血清铜及铜/锌值对肝癌鉴别作用的研究

本文测定了15例肝硬化、15例原发性肝癌病人的血清铜及铜／锌比值，并与17例正常人血清铜及铜／锌比值相比较，结果发现：①肝硬化和肝癌组病人血清锌水平低于正常对照组（分别为15．94±0．06和15．44±9．92μmol／L），但两组患者之间无显著性差异（P＞0．05）；②肝硬化组和肝癌组病人的血清铜水平均高于对照组，肝癌组病人的血清铜水平又显著高于肝硬化组（分别为31．92±0．07μmol／L和20．25±0．06μmol／L，P＜0．001），而肝硬化组与正常组血清铜水平差异不显著（20．25±0．06μmol／L和17．35±2．75μmol／L，P＞0．05）；③肝硬化组和肝癌组病人的血清铜及铜／锌显著高于对照组（分别P＜0．05和P＜0．001）．两组病人之间的血清铜／锌值有显著性差异（P＜0．001）。提示血清铜及铜／锌的测定有助于肝硬化和肝癌的鉴别诊断。     

内镜下十二指肠乳头大切开手术对患者术后胆囊功能的影响

【目的】探讨内镜下胆总管取石术中,十二指肠乳头括约肌切开术（ES T ）处理后对患者术后胆囊功能的影响。【方法】随机选择30例曾经接受内镜下胆总管取石术而行ES T （本组行大切开至乳头根部）患者作为观察组,选择同期30例健康体检者作为对照组。所有患者均采用99m Tc‐EHIDA肝胆动态核素显像进行定量分析,通过肝脏半排时间（TEX ）、胆囊显影时间（GBVT ）、胆肠分配率（Fgb）、肠道比例（Fsi）、胆囊的半排时间（GBT1／2）、30 min胆囊排空分数（GBEF）、胆囊排泄率（GBER）、胆总管高峰时间（CBD Tup）、十二指肠显影时间（DUT）、十二指肠高峰时间（DU Tup）综合评价胆囊的功能。【结果】与对照组比较,观察组TEX明显缩短（ P ＜0．05）,CBD Tup、DUT、DU Tup出现的时间较早（ P ＜0．05）,GBVT 时间延迟（ P ＜0．001）, GBT1／2缩短（ P＜0．001）,GBEF 30 min较大（ P ＜0．001）,10 min ,20 min及30 minGBER较快（ P ＜0．001）,Fgb明显减少（ P ＜0．001）,Fsi（％）增加（ P ＜0．001）。【结论】EST 患者胆囊贮存功能明显受损,排泄功能增强。     

三维体元模型超声重建法定量测定右室腔容积及右室游离壁心肌重量的实验研究

为了评价体元模型超声三维重建定量测定右室腔容积及右室游离壁心肌重量的准确性，我们对17只离体新鲜猪心模型进行研究，结果显示：三维法测量右室腔容积与实测值非常接近（分别为35．98±7．11和35．88±6．32ml），两者间的差别无统计学意义（P＞0．05）。与实测值之间高度相关（r＝0．95，P＜0．0001）。三维法测量右室游离壁心肌重量与实测值非常相近（分别为48．72±10．16和48．63±9．569），两者间的差别无显著意义（P＞0．05）。与实测值之间也高度相关（r＝0．96，P＜0．0001）。     

多平面经食管体元模型动态三维重建评价右心室射血分数的临床应用

本研究应用多平面经食管体元模型动态三维重建的方法测量8例健康志愿者和9倒房间隔缺损患者右室腔容积和右室射血分数，结果显示，房间隔缺损患者的右室腔三维形态与正常人相似，但比正常人饱满，表面乳头肌和肌小梁的压迹与正常人相仿，室间隔面仍然凹进，短轴截面基本为半月形。正常人右室舒张末期和收缩末期容积分别为37．82±10．6ml／m2和19．84±5．93ml／m2，房间隔缺损患者则分别为101．06±48．81ml／m2和52．69±31．02ml／m2，较正常人的右室容积均高（P＜0．01和P＜0．05），但EF值在正常人（0．48±0．04）和房间隔缺损患者（0．49±0．07）之间无明显差别（P＞0．05）。本研究建立了超声技术测定右室射血分数的方法，为无创伤性右心功能评价开辟了新途径。     

