胆囊切除术后胆汁返流性胃炎胃肠激素测定临床探讨

目的 探讨胆囊切除术后胆汁返流性胃炎胃黏膜损害及胃动素、胃泌素临床特点。方法对30例胆囊切除术后胃粘膜病理特点及胃动素、胃泌素分泌进行分析、比较。结果 胆囊切除术后胆汁返流性胃炎，胃粘膜损害的轻重及胃泌素的分泌增多均于胆汁返流有关。结论 胆囊切除术后胆汁返流性胃炎的发生，胃黏膜损害程度及胃泌素分泌增多均于病程的长短有关。     

A型肉毒毒素对大鼠胃排空及相关胃肠激素影响的研究

目的观察A型肉毒毒素(Botulinum toxin A,BTA)对大鼠胃排空及胃肠激素分泌的影响,探讨其可能的作用机制.方法选用雄性Wistar大鼠40只,随机分为四组:对照组、BTA小剂量(10 u)组、中剂量(20u)组及大剂量(40u)组.给药方法均为剖腹胃窦部肌层注射.12周末,测定胃半排空时间以评价BTA对胃排空的影响,用放免法测定血浆胃动素,免疫组化方法测定胃窦局部CCK、VIP的表达.结果①12周末,中剂量组和大剂量组胃半排时间(min)分别是(161.67±23.53、200.33±44.37),显著长于对照组(86.83±22.98)(P＜0.05).②中剂量组和大剂量组血浆胃动素(pg/ml)分别是(80.56±10.43、65.99±10.50)均低于对照组(123.65±31.10),差别有统计学意义(P＜0.05).③CCK在大剂量组胃窦部肌间神经丛表达的IOD值为(139.83±37.39),与对照组(77.91±32.21)比较,差别有统计学意义(P＜0.05).VIP在中、大剂量组胃窦肌间神经丛表达的IOD值为(63.83±19.62、58.40±15.52),低于对照组(100.04±26.36),差别有统计学意义(P＜0.05).结论大鼠胃窦部肌层内注射BTA引起胃动力降低,胃排空减慢.治疗后大鼠体内胃动素、VIP含量减少,CCK含量增加,提示BTA减慢胃排空过程可能与上述胃肠激素的变化有关.     

胆囊切除术后胆汁返流性胃炎21例报告

报告胆囊切除术后胆汁返流性胃炎２１例，其中１８例胃镜下见到胆汁返流，认为其发生机理与胆汁持续流入致十二指肠动力学紊乱、幽门括约功能障碍及胆汁成分改变有关，本病最可靠的诊断方法是胃镜检查，其治疗方法以药物治疗为主。     

肝硬化患者血浆VIP、CCK水平与胆囊排空功能的关系

探讨肝硬化时血浆胃肠激素水平对胆囊运动的影响。用放免法测定肝硬化患者及对照者血浆血管活性肠肽 (VIP)和胆囊收缩素 (CCK)含量 ;用B超测定餐前、餐后胆囊容积及排空率。结果 :肝硬化时血浆VIP、CCK均明显增高 (P <0 0 1,P <0 0 5 ) ;胆囊空腹容积、剩余容积均明显增大 (P <0 0 1,P <0 0 0 1) ,最大排空率较对照组无明显差异 (P >0 0 5 ) ,但Child -PughC级降低 (P <0 0 5 )。肝硬化组胆囊最大排空率与VIP呈负相关 ,胆囊空腹容积及剩余容积与VIP均呈正相关 ,胆囊空腹容积、剩余容积及最大排空率与CCK均无相关。提示肝硬化时VIP增高既抑制胆囊运动 ,又明显降低胆囊张力 ,肝硬化时可能存在对CCK的抵抗。     

胃肠激素及临床应用

胃肠激素及临床应用张宗英１侯振江１郭金英２Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｇａｓｔｒｉｎ；ｍｏｔｉｌｉｎ；ｓｅｃｒｅｔｉｎ；ｃｈｏｌｅｃｙｓｔｏｋｉｎｉｎ；ｓｏｍａｔｏｓｔａｔｉｎ；ｖａｓｏａｃｔｉｖｅｉｎｔｅｓｔｉｎａｌｐｅｐｔｉｄｅ；ｓｕｂｓｔａ...     

