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1.
目的探讨急性胆石性胰腺炎复发的预防方法.方法对1999年1月~ 2001年7月入院并治愈的112例急性胆石性胰腺炎患者的临床资料进行分析、随访.所有患者均为首次发病且未行胆囊切除术.根据是否行内镜下Oddi括约肌切开术 (endoscopic sphincterotomy, EST),将所有患者分为EST组和非EST组,并根据是否行胆囊切除术进一步分组,比较各组胆石性胰腺炎复发率.结果平均随访18.5个月(6 ~ 30个月).EST组38例,其中16例行胆囊切除术,均无胆石性胰腺炎复发(0/38);非EST组74例,14例胆石性胰腺炎复发(14/74),复发率为18.9%,两组有显著差异(P < 0.01).在非EST组中,胆囊切除29例,2例胆石性胰腺炎复发(2/29),复发率为6.9%;未作胆囊切除45例,12例胰腺炎复发(12/45),复发率为26.7%,胆囊切除后胰腺炎复发率显著降低(P < 0.05).复发距患者出院时间为2周至2年不等.对2例胆囊切除术后复发的胆石性胰腺炎行ERCP,均发现有胆总管结石,EST后,无胰腺炎发作.结论 EST能有效预防胆石性胰腺炎复发,并具有创伤小、恢复快等优点,适合于高龄、一般情况差、不能耐受手术的患者;胆囊切除能降低胰腺炎复发率,胆总管结石是胆囊切除术后胰腺炎复发的主要原因. 相似文献
2.
乳头切开术治疗胆总管结石远期并发症及其与胆囊结石关系的研究 总被引:1,自引:0,他引:1
目的 探讨内镜下十二指肠乳头括约肌切开术(EST)治疗胆总管结石患者的远期治疗效果,评估EST术后胆囊切除的必要性.方法 对2006年1月至12月因胆总管结石而行EST治疗257例患者进行随访,所有患者平均随访时间为34.8个月(26~48个月).根据不同病情和处理情况分为3组进行比较,合并有胆囊结石的患者EST术后行胆囊切除为A1组,EST术后未行胆囊切除为A2组;B组为未合并胆囊结石者.结果 出现远期并发症者31例(12.1%),胆总管结石复发25例(9.7%),胆管炎27例(10.1%),胰腺炎2例(0.8%),胆管癌1例(0.4%);A2组患者远期并发症发生率、胆总管结石复发率均高于A1组(P均〈0.05).结论 从远期疗效来看,EST是治疗胆总管结石的安全、有效的方法,对于合并有胆囊结石的患者EST术后行胆囊切除是有必要的. 相似文献
3.
目的 探讨内镜下十二指肠乳头括约肌切开术(EST)治疗胆总管结石患者的远期治疗效果,评估EST术后胆囊切除的必要性.方法 对2006年1月至12月因胆总管结石而行EST治疗257例患者进行随访,所有患者平均随访时间为34.8个月(26~48个月).根据不同病情和处理情况分为3组进行比较,合并有胆囊结石的患者EST术后行胆囊切除为A1组,EST术后未行胆囊切除为A2组;B组为未合并胆囊结石者.结果 出现远期并发症者31例(12.1%),胆总管结石复发25例(9.7%),胆管炎27例(10.1%),胰腺炎2例(0.8%),胆管癌1例(0.4%);A2组患者远期并发症发生率、胆总管结石复发率均高于A1组(P均〈0.05).结论 从远期疗效来看,EST是治疗胆总管结石的安全、有效的方法,对于合并有胆囊结石的患者EST术后行胆囊切除是有必要的. 相似文献
4.
5.
目的探讨内镜逆行胰胆管造影(ERCP)十二指肠乳头括约肌切开(EST)诊断、治疗胆总管结石的临床效果和价值。方法163例临床诊断胆总管结石者行ERCP检查,造影成功159例,150例确诊为胆总管结石并经内镜行乳头括约肌切开术。结果胆总管结石ERCP与临床诊断符合率为94.3%;胆总管结石150例,取石成功141例,成功率94.0%;EST术后发生急性胰腺炎4例,少到中等量肠道出血3例,高淀粉酶血症5例,无肠穿孔、大出血及死亡等并发症发生。结论ERCP可提高胆管结石的诊断准确率;EST取石是肝外胆管结石治疗的优良方法,对已作胆囊切除后肝外胆管残留或复发结石并应为首选治疗方法。 相似文献
6.
