Caroli氏病1例

Ｃａｒｏｌｉ氏病又称交通性海绵状胆管扩张症 ,1 958年由Ｃａｒｏｌｉ氏首先报道此病 ,本病属先天性胆管扩张的Ｖ型 ,极为罕见。患者　男 ,31岁。间断性右上腹不适 ,腹泻 2年入院。查体 :面色苍白 ,皮肤巩膜无黄染 ,无腹水征。实验室检查 :ＡＳＴ2 8.0Ｕ/Ｌ ,ＡＬＴ 31 .0Ｕ/Ｌ ,γ ＧＴ 2 0 .0Ｕ/Ｌ ,ＡＫＰ 48.0Ｕ/Ｌ ,ＴＢＡ 9.0ｕｍｏｌ/Ｌ ,ＴＰ 79.0 ｇ/Ｌ ,ＡＬＢ 49.0ｇ/Ｌ ,ＧＬＯ 30 .0 ｇ/Ｌ ,Ａ/Ｇ 1 .6 ,ＴＢＩＬ 8.0ｕｍｏｌ/Ｌ ,ＤＢＩＬ 2 .0ｕｍｏｌ/Ｌ ,ＩＢＩＬ 6 .0ｍｍｏｌ/Ｌ ,ＣＨＥ 62 70 0Ｕ/Ｌ。胃镜 :食管、胃…     

彩色多普勒超声引导下经皮气囊导管成形术治疗Budd-Chiari综合征

目的探讨彩色多普勒超声（ＣＤＵ）引导经皮气囊导管成形术（ＰＴＡ）治疗ＢｕｄｄＣｈｉａｒｉ综合征（ＢＣＳ）的可行性及临床实用价值。方法ＢＣＳ患者９例。其中下腔静脉膜型闭塞５例，节段型闭塞２例和狭窄１例；右肝静脉闭塞１例。在ＣＤＵ的引导和监视下，经右股静脉分别对上述患者静脉狭窄或闭塞段进行穿刺和气囊扩张，并根据静脉内径、血流方向及频谱形态决定扩张程度。结果ＣＤＵ可清晰显示导管、导丝、穿刺针及气囊导管在血管中的位置，正确引导术者进行ＰＴＡ治疗，技术成功率１００％；血管形态和血流动力学是判断ＰＴＡ治疗效果的可靠指标。结论ＣＤＵ是一种引导ＰＴＡ治疗ＢＣＳ的安全、可靠方法     

肾上腺髓质素与肾上腺紧张素在维持性血透中的变化

本文应用放免法测定了３２例维持性血透患者透析前后血浆肾上腺髓质素（ＡＤＭ１３－３２）及前体肾上腺素紧张素（ＡＤＭ１５３－１８５）水平，发现ＡＤＭ较正常人明显增高，Ｐ〈０．００１，而ＡＤＭ１５３－１８５明显下降，Ｐ〈０．０１，前者与ＡＭＰ，血浆ＢＵＮ，ＥＴ有明显相关性，ｒ值分别为０．４９２，０．７４３，０．４９２，而后者与ＭＡＰ，ＢＵＮ，ＥＴ无关，血液透析后，ＡＤＭ１３－５２与ＡＤＭ１５３－１８５这     

OSTEOGENIC POTENTIAL OF RABBIT DERMAL FIBROBLASTS CULTURED IN VITRO: A HISTOCHEMICAL AND RADIOAUTO-GRAPHICAL STUDY

ＯＳＴＥＯＧＥＮＩＣＰＯＴＥＮＴＩＡＬＯＦＲＡＢＢＩＴＤＥＲＭＡＬＦＩＢＲＯＢＬＡＳＴＳＣＵＬＴＵＲＥＤＩＮＶＩＴＲＯ：ＡＨＩＳＴＯＣＨＥＭＩＣＡＬＡＮＤＲＡＤＩＯＡＵＴＯ┐ＧＲＡＰＨＩＣＡＬＳＴＵＤＹＣＨＡＩＢｅｎ－ｆｕ（柴本甫），ＴＡＮＧＸｕｅ－...     

