细胞亚群、免疫球蛋白、ET和sIL-2R水平的变化差异具有统计学意义。结论谷氨酰胺对良性梗阻性黄疸术后的免疫功能变化具有一定的影响。     

超声内镜在壶腹部病变所致梗阻性黄疸中的诊断价值

目的探讨超声内镜(endoscopic ultrasonography,EUS)在壶腹部病变所致肝外梗阻性黄疸中的诊断价值。方法系统性回顾武汉大学人民医院消化内科2009年-2013年行EUS检查的患者,有163例为壶腹部病变所致梗阻性黄疸病例,比较分析EUS在不同病因所致梗阻性黄疸中的超声表现、定性诊断及对诊疗措施的指导作用。结果 163例患者皆为常规彩超(B超)、腹部CT、MRCP、MRI怀疑为低位梗阻性黄疸,最后均行EUS检查的患者,诊断病因有:胆总管结石71例(43.6%)、胆总管下端肿瘤23例(14.1%)、壶腹部肿瘤同时侵及胆总管下端胰头21例(12.9%)、胰头肿瘤18例(11.0%)、炎性狭窄16例(9.8%)、十二指肠乳头肿瘤13例(8.0%)、外压性1例(0.6%)。EUS对壶腹部病变所致梗阻性黄疸的诊断准确率达97.5%,明显优于其他影像学检查。结论 EUS对壶腹部病变所致梗阻性黄疸的定性、定位诊断及指导治疗有重要价值。     

胆汁内外引流术对梗阻性黄疸大鼠肺肿瘤坏死因子α、中性粒细胞弹性蛋白酶的影响

目的研究胆汁内外引流方法对梗阻性黄疸大鼠肺肿瘤坏死因子α(TNF-α)、中性粒细胞弹性蛋白酶(NE)水平的影响。方法将64只成年SD雄性大鼠随机分为4组,分别建立梗阻性黄疸(OJ)、胆汁内引流术(ID)、胆汁外引流术(ED)及假手术(SH)4组模型。于2次术后第14天留取肺组织匀浆液标本。采用双抗体夹心酶联免疫吸附法(ELISA)检测10%肺匀浆液TNF-α水平,生化法检测10%肺匀浆液NE水平。结果成功建立了大鼠梗阻性黄疸及内外引流术模型。梗阻性黄疸时大鼠肺TNF-α、NE水平较假手术对照组明显升高(100.893 pg/mL±21.271 pg/mL vs 64.091 pg/mL±13.034 pg/mL,P<0.01;50.396μg/mL±17.388μg/mL vs 39.718μg/mL±9.625μg/mL,P<0.05)。通过胆汁内引流术解除黄疸后,大鼠肺TNF-α浓度(75.141 pg/mL±15.849 pg/mL)与梗阻性黄疸组相比下降明显(P<0.01);而通过胆汁外引流术解除黄疸后,大鼠肺TNF-α浓度仍较高(112.129 pg/mL±36.886 pg/mL),与梗阻性黄疸组相比无差异(P>0.05)。行胆汁内、外引流术后,大鼠肺NE水平均降低(39.390μg/mL±12.410μg/mL、44.790μg/mL±16.681μg/mL),但与梗阻性黄疸组相比内引流明显(P<0.05)、外引流无差异(P>0.05),且内引流恢复至正常水平,与假手术对照组相比无差异(P>0.05)。结论梗阻性黄疸可导致肺组织炎症细胞因子升高,胆汁内引流术可明显改善梗阻性黄疸时肺组织炎症细胞因子水平、甚至接近正常,而胆汁外引流术没有改善肺炎症细胞因子水平,提示术前利用胆汁内引流术解除梗阻性黄疸缓解肺部炎症反应优于外引流术。     

梗阻性黄疸肝再生受损机制的研究进展

肝脏具有惊人的再生能力.然而,部分肝门胆管癌患者术前所出现的梗阻性黄疸将会影响到术后的肝再生,甚至引起肝衰竭.从某种意义而言,梗阻性黄疸患者肝再生的受损程度将决定着是否可以进行外科手术治疗.目前,研究者对梗阻性黄疸肝再生受损机制已经进行了大量的研究.研究结果表明,肝再生受损机制主要包括:(1)门静脉血流量减少;(2)肝细胞凋亡率增加;(3)肝再生相关因子表达的变化.因此,调节上述因素将有可能改善梗阻性黄疸患者术后的肝再生.     