甲状腺切除术中带状肌侧径路应用的初步报告

采用带状肌侧径路及带状肌正中径路完成36例甲状腺侧叶与腺叶加峡部切除术，两径路组各18例。带状肌侧径路组肿瘤大于正中径路组（4．4±1．92cm，4．2±1．67cm，P＜0．05），而切口长度（5．56±1．48cm，9．47±1．74cm，P＜0．001），甲状腺上极显露程度（P＜0．01），不横断带状肌例数（P＜0．05），手术时间（80．56±34．25min，140．56±5775min，P＜0．001），未中出血（70．57±62．07ml，164．44±98．53ml，P＜0．01）及水后负压引流量（22．78±18．65ml，41．67±24．55ml，P＜0．02）等指标均以带状肥料径路组为优．文中详细介绍了带状肌侧径路的手术操作，手术要点及其适应证。     

兴城矿泉浴对胆石病患者胆囊排空功能的影响

目的　观察兴城故泉浴对胆石病的治疗作用。方法　经Ｂ 超证实的胆石病患者７６ 例，随机分为矿泉浴组和淡水浴组（ 各为３８ 例） 。矿泉为兴城矿泉，淡水为兴城饮用自来水，水温３８～４０ ℃，每日１ 次，每次３０ 分钟，共３０ 次。在受试前后于空腹和试餐后用Ｂ超测算空腹胆囊容积、胆囊最大排空率、最大排空时间及餐后６０ｍｉｎ 胆囊排空率。结果　矿泉浴前后胆囊最大排空率，空腹胆囊容积的差异不显著（Ｐ＞０ ．０５） ，最大排空时间及餐后６０ｍｉｎ 胆囊排空率的差异显著（Ｐ＜ ０．０５） ，治疗后症状改善。淡水浴前后胆囊最大排空率、最大排空时间、空腹胆囊容积及餐后６０ｍｉｎ 胆囊排空率的差异不明显（Ｐ＞ ０ ．０５） ，症状改善，但差异不显著（Ｐ＞ ０ ．０５） 。结论　兴城矿泉浴能改善胆石病患者的症状及胆囊排空功能。     

B超对胃节律紊乱综合征的胆囊运动研究

目的 了解胃节律紊乱综合征患（GDS）的胆囊运动。方法 用超声显像对27例GDS患在治疗前后进行空腹胆囊及餐后胆囊排空运动对比检查,并与15例正常人进行比较。结果 GDS组胆囊排空分数（EF）明显低下（P＜0．01）;治疗4周后,其中21例得到纠正,与治疗前比较,胆囊排空分数显提高（P＜0．01）,接近对照组（P＜0．05）。结论 GDS患在胃运动障碍的同时,也存在着胆囊排空运动障碍;GDS患用药治疗后,不仅胃排空运动障碍得以纠正,而且胆囊排空运动障碍也得以显改善。     

腹腔镜胆囊切除术对急性结石性胆囊炎患者胃肠功能及C-反应蛋白水平的影响

目的：比较腹腔镜胆囊切除术和开腹胆囊切除术对急性结石性胆囊炎患者胃肠道功能及外周血C-反应蛋白水平的影响。方法本院胃肠外科于2011年1～12月收治的88例急性结石性胆囊炎纳入对照组，行开腹胆囊切除术治疗；余2012年1～12月收治的86例患者纳入研究组，行腹腔镜胆囊切除术治疗。比较两组患者胃肠道功能恢复情况及外周血C-反应蛋白水平。结果研究组患者肛门排气时间为（24．75±4．12）h ，对照组为（49．27±7．03）h ，比较差异有统计学意义（P＜0．05）。研究组肠鸣音恢复时间为（11．20±2．03）h ，对照组为（25．01±177;5．37）h ，比较差异有统计学意义（P＜0．05）。两组患者术前C-反应蛋白水平比较差异无统计学意义（P＞0．05）；术后，研究组患者C-反应蛋白水平为（35．20±6．74）mg/L ，对照组为（59．01±10．03）mg/L ，比较差异有统计学意义（P＜0．05）。结论腹腔镜胆囊切除术对急性结石性胆囊炎患者的胃肠功能影响较小，且组织损伤较轻，值得在临床中进一步推广应用。     

