阻塞性黄疸诊断方法的探讨

阻塞性黄疸是临床上常见的症状,但要鉴别肝内或肝外阻塞,确定阻塞的部位和病因仍不容易。本文仅在临床症状、体征、实验室检查、B型超声扫描、碘~(131)-玫瑰红肝扫描和经皮肝穿刺胆道造影等方面来探讨阻塞性黄疸的诊断问题。     

~(131)碘——玫瑰红肝胆排泄试验在梗阻性黄疸鉴别诊断上的应用

黄疸是临床上常见的征候之一。尽管应用临床生化及X光检查,有时仍难得到较明确的诊断。为了对梗阻性黄疸提供有价值的鉴别诊断指标,我科于80年4月开始对70余例黄疸病人进行了~(131)碘—玫瑰红(简称~(131)I—RB)肝胆排泄试验,其中29例经剖腹探查、胰胆管造影等己获明确诊断。现     

胆汁淤积型肝炎~(99m)Tc-EHIDA与~(99m)Tc-MIBI肝胆显像对比研究

目的探讨~(99m)Tc-MIBI肝胆动态显像是否可用于婴儿肝炎综合征和先天性胆道闭锁的鉴别诊断,为临床诊治提供依据。方法随机抽取34例~(99m)Tc-EHIDA SPECT肝胆动态延迟显像肠道不显影而最终临床诊断为胆道闭锁的患儿作为观察组,10例同期临床诊断为肝炎综合征的患儿作为对照组,在行~(99m)Tc-EHIDA肝胆显像后次日行~(99m)Tc-MIBI肝胆显像;对比分析~(99m)Tc-EHIDA与~(99m)Tc-MIBI肝胆显像在婴儿先天性胆道闭锁及婴儿肝炎综合征的影像特征。结果 34例观察组和10例对照组~(99m)Tc-MIBI肝胆显像均出现肠道显影,且肠道放射性分布出现时间较早,提示肠道放射性并非来自肝胆排泄而是肠道自身的摄取。结论对于~(99m)Tc-EHIDA SPECT肝胆显像肠道未出现放射性核素影像的黄疸患儿,~(99m)Tc-MIBI肝胆显像对于婴儿肝炎综合征和先天性胆道闭锁的鉴别诊断价值有限。     

~(131)I～RB肝胆动态显像对黄疸鉴别诊断的临床评价

我们自1979年以来,用~(131)碘～玻瑰红(~(131)I～RB)肝胆动态显像的方法,对病人进行了271例检查(哲盟医院200例,内蒙古医学院附院35例,包头医学院36例)其中无黄疸肝功能正常(正常对照)70例肝细胞性黄疸73例,肝外阻塞性黄疸128例(不全阻塞占59例)。     

~(131)I—RB 肝胆扫描在黄疸病人中的应用(摘要)

<正> 我院自1976年以来,用~(131)Ⅰ—RB(玫瑰红)对136例黄疸患者进行了肝胆扫描,其中46例经手术、病理确诊为肝胆系统疾病,现就其在黄疸患者中的应用价值,进行分析、探讨。本文在扫描结果判断上共分四型:肝内梗阻性黄疸;肝外不完全梗阻性黄疸;肝外完全     

根据红细胞碘~(131)与血浆碘~(131)的比率测定甲状腺机能状态

血浆中的碘~(131)以两种形式存在,一种是无机碘~(131),一种是蛋白结合碘~(131)。无机碘~(131)能穿透红细胞的细胞膜进入红细胞内,蛋白结合碘~(131)不能穿透红细胞的细胞膜而存留在血浆中。在服碘~(131)后24小时,红细胞内碘~(131)和血浆中碘~(131)就达到了平衡。甲状腺机能正常时,红细胞碘~(131)与血浆碘~(131)有一定的比率。甲状腺机能亢进时,血浆中蛋白结合碘~(131)增高,无机碘~(131)减少,比值下降。甲状腺机能减退时,血浆中蛋白结合碘~(131)减少,无机碘~(131)增高,比值升高。因此,根据红细胞碘~(131)与血浆碘~(131)的比率可以测定甲状腺机能状态。我们根据这个原理共测定了93例,其中甲状腺机能正常者30例,甲     