缺血后处理对梗阻性黄疸肾缺血再灌注损伤大鼠血清 TNF-α水平的影响

目的探讨缺血后处理对梗阻性黄疸肾缺血再灌注损伤大鼠血清TNF-α水平的影响。方法 60只SD大鼠随机分成梗阻性黄疸对照组(S组)、梗阻性黄疸肾缺血再灌注组(I/R组)、梗阻性黄疸肾缺血再灌注缺血后处理组(IPO组),每组20只。根据缺血后再灌注时间点各组又分为再灌注0 h(T0)、1 h(T1)、3 h(T2)、6 h(T3)4个亚组各5例。检测再灌注后的各时点血清中尿素氮(BUN)、肌酐(Cr)、TNF-α水平,观察肾组织的病理改变。结果 I/R组和IPO组血清BUN、Cr、TNF-α水平均高于S组(P均<0.05),IPO组T2时间点血清Cr、BUN、TNF-α水平均低于I/R组(P均<0.05)。结论缺血后处理可以下调大鼠血清TNF-α水平,从而减轻梗阻性黄疸大鼠肾缺血再灌注损伤,其机制可能与抑制炎症反应有关。     

腹腔镜输入段结扎胆肠袢式吻合术在晚期恶性梗阻性黄疸中的临床应用

胆肠Roux-en-Y吻合是治疗晚期恶性梗阻性黄疸的经典术式,其减黄效果可靠,并发症较少,但创伤较大。随着腹腔镜技术的发展和成熟,在腔镜下完成胆管空肠Roux-en-Y吻合在技术上已成为可能。我院自2007年起对14例晚期恶性梗阻性黄疸患者实施了腹腔镜输入袢结扎胆肠袢式吻合术,疗效满意。     

胆汁酸膜受体Gpbar1在梗阻性黄疸发病机制中的意义与研究进展

Gpbar1是第一个被证实的G蛋白偶联胆汁酸膜受体,其广泛表达于体内肝、胆、肾、肠、神经与心血管系统等.梗阻性黄疸发生时, Gpbar1被胆汁酸信号激活,介导不同的信号转导通路,从而在梗阻性黄疸的发病过程中发挥着相应的病理生理功能. Gpbar1通过控制炎症、调节胆管上皮屏障功能、抑制肾脏氧化应激、调节肠粘膜屏障与肠道菌群、调控瘙痒与感觉障碍、调控心血管功能等,可能是梗阻性黄疸的潜在治疗靶点.本文对Gpbar1在梗阻性黄疸发病机制中的意义与研究进展进行了综述.     

腹腔镜输入段结扎胆肠袢式吻合术在晚期恶性梗阻性黄疸中的临床应用

胆肠Roux-en-Y吻合是治疗晚期恶性梗阻性黄疸的经典术式,其减黄效果可靠,并发症较少,但创伤较大.随着腹腔镜技术的发展和成熟,在腔镜下完成胆管空肠Roux-en-Y吻合在技术上已成为可能.我院自2007年起对14例晚期恶性梗阻性黄疸患者实施了腹腔镜输入袢结扎胆肠袢式吻合术,疗效满意.     

Ultrasound in obstructive jaundice

One hundred and twenty-five consecutive patients with obstructive jaundice were prospectively studied by ultrasonography to determine the level and cause of obstruction. These were diagnosed precisely in 80 (72%) and 52 patients (41.6%) respectively. The results were compared with cholangiography. The final diagnosis was established at surgery (97 cases) and fine needle aspiration cytology (28 cases). While US is an excellent screening modality in distinguishing obstructive and non-obstructive jaundice, cholangiography is still the gold standard for determining the precise anatomic level and cause of obstruction.     