三维超声心动图评价肥厚型心肌病患者左心房功能及其影响因素的临床研究

目的应用三维超声心动图（3DE）评价肥厚型心肌病（HCM）患者左心房的功能,并探讨导致左心房功能改变的影响因素。方法46例HCM患者（梗阻性HCM组25例,非梗阻性HCM组21例）与46名健康对照者（健康对照组）入选此研究。应用3DE获得2组受检者的左心房时间－容积曲线,测量左心房最大容积（LAVmax）、左心房最小容积（LAVmin）及左心房收缩前容积（LAVp）,计算左心房容积指数（LAVI）、左心房扩张指数（LAEI）、左心房排空分数（LAEF）、左心房被动排空分数（LAPEF）及左心房主动排空分数（LAAEF）,2组间进行对比分析。并对所有入选者的室间隔厚度（IVSd）、左心室流出道峰值压差（LVOT－PG）、二尖瓣反流（MI）量、左心室舒张功能（LVDF）与LAVI进行Spearman线性相关分析及多元线性回归分析。结果健康对照组LAVmax（45．67±11．96）ml、LAVmin（20．48±6．80）ml、LAVp（24．48±9．31）ml、LAVI 25．63±6．52、LAEI（1．32±0．49）％、LAEF （55．25±8．06）％、LAPEF（35．90±7．00）％、LAAEF（30．20±10．13）％,HCM组LAVmax（81．45±24．24）ml、LAVmin（44．60±18．96）ml、LAVp（61．00±21．64）ml、LAVI 45．39±14．17,与健康对照组比较均明显增高,2组间差异有统计学意义（t＝8．978、8．123、9．227、8．436,P均＜0．01）;HCM组LAEI（0．95±0．43）％、LAEF（46．15±11．12）％、LAPEF（25．64±9．09）％,与健康对照组比较明显减低,2组间差异亦有统计学意义（t＝－3．865、－4．493、－6．504,P均＜0．01）;HCM组LAAEF（28．20±9．26）％,与健康对照组比较仅轻度减低,2组间差异无统计学意义（t＝－0．656,P＞0．01）。 IVSd、LVOT－PG、MI、LVDF均与LAVI在0．01水平上呈显著正相关（r＝0．704、0．517、0．640、0．701,P均＜0．01）,多元回归分析得出IVSd、LVOT－PG、MI、LVDF均为LAVI的影响因素（标准回归系数绝对值分别为0．264、0．515、0．614、0．341,P均＜0．05）。结论3DE能够评估HCM患者左心房的容积及功能,主要表现为各时相左心房容积显著增加,而储蓄功能、管道功能、辅泵功能减低。 HCM患者的二尖瓣反流、左心室流出道梗阻、左心室舒张功能障碍以及室壁的增厚均为左心房功能受损的影响因素,其中二尖瓣反流对其影响最大。     

慢性胆囊炎与胆结石形成关系的超声研究

目的 探讨慢性胆囊炎与胆结石形成的关系.方法 慢性胆囊炎、胆结石患者及正常人各20例采用超声法进行脂餐前后胆囊容积及排空率的测定.结果 结石组较对照组脂餐前、餐后各期胆囊容积增大,排空率降低(P＜0.05).慢性胆囊炎组餐后胆容积及排空率与对照组无显著性差异(P＞0.05),但空腹容积显著增大(P＜0.05).结论 慢性胆囊炎患者存在胆囊运动功能异常,这种异常可能是胆囊结石形成的原因之一.     

Effects of massive small bowel resection on metabolism of bile acids and vitamin D3 and gastrin release in dogs.