目的回顾分析急性胆源性胰腺炎(ABP)复发的临床特征及原因。方法对2004-01~2008-07收治的115例ABP患者的临床资料进行回顾性分析。结果 115例的随访观察时间为6~54个月,平均为27.6个月。常规内科治疗组63例,20例复发,复发率为31.7%;内科治疗辅助胆囊切除术组52例,6例复发,复发率为11.5%,常规内科治疗组的复发率高于内科治疗辅助胆囊切除术组(P0.01)。结论切除胆囊能降低胰腺炎复发率,胆总管结石是胆囊切除后胰腺炎复发的主要原因。 相似文献
7.
目的:分析腹腔镜胆囊切除前后急性胰腺炎的临床特点,了解其相关的影响因素。方法回顾性分析30例胆囊切除前急性胆源性胰腺炎( A组)和30例腹腔镜胆囊切除后急性胰腺炎( B组)的临床资料。结果 A组的病因均为胆囊结石,且其中24例为胆囊多发小结石;B组占同期所有病因导致急性胰腺炎的8.9%,其中16例为胆源性胰腺炎,6例病因未明,10例为复发性。 A组DBIL/TBIL、GGT异常例数均多于B组( P均<0.05)。肝功能检验指标比较两组间差异无统计学意义( P>0.05)。结论胆囊切除前急性胆源性胰腺炎的主要病因是胆囊多发小结石,多数病例DBIL/TBIL(>50%)及GGT高于正常,腹腔镜胆囊切除术后急性胰腺炎的主要病因为胆总管结石,并且具有复发性。 相似文献
8.
目的探讨不同的常用内镜治疗方法对胆总管结石青年患者治疗后结石复发的影响以及结石近期复发、远期复发的危险因素。方法选择经一次性治疗性内镜逆行胰胆管术(ERCP)成功取石后随访资料完整的胆总管结石青年(21~45岁)患者,按手术方式分为内镜下乳头球囊扩张术(EPBD)组、乳头括约肌切开术(EST)组、EST(切开〈0.5cm)+EPBD组,进行随访,统计近期(≤3年)及远期(〉3年)结石复发率,并对复发危险因素进行Logistic回归分析。结果资料完整的327例患者平均随访76.5个月,54例(16.5%)结石复发,其中近期复发35例(10.7%),远期复发19例(5.8%)。近期胆总管结石复发率EPBD组(11.3%)和EST组(13.2%)均高于EST+EPBD组(8.1%),但无统计学差异(P均〉0.05)。远期胆总管结石复发率EPBD组(11.3%)和EST组(6.6%)均显著高于EST+EPBD组(0.8%),差异具统计学意义(P均〈0.05)。Logistic回归分析结果表明,胆囊结石、结石最大径、结石个数、机械碎石与近期结石复发显著相关(P〈0.05),而远期胆总管结石复发则与结石最大径及单纯球囊扩张显著相关(P〈0.05)。结论对于胆总管结石青年患者,单纯EPBD取石固然可保留乳头括约肌功能,但增加了结石的远期复发风险,而乳头括约肌小切开联合EPBD取石可显著降低胆总管结石复发率。 相似文献
9.
目的探讨内镜下乳头括约肌切开(endoscopic sphincterotomy,EST)对预防急性胆源性胰腺炎(acutebiliary pancreatitis,ABP)复发的临床价值。方法将临床治愈的296例ABP患者分为EST治疗组(n=119)和非EST对照组(n=177)。将两组患者进一步分为胆囊切除组和非胆囊切除组。随访所有ABP患者,比较两组复发率有无显著差异。结果两组ABP患者平均随访时间32±14月;15例失访,随访率94.9%。EST治疗组(11/113)的复发率明显低于非EST治疗组(75/168),差异有显著性(P〈0.01);胆囊切除虽然能降低ABP的复发率,但其差异无显著性地(P〉0.05)。结论应用EST技术治疗ABP,可预防ABP的再次发作。 相似文献
10.