Obstructive jaundice due to a textiloma mimicking a common bile duct stone

A foreign body is a rare cause of obstructive jaundice. We report a 19-year-old woman with jaundice caused by a surgical gauze in the common bile duct (CBD). Four yours earlier, she had undergone a cholecystectomy and drainage for hydatid disease of the liver. Her postoperative course was complicated by a biliary fistula that healed after 50 days. She now presented with obstructive jaundice of 2 weeks' duration. Magnetic resonance cholangiopancreatography (MRCP) showed a signal-void mass, consistent with a CBD stone. Surgical exploration of the CBD revealed a surgical gauze as the cause of the obstruction. To the best of our knowledge, this is the first case of a surgical gauze obstructing the CBD requiring surgical removal.     

Effect of percutaneous biliary drainage on serum levels of tumor markers in patients with obstructive jaundice

BACKGROUND/AIMS: Some tumor markers such as CA 19-9 are shown to be increased in obstructive jaundice due to either benign or malignant causes. In this study the clinical importance of raised serum levels of tumor markers have been evaluated, with particular reference to obstructive jaundice and percutaneous biliary drainage. METHODOLOGY: We conducted a prospective longitudinal before-after trial. Twenty-one patients with obstructive jaundice were investigated, 5 with benign obstruction and 16 with malignant disease. All patients were examined with abdominal CT prior to biliary drainage. All patients underwent percutaneous transhepatic cholangiography, and 20 of 21 patients underwent percutaneous biliary drainage within 3 days after the CT examination. RESULTS: The mean CA 19-9 at presentation was lower in the group with benign disease (95 +/- 60.9 IU/mL) than those with malignancy (461.9 +/- 331.4 IU/mL). The mean CA 19-9 level in the benign group 1 week after drainage was 12 +/- 11.8 IU/mL. The mean CA 19-9 level in the malignant group after drainage was 249.7 +/- 279.5 IU/mL. CONCLUSIONS: A prominently high serum CA 19-9 level at the presentation and a high serum CA 19-9 level after successful biliary drainage should prompt investigation for a malignant etiology of obstructive jaundice.     

Inhibition of 5-lipoxygenase promotes the regeneration of the liver after partial hepatectomy in normal and icteric rats

The role of leukotriene (LT) on liver regeneration after hepatectomy is still unknown. LTB4 stagnates in the liver with obstructive jaundice, because LTB4 is excreted in the bile; therefore, LTB4 may have an effect on liver regeneration after hepatectomy with obstructive jaundice. Release of obstructive jaundice and simultaneous 70% hepatectomy was performed in rats to study the effect of 5-lipoxygenase inhibitor (AA-861) on liver regeneration. Group 1 underwent hepatectomy with administration of 0.1 mL dimethyl sulfoxide (DMSO), group 2 underwent hepatectomy with administration of AA-861 (20 mg/kg/d) dissolved in 0.1 mL DMSO, group 3 underwent hepatectomy with administration of AA-861 (40 mg/kg/d) dissolved in 0.1 mL DMSO, group 4 underwent release of obstructive jaundice and hepatectomy with administration of 0.1 mL DMSO, and group 5 underwent relief of obstructive jaundice and hepatectomy with administration of AA-861 (20 mg/kg/d). DMSO or AA-861 was administered 24 hours before, during, and 24 hours after hepatectomy in each group. Whole blood LTB4 and serum alanine aminotransferase (ALT), total bilirubin, and bromodeoxyuridine labeling index (LI) were measured before and after hepatectomy. The LTB4 level increased during obstructive jaundice and after hepatectomy. LTB4 and serum ALT levels were significantly lower after hepatectomy in the rats that were administered AA-861, and a significantly higher LI was observed at 24 hours after hepatectomy in rats receiving AA-861. Inhibition of 5-lipoxygenase promotes liver regeneration and decreases hepatocyte injury after hepatectomy associated with obstructive jaundice. (Hepatology 1996 Mar;23(3):544-8)     