The effects of ursodeoxycholic acid (UDCA) and 1 alpha-hydroxyvitamin D3 on pathophysiological changes following massive resection of the distal small bowel (75%) were investigated by using adult beagle dogs. After surgery, body weight decreased, watery diarrhea occurred, and the transit time of the alimentary tract shortened. These undesirable consequences lessened markedly after oral administration of UDCA, though 1 alpha-hydroxyvitamin D3 was not effective. Plasma levels of both 25-hydroxyvitamin D3 and 24, 25-dihydroxyvitamin D3 decreased after surgery, while plasma 1 alpha, 25-dihydroxyvitamin D3 concentrations remained unchanged during the observation period of six months. Although fasting plasma concentrations of total bile acid were not reduced, the integrated response to a meal decreased significantly after surgery in spite of the administration of UDCA. The concentration of UDCA in the gallbladder bile increased markedly in dogs which received UDCA. Taurine-conjugated bile acids accounted for more than 90% of the gallbladder bile. Postprandial hypergastrinemia occurred following the massive small bowel resection in the control group and in the group which received 1 alpha-hydroxyvitamin D3 alone, while it did not occur in the group given UDCA together with 1 alpha-hydroxyvitamin D3. These results indicate that administration of UDCA after massive resection of the small intestine is effective in maintaining good nutritional state.     

Effect of ageing on postprandial conjugated and unconjugated serum bile acid levels in healthy subjects

Abstract. Colorectal cancer is a disease of elderly subjects. A decreased ileal absorption of bile acids in elderly subjects may lead to an increased exposure of the colonic mucosa to secondary bile acids. This may contribute to an enhanced risk of colorectal cancer. In this study fasting and postprandial conjugated and unconjugated serum levels of cholic, chenodeoxycho-lic, and deoxycholic acid in 12 elderly and 12 younger subjects were investigated. Intestinal transit time, gallbladder emptying and jejunal bacterial flora were also studied in both age groups. Fasting levels of conjugated and unconjugated serum bile acids were similar in both age groups. Postprandial levels of all individual conjugated bile acids increased to a significantly higher extent in the younger subjects. Postprandial unconjugated serum bile acid levels did not differ significantly between both age groups, although unconjugated deoxycholic levels tended to increase to higher levels in the elderly. Results of jejunal bacterial counts, gallbladder emptying and intestinal transit time were similar in both groups. These data suggest that conjugated bile acids are reabsorbed less effectively in elderly subjects.     

三孔与单孔腹腔镜切除术式治疗急性阑尾炎合并胆囊结石的疗效对比

目的探讨三孔与单孔腹腔镜胆囊阑尾联合切除术式治疗急性阑尾炎合并胆囊结石临床疗效差异。方法研究对象选取该院及临汾市人民医院2012年8月-2015年8月收治急性阑尾炎合并胆囊结石患者共110例,以随机抽签法分为对照组(55例)和观察组(55例),分别采用三孔和单孔腹腔镜下胆囊阑尾联合切除术式治疗;比较两组患者手术相关临床指标、Brown手术满意度评分、手术前后抑郁焦虑视觉模拟评分法(VAS)及术后并发症发生率等。结果观察组患者切口长度明显短于对照组(P0.05);观察组患者手术操作用时则明显长于对照组(P0.05);观察组患者术后抑郁焦虑VAS评分均明显低于对照组、治疗前(P0.05);同时两组患者术后并发症发生率比较差异无统计学意义(P0.05)。结论相较于三孔腹腔镜术式,单孔腹腔镜胆囊阑尾微创联合切除治疗急性阑尾炎合并胆囊结石可有效缩短切口长度,改善手术美观性和术后负面情绪,且未导致术后并发症风险上升。     