血,尿β2微球蛋白RIA和肾图联合检查对肾功能的评价

β_2微球蛋白(β_2M)自从1968年被发现以来,已广泛用于肾脏疾病的检查.~(131)碘一邻碘马尿酸钠(~(131)I—OIH)肾图也是临床常用的肾功能检查方法.本文对32例慢性肾炎,38例结石患者的血、尿β_2MRLA测定及~(131)I—OIH肾图的检查结果,以单一与组合检查的临床意义,进行了分析总结.     

放射性同位素扫描诊断甲状腺肿瘤的临床应用

我科五年来(1973年5月～1978年4月),用~(131)碘、~(99m)锝进行甲状腺扫描检查甲状腺肿瘤393例,其中经手术或病理切片证实的有105例,现小结如下: 一、一般资料 105例患者中男性31例、女性74例。男:女为1:2.4。年龄在13～65岁之间。药物及方法:用~(131)碘扫描,常规地先测甲状腺吸~(131)碘功能后按以下公式计算扫描剂剂量微居里。口服     

常规肺功能与肺胺代谢功能初步探讨

本文报告了36例研究对象肺廓清~(131)I-三甲基羟基-间碘-苯二胺(~(131)I-HIPDM)结果,其中31例作了常规肺功能及动脉血气检查。结果表明不同组间肺廓清~(131)I-HIPDM速率不同,能形成一个新的肺功能障碍指数。右肺廓清~(131)I-HIPDM快相与用力肺活量(FVC)、第1秒用力呼气量(FEV_1)、功能残气量(FRC)、残气量(RV)肺总量(TLC)相关P<0.01;与最大呼气流量(PEFR)、肺活量(VC)、最大通气量(MVV)、动脉血氧分压(PaO_2)相关P<0.05。肺廓清~(131)I—HIPDM速率反映了肺功能状态,对疾病分期及早期肺功能损伤检测优于常规肺功能。     

兔急性心肌梗死模型血运再通的实验研究

目的:研究急性心肌梗死血运再通与心交感神经损伤关系。方法:完全闭塞12只雄性新西兰大白兔冠状动脉左前降支45min后血运再通4h,以131碘-间位碘代苄胍(131I-MIBG)、99m锝-甲氧基异丁基异腈(99mTc-MIBI)双核素放射自显影,并对照两种自显影与TTC组织染色间的联系。结果:血运再通4h,TTC组织染色面积缺损百分比小于无血运再通组,131I-MIBG及99mTc-MIBI自显影在同一区域摄取存在差异性,以急性无血运再通组,131I-MIBG缺损面积(38.8±3.1)%比组织TTC染色及99mTc-MIBI显影缺损大(P<0.001)。结论:急性无血运再通心肌梗死,心交感神经末梢颗粒损害敏感早而广,血运再通早能阻止神经损伤,本实验以MIBG显影,能够监测心肌梗死病变心交感神经活性改变。     

新生儿消化道常见畸形治疗进展

新生儿先天性畸形是婴儿死亡的重要原因之一。新生儿消化道畸形的发生率在新生儿先天性畸型中居第三位,常需进行手术治疗。该文介绍了食道闭锁、先天性幽门肥厚狭窄、小肠闭锁、先天性巨结肠及胆道闭锁等畸形手术治疗的进展。     

胆道闭锁和新生儿肝炎肝脏的电镜观察

对6例胆道闭锁患儿和3例新生儿肝炎患儿肝脏进行了透射电镜的观察。发现胆道闭锁患儿肝细胞质内高电子密度物质(EDM)较新生儿肝炎患儿为多。认为其与胆汁淤滞有密切关系。推测其为胆色素性物质。胆道闭锁患儿毛细胆管数量较新生儿肝炎患儿为多,管腔稍有扩张。还可见到胆道闭锁患儿毛细胆管处细胞连接破坏现象。这些可能是胆管梗阻,胆管内压增高所致。     