六种八肽胆囊收缩素（CCK－8）类似物对豚鼠胆囊收缩活性的测定

测定了六种ＣＣＫ－８类似物对豚鼠胆囊肌条的收缩活性，在Ｅ０５０值的基础上与ＣＣＫ－８标准品比较。结果显示，其活性顺序为：类似物（２）＞类似物（１）＝ＣＣＫ一８标准品＝类似物（３）＞类似物（４），类似物（５）及类似物（６）在剂量高达１０－７ｍｏｌ／Ｌ时仍未显示其活性。实验表明：脱去Ｎ－端氨基的ＣＣＫ一８类似物即Ｓｕｃ－ＣＣＫ－７［类似物（２）］较ＣＣＫ一８活性明显增加，有临床价值，在类似物（３）中，甲硫氨酸被正亮氨酸取代，活性可完全保留，类似物（４）因ＧＬＹ２９被Ｄ－ＡＬａ取代，活性显著降低，但仍可表现其激动剂性质，当ＧＬＹ２９被β－ＡＬａ取代时，即类似物（５）失去了收缩胆囊的活性。     

Changes of gastrointestinal myoelectric activity and bile acid pool size after cholecystectomy in guinea pigs

AIM: To investigate the bile acid pool size after cholecystectomy whether or not correlated to the gastrointestinal migrating myoeiectric complex (MMC) in guinea pigs. METHODS: Gallbladder motilities were assessed before cholecystectomy. Furthermore, we continuously monitored interdigestive gastrointestinal motilities using bipolar electrodes in conscious guinea pigs before and after surgery at 4 wk in standard diet group and high cholesterol diet (cholesterol gallstone) group. Total bile acid pool sizes were measured by isotope dilution method at meantime. RESULTS: After cholecystectomy, there were parallel falls in duration of phase Ⅰ, Ⅱ, Ⅲ and MMC cycle duration but increase in amplitude in the guinea pigs with normal gallbladder function, and in the guinea pigs with cholesterol stones. However, There were not significantly differences. On the other hand, the bile acid pool was definitely small in the GS guinea pigs compared to normal guinea pigs and became slightly smaller after cholecystectomy. Similarly, bile acid in gallbladder bile, fecal bile acid was slightly increased in GS guinea pigs after cholecystectomy, to the same degree as normal. These differences, however, were not significant. CONCLUSION: It is concluded that in the guinea pigs with normal gallbladder function, and in the guinea pigs with cholesterol stones: (1) Cholecystectomy produce a similar but less marked trend in bile acid pool; and (2) MMC are linked to enterohepatic circulation of bile acids, rather than surgery, which is consistent with changes of the bile acid pool size. As a result, gastrointestinal dyskinesia is not involved in occurrence of postchole cystectomy syndrome.     

十二指肠镜在诊治腹腔镜胆囊切除术后胆漏中的应用

目的:探讨十二指肠镜在诊治腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后胆漏中的应用.方法:对天津市南开医院2004-06/2010-01十二指肠镜诊治LC术后出现胆漏的32例患者处理方法及效果进行回顾性分析.结果:经十二指肠镜诊查,32例胆漏患者中,胆囊管残端胆漏20例,胆总管...     

正常高值血压患者血浆血管活性因子和抗氧化酶的变化及其意义

目的正常高值血压具有较高的发展成为高血压的危险性。本研究的目的是观察正常高值血压患者血浆中血管活性因子和抗氧化酶的变化,以探讨其在高血压治疗和预防方面的意义。方法根据JNC-7诊断标准筛选病例并分为三组：正常血压组（NT组）为74例正常血压健康人,男性38例,女性36例,平均年龄（47．15±7．77）岁;正常高值血压组（PH组）为51例正常高值血压患者,男性29例,女性22例,平均年龄（47．82±5．16）岁;高血压组（EH组）为71例原发性高血压患者,男性37例,女性34例,平均年龄（48．25±7．97）岁。抽取静脉血,离心后分别采用放免法和酶联免疫法测定血中的血管紧张素Ⅱ（AngⅡ）、内皮素（ET）、血管加压素（AVP）、降钙素基因相关肽（CGRP）、一氧化氮合成酶（NOS）、超氧化物岐化酶（SOD）和谷胱甘肽过氧化物酶（GPX）等含量。结果与NT组相比,EH组和PH组血中甘油三酯、总胆固醇和低密度脂蛋白胆固醇水平明显升高（P〈0．05）;高密度脂蛋白胆固醇在PH组中降低,EH组明显降低（P〈0．05）;AngⅡ、AVP和ET在EH组和PH组均增高（P〈0．05）;CGRP在PH组和EH组均下降（P〈0．05;P〉0．05）;NOS在三组之间无明显的差异;SOD在PH和EH组明显下降（P〈0．05;P〈0．01）而GPX明显增高（P〈0．05;P〈0．01）。结论PH患者血中脂类物质、血管活性物质、抗氧化酶出现了异常变化,这会增加患高血压的可能性。为尽可能减少和防止其进展为高血压,应该对PH患者进行相应的治疗和控制。     