腹腔镜与传统开腹手术治疗胆囊结石合并胆总管结石的临床研究

目的探讨腹腔镜与传统开腹手术治疗胆囊合并胆总管结石的临床疗效。方法选取50例胆囊合并胆总管结石患者的临床资料进行回顾性分析,按手术方式的不同分为研究组25例和对照组25例。研究组给予腹腔镜手术治疗,对照组给予开腹手术治疗。观察对比两组:包括手术时间、术中出血量、术后排气时间、术后并发症的发生情况、术后住院时间等。结果两组的手术情况对比结果:术中出血量研究组比对照组差不多,术后并发症的切口感染率、结石残留低于对照组,但差异无统计学意义(P>0.05);研究组术后排气时间明显短于对照组,术后住院时间明显短于对照组,差异有统计学意义(P<0.05);手术时间研究组明显高于对照组,差异有统计学意义(P<0.05)。结论腹腔镜手术治疗胆囊合并胆总管结石临床症状疗效可与开腹手术相似,且具有微创优势。     

Gallbladder wall thickening: a frequent finding in various nonbiliary disorders--a prospective ultrasonographic study

A comprehensive prospective ultrasonographic study was performed in 93 patients to investigate gallbladder wall thickness and gallbladder volumes in various nonbiliary disease states. Without changes in gallbladder volume, mean gallbladder wall thickness was significantly increased (p less than 0.01) in patients with liver cirrhosis, viral hepatitis, chronic congestive heart failure, hypoalbuminemia, and chronic renal failure (p less than 0.05) but not in patients with diabetes mellitus (n = 14) as compared to a control group. The present study confirms that a variety of nonbiliary disorders are associated with significant thickening of gallbladder walls and that this finding is not caused by incomplete gallbladder contraction.     

Gallbladder motility and cholesterol crystallization in bile from patients with pigment and cholesterol gallstones

BACKGROUND: Little is known about gallbladder motility in patients with black pigment stones when compared to cholesterol gallstone patients, or about their relationship to biliary composition, crystallization and stone characteristics. DESIGN: Fasting and postprandial gallbladder volumes were studied by ultrasonography in 49 gallstone patients with pigment (n = 14) or cholesterol (n = 35) stones and 30 healthy controls. After cholecystectomy stone composition, gallbladder wall inflammation, cholesterol saturation index and appearance of platelike cholesterol crystals in bile were evaluated in gallstone patients. RESULTS: Fasting gallbladder volume was significantly (P < 0.05) increased in cholesterol stone patients (31.7 +/- 1.9 mL) but not in pigment stone patients (21.9 +/- 3.1 mL), compared to controls (21.0 +/- 1.5 mL). Postprandial emptying was delayed in patients (half-emptying time: 31 +/- 2 min, 35 +/- 3 min, 24 +/- 2 min in cholesterol stone patients, pigment stone patients and controls, respectively, P < 0.05) and incomplete (residual volume: 43.2 +/- 2.7%, 40.0 +/- 4.3%, 15.8 +/- 1.6% min in cholesterol stone patients, pigment stone patients and controls, respectively, P < 0.05). The inflammation of the gallbladder wall was mild or absent in all cases. Biliary cholesterol saturation index was 152.3 +/- 8.5% and 92.9 +/- 4.8% in patients with cholesterol and pigment stones, respectively (P < 0.01). Whereas cholesterol crystals never appeared during 21 days in biles from patients with pigment stones, crystal observation time in patients with cholesterol gallstone was 5 days (median) and was significantly shorter in patients with multiple (4 days) than in patients with solitary (12 days) cholesterol stones (P = 0.0019). CONCLUSIONS: Patients with black pigment stones who do not have excess cholesterol and do not grow cholesterol crystals in bile have decreased gallbladder emptying, although to a lesser extent than patients with cholesterol stones. Thus, gallbladder stasis is likely to put a subset of subjects at risk for the formation of pigment gallstones, and pathogenic mechanisms need to be further investigated.     