先天性胆道闭锁的早期诊断研究进展

先天性胆道闭锁是新生儿胆汁淤积症最常见的病因,也是小儿肝移植的主要指征,如果不及时诊治,可导致患儿进行性肝纤维化、胆汁淤积性肝硬化甚至死亡。目前普遍认为及时行Kasai术或肝移植可明显改善先天性胆道闭锁患儿预后,因此其早期鉴别诊断极其重要。然而,先天性胆道闭锁与其他原因引起的新生儿胆汁淤积症早期在临床表现、实验室检查以及影像学特征方面存在着诸多共同点,给临床鉴别诊断带来极大困难。过去的十年里,各种无创性检查诊断先天性胆道闭锁取得了很大进展,包括早期筛查,特征性生物标志物的研发,超声检查定性、定量指标的完善,放射性核素肝胆动态显像价值所在的明确,经内镜逆行胰胆管造影术及磁共振胰胆管造影应用的探索等。但目前临床上尚无一种同时具有高敏感性和特异性的无创性早期鉴别诊断先天性胆道闭锁的方法。术中胆道探查、造影仍是目前诊断先天性胆道闭锁的最准确的方法,但该法的有创性及对术者的高要求限制了其在临床上的应用。本综述在阐述临床常用早期鉴别诊断先天性胆道闭锁方法特点的基础上,进一步探索了多学科、多技术联合应用早期鉴别诊断先天性胆道闭锁的最佳策略,为提高先天性胆道闭锁早期鉴别诊断的敏感性、特异性提供参考。      

Screening for biliary atresia

Biliary atresia is a severe progressive cholangiopathy which leads to early liver cirrhosis and is uniformly fatal. Early surgical intervention (the Kasai procedure) is needed for an improved outcome. However, early recognition and diagnosis is not easy during the neonatal period because of the high incidence of neonatal jaundice, ill-informed and less than urgent appraisal of the clinical manifestations among jaundiced neonates. A mass screening program for biliary atresia using a stool color card was conducted in Taiwan from March 2002 (in 49 hospitals and clinics) to December 2003 (in 95 hospitals and clinics). The stool color card for infants has proved to be a sensitive and specific screening method for biliary atresia in infants younger than two months of age.     

先天性胆道闭锁肝内毛细胆管超微结构与临床预后关系探讨

目的　探讨先天性胆道闭锁 (CBA)肝内毛细胆管超微结构与临床预后的关系。方法　用PHILIPSCM10透射电镜观察肝内毛细胆管超微结构 ,比较肝组织电镜切片中发育良好与发育不良的毛细胆管数目 ,并与临床预后作比较。结果　 2 5例CBA患儿中 ,肝内毛细胆管发育良好为主的 13例 ,其中 12例术后生存 ,生存率为 92 3% (12 / 13) ;毛细胆管发育不良为主的 12例中 ,仅有 4例生存 ,生存率为 33 3% (4 / 12 ) ,两组生存率有显著性差异 (P <0 0 5 )。结论　肝内毛细胆管的发育情况可作为初步判断术后临床预后指标之一。     

Biliary atresia associated with meconium peritonitis

Biliary atresia, malrotation, meconium peritonitis and transient hypothyroidism are occasionally seen in neonatal infants. Biliary atresia associated with malrotation has been reported in some patients with polysplenia syndrome, but biliary atresia associated with meconium peritonitis has only been described by a few investigators. Here we present a case of meconium peritonitis due to malrotation with volvulus, followed by biliary atresia and transient hypothyroidism during early infancy.     