Effects of sera from patients with obstructive jaundice on the generation of oxygen intermediates by normal polymorphonuclear leukocytes

Recently it has been suggested that oxygen intermediates play an important role in the pathogenesis of tissue damage. The effect of sera from patients with obstructive jaundice on the generation of oxygen intermediates by normal polymorphonuclear leukocytes (PMNs) was investigated. Sera from patients with obstructive jaundice increased superoxide anion (O2-), hydrogen peroxide (H2O2) and hydroxol radical (OH.) generation compared with sera from healthy individuals or patients with biliary tract stones and/or tumors of the biliary tract or pancreas (without obstructive jaundice). In particular, the hydroxyl radical, which is one of the most potent oxidants capable of causing tissue damage, was produced in large quantities. Sera from patients with obstructive jaundice have a strong capacity to induce production of oxygen intermediates from PMNs, and oxygen intermediates may play a role in the pathogenesis of hepatic and other organ injury in obstructive jaundice.     

Hepatic functional evaluation using the galactose tolerance test in patients with obstructive jaundice

Hepatic functional mass was evaluated in patients with obstructive jaundice using the galactose tolerance test (GaTT), which reflected cytosolic function of hepatocyte. The T-1/2 values as an index on the GaTT were significantly prolonged in patients with obstructive jaundice in comparison with control subjects whether before or after percutaneous transhepatic biliary drainage (PTBD). But in each cases, some showed nearly normal GaTT-T/2 value and others showed severely prolonged value. Patients with obstructive jaundice could be divided into two groups according to the GaTT-T/2 value before PTBD. The decreasing rate of serum bilirubin level "b" after PTBD was significantly fair in the group A patients (good GaTT-T/2 value before PTBD) than the group B (poor GaTT-T/2 value before PTBD) (P less than 0.05). It was that GaTT-T/2 before PTBD which represented hepatic cytosolic functional mass could predict the effect of PTBD in patients with obstructive jaundice.     

梗阻性黄疸的MRCP表现（附47例报告并文献复习）

目的 总结梗阻性黄疸的MRCP表现,提高其诊断的准确性.方法 回顾分析47例经手术和病理证实的梗阻性黄疸患者的MRCP表现.结果 恶性梗阻性黄疸25例,其中肝门胆管癌6例,胆囊癌2例,胆总管腺癌4例,胰头癌、十二指肠腺癌各3例,胰头转移瘤7例.良性梗阻性黄疸22例,其中炎性梗阻3例,胆囊或胆总管结石伴炎症13例,术后瘢痕、胆总管囊肿、十二指肠息肉各2例.恶性梗阻性黄疸的典型MRCP表现为肝内胆管呈"藤蔓"征,胆管突然截断,断端圆钝形态不规则,呈偏心性或向心性狭窄或充盈缺损.良性梗阻性黄疸的MRCP表现为肝内胆管呈"枯树枝"征,胆总管逐渐变窄或其内形态规则的充盈缺损,断端锐利、平直或倒杯口状或圆锥状.结论 MRCP是诊断良、恶性梗阻性黄疸的有效方法.     

Serum Total Sialic Acid in Differential Diagnostics of Jaundice Caused by Malignant and Nonmalignant Diseases: A ROC Curve Analysis

The purpose of this study was to evaluate the usefulness of serum total sialic acid (SA) for discrimination of malignant and nonmalignant jaundice. Serum SA concentration and its ratio with total protein (SA/TP) were determined in 55 patients with jaundice: 25 malignant and 30 nonmalignant. SA was estimated by enzymatic method. Serum total SA and the ratio SA/TP were significantly higher in malignant than in nonmalignant jaundice. Diagnostic sensitivity of SA and the ratio of SA/TP in both types of jaundice reached the value of 95.8%. The specificity, positive and negative predictive values, and efficiency of SA and SA/TP were higher in malignant than in nonmalignant jaundice. Areas under ROC curves for SA and the ratio of SA/TP in malignant jaundice were higher than in nonmalignant, but there were not statistically significant differences. SA levels and the ratio of SA/TP do not have the ability to discriminate between these types of jaundice.