Gallbladder function and dynamics of bile flow in asymptomatic gallstone disease

AIM： To investigate the effects of gallbladder stones on motor functions of the gallbladder and the dynamics of bile flow in asymptomatic gallstone disease. METHODS： Quantitative hepatobiliary scintigraphy was performed to detect the parameters of gallbladder motor function [gallbladder ejection fraction （GBEF）, gallbladder visualization time （GBVT）, gallbladder time to peak activity （GBTmax）, gallbladder half emptying time （GBT1/2）, and transit time of bile to duodenum （TTBD）] in 24 patients with asymptomatic cholelithiasis who were diagnosed incidentally during routine abdominal ultrasonographic examination and 20 healthy subjects with normal gallbladder. RESULTS： Even though there was no significant difference in the clinical and laboratory parameters between the patient and control groups, all parameters of gallbladder function except TTBD were found to differ significantly between the two groups. GBEF in the patient group was decreased （P = 0.000） and GBVT, GBT GBT1/2 in the patient group were longer （P = 0.000, P = 0.015, P = 0.001, respectively）.there were not any clinical and laboratory findings, gallbladder filling and emptying could be impaired in patients with gallstone disease.     

模拟失重对大鼠血浆ghrelin、VIP和胃肠动力的影响

目的探讨模拟失重状态下胃肠激素ghrelin和VIP的改变以及对胃肠动力的影响。方法 32只Wistar大鼠,随机分为4组,每组8只,按模拟失重的时程分为14 d组和21 d组,并分别设立非悬吊14 d对照组和非悬吊21 d对照组。先后进行胃浆膜肌电的描记、葡聚糖蓝2000标记法测定胃残留率和小肠推进率,血浆ghrelin和VIP浓度分别用酶免法(ELISA)和放免法(RI)测定。结果悬吊14 d组与21 d组与相应对照组比较,ghrelin浓度下降VIP浓度升高,同时表现为胃肌电延缓,胃残留率增加;小肠推进率下降,差异均具有统计学意义(P<0.05)。结论模拟失重状态下血浆ghrelin下降和VIP升高可能是导致胃肠动力下降的重要因素之一。     

单中心腹腔镜胆囊切除致胆管损伤近年变化及特点分析

目的总结单中心腹腔镜胆囊切除致胆管损伤近年的变化及特点。方法回顾性分析总结近期组（2003年6月至2009年3月）和早期组（1992年10月至1998年6月）进行腹腔镜胆囊切除术（LC）患者的临床资料,并进行对比分析。结果近期组18613例中发生胆管损伤11例（发生率0．06％）,包括胆管横断伤2例（1例是中转开腹以后发生）、胆管分离性损伤3例、电凝伤2例（肝总管1例、副肝管1例）、胆总管部分剪切伤2例、副肝管横断伤1例、中转开腹肝总管部分缝扎伤1例;早期组11796例中发生胆管损伤15例（发生率0．13％）,包括横断伤6例、电灼胆管侧壁伤6例、分离伤3例。近期组LC致胆管损伤的发生率明显低于早期组（χ2=3．92,P=0．04784）。结论近期组Lc致胆管损伤的发生率较早期组明显降低,损伤程度也在降低,但损伤种类在不断增加,依据胆管损伤的类型进行“个体化”处理可减少胆管进一步损伤以及术后并发症的发生。     

The correlation between cholecystectomy and fecal bile acids,and large-bowel cancer induced with 1,2-dimethylhydrazine in mice