内镜治疗急性胆源性胰腺炎的临床评价 总被引:1,自引:0,他引:1
目的探讨内镜治疗急性胆源性胰腺炎(acute biliary pancreatitis,ABP)的临床效果。方法将89例急性胆源性胰腺炎随机分为内镜治疗组和对照组,两组均给予内科常规综合治疗.内镜治疗组在入院48小时内行逆行胆管造影(Endoscopic retrogade cholangiography,ERCP),胆总管结石行乳头肌切开(Endoscopic sphincteropapillotomy,EST)+网篮取石,如胆总管结石多且大、无法一次取尽者或未发现结石,则行鼻胆管引流(Endoscope nasobiliary drainage,ENBD),胆囊结石、胆总管扩张、乳头狭窄、反复多次发作胰腺炎.虽胆总管未见结石也行乳头肌中小切开。结果内镜治疗组在腹痛消失时间、血淀粉酶恢复时间、住院时间、胰腺炎随访复发率等与对照组有显著差别。结论内镜治疗ABP安全有效,且能减少ABP的复发。 相似文献
11.
目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤,因其临床表现多样,导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用,拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点,以期有助于提高影像学的诊断准确率和降低漏诊率,尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。
方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料,检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例,通过查阅病例的方法,提取出胰岛素瘤的大小和解剖分布等数据,进一步分析其特点。
结果共检索到确诊为胰岛素瘤的患者116例,其中,男45例、女71例,年龄13~76岁,平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布:头颈部46例(39.7%),单发45例、多发1例;体尾部68例(58.6%),单发65例、多发3例;全胰腺多发2例(1.7%)。病变大小特点:最大径0.4~3.4 cm,平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例,≤3 cm 15例,>3 cm 3例。年龄与肿瘤的大小相关,≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm,P<0.05。头颈部的肿瘤大于体尾部的肿瘤,头颈部肿瘤平均大小(1.66±0.63)cm,体尾部(1.42±0.52)cm,P<0.05。
结论胰岛素瘤在胰腺体尾部较头颈部更好发;绝大多数单发,但可以全胰腺多发;多数小于1.5 cm,肿瘤的大小与患者年龄和肿瘤的解剖分布相关。 相似文献
12.
Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa. 相似文献
13.
Sergio Muntoni Paola Tagliamonte Federico Sirigu Giovanni Umberto Corsini 《Acta diabetologica》1973,10(6):1300-1307
Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting
oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory
effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts
for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides.
There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from
being transported across the mitochondrial membrane to the site of oxidation.
Traduzione a cura degli AA. 相似文献
14.
P. Brar G.Y. Kwon I.I. Egbuna S. Holleran R. Ramakrishnan G. Bhagat P.H.R. Green 《Digestive and liver disease》2007,39(1):26-29
BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease. 相似文献
15.
血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。 相似文献
16.
目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。 相似文献
17.
氯硝柳胺悬浮剂的毒性评价 总被引:2,自引:2,他引:2
目的评价氯硝柳胺悬浮剂的毒性,为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg,经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3,该药经口、经皮肤、经呼吸道毒性均属微毒类药物;兔眼用药后,观察期内无不良反应,对眼无刺激性;皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比,氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物,对鱼的毒性低于其乙醇胺盐可湿性粉剂,适合于现场应用。 相似文献
18.
The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile
chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared
to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL.
The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with
pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other
types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients
had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA
was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm
these results, as the number of subjects in the three groups was rather low.
Received: 26 September 2001 / Accepted: 8 February 2002 相似文献
19.
Marc B. Taub Thomas A. Peyser J. Erik Rosenquist 《Journal of diabetes science and technology》2007,1(5):685-694
Background
A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl−1•min−1 (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl−1•min−1 (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.Method
Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.Results
The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.Conclusions
The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions. 相似文献20.
Toshihide Iijima M.D. 《Diseases of the colon and rectum》1988,31(1):46-49
Angiography using Prostaglandin El® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon. 相似文献