Biliary atresia--translational research on key molecular processes regulating biliary injury and obstruction

Biliary atresia is the most common cause of pathologic jaundice in young infants and results from the obstruction of the extrahepatic bile ducts by an inflammatory and fibro-obliterative process. Although the pathogenesis of the disease is multifactorial, recent patient- and animal-based studies began deciphering the molecular pathways involved in biliary injury and duct obstruction. Using large-scale genomics and immunostaining of livers from children with biliary atresia, investigators have discovered unique molecular signatures of dominant proinflammatory cytokines at the time of diagnosis. To study hypotheses generated from these patient-based studies, the anatomical and inflammatory profiles of a mouse model of rotavirus-induced biliary atresia were analyzed and found to share striking similarities with the human profiles. Then, using these mice in mechanistic studies, interferon-gamma (IFNgamma) has been shown to regulate the biliary tropism of lymphocytes to the biliary system, and to play a critical role in the inflammatory obstruction of extrahepatic bile ducts. The ability to combine human studies with a laboratory model of neonatal biliary injury and obstruction opens a new era of opportunities to advance the field of biliary atresia, and to develop new therapeutic strategies to improve long-term outcome with the native liver of children with biliary atresia.     

Characteristics of Malaysian infants with biliary atresia and neonatal hepatitis

Cholestatic disorders of infancy (viz neonatal hepatitis and biliary atresia) have not been well studied in Malaysia. In a retrospective study in the Department of Paediatrics, University Hospital, Kuala Lumpur from January 1982 through December 1991, a total of ninety-three infants with such conditions were identified: 35 (38%) had biliary atresia, 58 (62%) neonatal hepatitis. There was a statistically significant male preponderance in the neonatal hepatitis group (P = 0.020). There was no significant difference in the racial distribution and in the proportions of low birthweight infants between the two groups of disorders. When the biliary atresia group was compared with the neonatal hepatitis group, significant differences were observed in the age of presentation (mean +/- SD) 9.8 +/- 6.8 VS 20 +/- 17.3 weeks (P < 0.001), proportion of infants with prolonged jaundice (> seven weeks) 28/35 (80%) VS 20/58 (34.5%) (P < 0.00001), occurrence of alcoholic stools 26/35 (74.3%) VS 27/58 (46.6%) (P = 0.020), liver size (mean +/- SD): 4.3 (1.6 cm VS 3.3 +/- 1.8 cm (P < 0.01) and splenic size: 2.5 (1.8 cm VS 1.4 (1.2 cm (P < 0.001). There was however considerable overlap between the two groups in these features at presentation, making clinical differentiation between the two conditions difficult. Infants with cholestasis tended to present late, compromising the chance of survival. In order to improve the medical care of these patients, these conditions must be emphasised during the training of medical practitioners, and efforts to increase public awareness of these conditions must be created.     

Neonatal jaundice: the surgical viewpoint.

There is good evidence that neonatal hepatitis, biliary hypoplasia, biliary atresia and choledochal cyst are different stages of one disease process for which the term infantile obstructive cholangiopathy has been suggested. Thanks to the work of Kasai and the operation of hepatic portoenterostomy the surgical outlook has greatly improved, although in North America it still leaves much to be desired. One cannot procrastinate too long in the hope that the patient's condition will improve spontaneously, because the surgical results are much better when the operation is performed before the patient is 10 weeks old. This article outlines the steps that should be followed in investigating neonatal jaundice, the nonsurgical measures that can be taken in an attempt to reverse or alleviate the underlying condition, and the specific role of the pediatric surgeon in the management of choledochal cyst and biliary atresia.     

新生儿先天性心脏病的急诊处理(附25例分析)

25例新生儿中患有动脉导管未闭10例、室间隔缺损4例、主动脉缩窄5例、主动脉中断2例、主动脉瓣狭窄、三尖瓣闭锁、肺动脉瓣闭锁、大血管转位各1例,报告了治疗经过,结合文献讨论了新生儿先天性心脏病的分类及治疗。