雌性激素对妊娠豚鼠胆囊运动功能影响的实验研究

目的:探讨妊娠情况下雌性激素对豚鼠胆囊运动功能的影响及对胆囊结石形成的作用。方法:60只雌性豚鼠随机分为实验组(40只)和对照组(20只),实验组建立妊娠豚鼠动物模型,分为妊娠30d组和妊娠60d组,采用化学发光法和酶联亲和抗体组织化学法分别进行血清雌二醇(E2)、孕酮(Pg)浓度检测及胆囊组织雌激素受体(E R)、孕激素受体(PR)的检测,同时测量各组豚鼠胆囊空腹体积(FV),胆囊空腹胆汁量(FB)的变化,并观察胆囊结石形成情况。结果:妊娠60d组豚鼠有3只形成胆囊结石,妊娠豚鼠血清E2、Pg含量,胆囊组织E R、PR阳性表达率均明显高于非孕豚鼠(P<0.001),且随妊娠期进展而呈逐渐升高趋势。妊娠60d组豚鼠FV及FB明显大于妊娠30d组和对照组(P<0.001)。结论:妊娠期血清E2和Pg含量显著升高,诱发胆囊运动功能下降,胆囊胆汁淤积,是妊娠期胆囊结石形成的重要原因。     

肝胆疾患胆囊动力学研究及其临床意义

目的与方法：利用Ｂ超超声检查１４例慢性胆囊炎、１２例胆囊结石、１３例肝硬化病人的胆囊充盈和排空功能,旨在阐明其胆囊动力学变化及其可能的机制和临床意义,结果：与正常对照比较,胆囊炎和胆囊结石患者空腹胆囊容积无变化;胆囊最大排空指数（ＧＢＥＦｍａｘ）明显下降（Ｐ均〈０．０５）;胆囊炎与胆囊结石间ＧＢＥＦ－ｍａｘ无显著性差异。胆硬化组病人空腹胆囊体积比对照组健康者明显扩大（Ｐ〈０．０１）,而ＧＢＥＦｍａ     

Endoscopic sonographic evaluation of the thickened gallbladder wall in patients with acute hepatitis

PURPOSE: Thickening of the gallbladder wall is often observed during abdominal sonographic examination in patients with acute hepatitis. However, there is rarely an opportunity for a histopathologic analysis of these structural changes. Endoscopic sonography (EUS) can accurately delineate the structure of the gallbladder wall and therefore may be useful for visualizing changes in the gallbladder wall in patients with acute hepatitis. Hence, we prospectively studied the ability of EUS to detect specific structural changes in the gallbladder wall in patients with acute hepatitis and examined the effect of high elevation of serum liver enzyme levels on the gallbladder wall. METHODS: A study group of patients diagnosed with acute hepatitis who had gallbladder wall thickening and a control group of patients without acute hepatitis or gallbladder disease underwent EUS between May 1, 1999, and June 1, 2002. EUS was used to measure the thickness of the gallbladder wall and to visualize each of its layers. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of the patients with acute hepatitis were measured at the time of the EUS examination. Statistically significant differences were determined using an independent t test and the chi-squared test. A p value of less than 0.05 was considered statistically significant. RESULTS: The acute hepatitis group comprised 28 men and 24 women with a mean age of 40.8 years. The control group comprised 25 men and 25 women with a mean age of 45.1 years. The mean gallbladder wall thickness +/- standard deviation in the acute hepatitis group (6.3 +/- 2.6 mm) was significantly greater than that in the control group (1.6 +/- 0.4 mm; p < 0.01). The mean thickness of the gallbladder wall for patients in whom both the AST and the ALT levels were 500 U/l or higher (7.0 +/- 2.6 mm) was significantly greater than that for patients with levels below 500 U/l (5.4 +/- 2.3 mm; p < 0.05). In the acute hepatitis group, EUS showed thickened, well-defined muscular and serosal layers of the gallbladder wall in 24 of the patients and a diffusely thickened gallbladder wall, in which each layer was ill defined, in the other 28 patients. The mean thickness of the gallbladder wall for patients with the pattern of ill-defined layers was significantly greater than that for the patients with the pattern of well-defined layers (p < 0.05). The pattern of ill-defined layers was more common among patients in whom the serum AST and ALT levels were at least 500 U/l than among patients with levels below 500 U/l (p < 0.05). CONCLUSIONS: We propose that gallbladder wall thickening in patients with acute hepatitis is associated with prominent changes in the muscular and serosal layers. Patients with highly elevated serum liver enzyme levels are more likely to have gallbladder wall thickening and disruption of planes between the muscular and serosal layers than are patients with normal liver enzyme levels.