The relationship between cholecystectomy and large-bowel cancer development was investigated in animal models. Female ICR mice underwent cholecystectomy, and received 15 weekly intragastric administrations (Experiment 1) or 10 weekly subcutaneous injections (Experiment 2) of 15 mg/kg body weight of large-bowel carcinogen 1,2-dimethylhydrazine (DMH). Autopsy at 28 weeks after surgery showed that cholecystectomized mice had a nonsignificantly increased incidence of large-bowel carcinomas, compared to sham-operated and/or unoperated control mice (85 vs. 64 percent in Experiment 1; 31 vs. 16 and 20 percent in Experiment 2). Cholecystectomy alone without DMH treatment did not produce any cancer. Cholecystectomized mice excreted a significantly increased level of primary bile acids but an unchanged level of secondary bile acids in the feces, compared with unoperated control mice. It is obvious that cholecystectomy enhanced the development of DMH-induced, large-bowel carcinomas along with the change of fecal bile acid composition, suggesting that changes of bile acid metabolism after cholecystectomy may enhance or promote large-bowel carcinogenesis in man as well. This association of cholecystectomy and large-bowel cancer is not a strong one however, as presented in epidemiologic as well as experimental studies. Supported in part by Grant-in-Aid for Cancer Research from the Ministry of Education, Science, and Culture, and the Ministry of Health and Welfare, Japan.     

腹腔镜胆囊切除术后胆道损伤实施介入治疗的临床价值观察

目的探讨介入治疗在腹腔镜胆囊切除术（LC）后胆道损伤（BDI）中的临床价值。方法回顾性分析并总结1997年6月至2007年5月收治的24例接受介入治疗的LC术后BDI患者的临床资料。结果按刘允怡胆管损伤分类法,24患者中Ⅰ型5例、Ⅱ型11例、Ⅲ型2例、Ⅳ型6例。2例术中发现BDI并中转开腹,但分别于术后10个月和2年出现胆道感染;22例术后发现,其中13例为LC术后3—12d发现,7例为20～60d发现,2例在术后2年发现。24例患者中5例在接受介入治疗后获得治愈,19例在胆管炎和黄疸得到控制后手术治愈。其中LC术后3—12d发现的13例患者中,6例接受急诊手术,均告失败,而直接接受介入治疗的7例中3例治愈,4例在控制胆管炎和黄疸后择期手术治愈。结论LC术后BDI实施介入治疗,建立必要的胆管内支撑和通畅的胆汁引流,不仅可有效控制胆管炎,消退黄疸,获得全面的胆道树影像,有利于增加手术的安全性,甚至可以起到治愈的效果。     

Isolated right posterior bile duct injury following cholecystectomy:Report of two cases

Anatomic variations of the right biliary system are one of the most common risk factors for sectoral bile duct injury(BDI)during cholecystectomy.Isolated right posterior BDI may in particular be a challenge for both diagnosis and management.Herein we describe two cases of isolated right posterior sectoral BDI that took place during laparoscopic cholecystectomy.Despite effective external biliary drainage from the liver hilum in both cases,there was a persistent biliary leak observed which was not visible on endoscopic retrogradecholangiogram.Careful evaluation of images from both endoscopic and magnetic resonance cholangiograms revealed the diagnosis of an isolated right posterior sectoral BDI.These were treated with a delayed bisegmental(segments 6 and 7)liver resection and a Roux-en-Y hepaticojejunostomy respectively with good outcomes at 24 and 4 mo of follow-up.This paper discusses strategies for prevention of such injuries along with the diagnostic and therapeutic challenges it offers.     

内镜治疗和传统治疗对胆囊切除术后胆瘘的诊治疗效对比分析

目的 对比内镜与传统方法治疗胆囊切除术后胆瘘的效果.方法 回顾性分析35例胆囊切除术后发生胆瘘的患者资料,其中传统治疗组18例,采用保守治疗及手术等治疗;内镜组17例,根据病情应用十二指肠镜进行ERCP等内镜治疗.对比2组患者的胆瘘愈合时间、再次手术率、并发症发生情况等.结果 传统治疗组胆瘘部位明确7例,胆瘘愈合时间平均23d,再次手术8例,发生并发症7例;内镜组胆瘘部位明确13例,胆瘘愈合时间平均13 d,再次手术2例,发生并发症3倒.各项指标内镜组均明显优于传统治疗组(P均＜0.05).结论 十二指肠镜能够明确胆囊切除术后胆瘘的部位、性质,能治疗大部分该类患者,并为需外科手术病例提供指导,具有微创、安全、疗效确切等优点.