A Comparison in Healing of Skull Defect Repaired with Four Different Kinds of Graft Materials in Rabbits

ＡＣＯＭＰＡＲＩＳＯＮＩＮＨＥＡＬＩＮＧＯＦＳＫＵＬＬＤＥＦＥＣＴＲＥＰＡＩＲＥＤＷＩＴＨＦＯＵＲＤＩＦＦＥＲＥＮＴＫＩＮＤＳＯＦＧＲＡＦＴＭＡＴＥＲＩＡＬＳＩＮＲＡＢ┐ＢＩＴＳＤＩＮＧＺｈｅｎ－ｑｉ（丁真奇）１，ＴＡＮＦｕ－ｓｈｅｎｇ（谭富生）２，...     

EXPERIMENTAL STUDY ON EARLY REPAIR OF MANDIBULAR DEFECT FOLLOWING HIGH VELOCITY MISSILE WOUND

ＥＸＰＥＲＩＭＥＮＴＡＬＳＴＵＤＹＯＮＥＡＲＬＹＲＥＰＡＩＲＯＦＭＡＮＤＩＢＵＬＡＲＤＥＦＥＣＴＦＯＬＬＯＷＩＮＧＨＩＧＨＶＥＬＯＣＩＴＹＭＩＳＳＩＬＥＷＯＵＮＤＬＩＵＹａｎ－ｐｕ（刘彦普），ＬＥＩＤｅ－ｌｉｎ（雷德林），ＺＨＡＮＧＨａｉ－ｘｉａ（张...     

中国美利奴羊不同品系随机扩增多态性DNA（RAPD）分析

本实验从８６个随机引物中筛选出１７个特异性引物，对中国美利妈羊新疆军垦型Ａ品系，Ｂ品系，超细品系，多胎品系和Ｕ品系的ＤＮＡ进行ＲＡＰＤ分析。聚类分析结果表明，所有供试材料可被明确区分。实验结果表明，ＲＡＰＤ可作为一种有效的标记用于绵羊品系之间亲缘关系的分析。     

B超对胆管梗阻性病变的鉴别诊断

Ｂ超诊断与鉴别胆管梗阻性病变的报道较少,本研究对我院1993～1997年的89例胆管梗阻性病变的Ｂ超声像图表现进行分析、评价,以提高对该病变的鉴别水平。作者单位　730050　兰州市　兰州军区兰州总医院超声诊断科1　资料与方法89例均经手术、病理证实。男51例,女38例。年龄20～80岁。临床表现;轻微黄疸11例,间歇性黄疸39例,进行性逐渐加深性黄疸37例,未出现黄疸2例。发烧27例,腹痛62例,触及腹部包块9例,伴消瘦40例。采用ＡＬＯＫＡＳＳＤ256型、ＥＵＢ26型、ＡＴＬ超9型及ＡＰＯＯＧＥ800型超声诊断仪,探头频率3.5ＭＨｚ。检查前禁食8～12小…     

EXPERIMENTAL STUDY AND CLINICAL OBSERVATION ON CHANGES OF β-ENDORPHIN AFTER HEAD INJURY

ＥＸＰＥＲＩＭＥＮＴＡＬＳＴＵＤＹＡＮＤＣＬＩＮＩＣＡＬＯＢＳＥＲＶＡＴＩＯＮＯＮＣＨＡＮＧＥＳＯＦβ┐ＥＮＤＯＲＰＨＩＮＡＦＴＥＲＨＥＡＤＩＮＪＵＲＹＺＨＡＮＧＧｕａｎｇ－ｊｉ（张光霁），ＺＨＵＣｈｅｎｇ（朱诚），ＪＩＡＮＧＪｉ－ｙａｏ（江基尧），...     

SUPEKFICIAL RADIA L BRANCH GRAFT WITH VASCULARIZED PEDICLE TO REPAIRLONGDEFECTOFTHERADIALNERVE：AREPORTOF8CASE

ＳＵＰＥＫＦＩＣＩＡＬＲＡＤＩＡＬＢＲＡＮＣＨＧＲＡＦＴＷＩＴＨＶＡＳＣＵＬＡＲＩＺＥＤＰＥＤＩＣＬＥＴＯＲＥＰＡＩＲＬＯＮＧＤＥＦＥＣＴＯＦＴＨＥＲＡＤＩＡＬＮＥＲＶＥ：ＡＲＥＰＯＲＴＯＦ８ＣＡＳＥＳＮｉＡｉ－ｍｉｎ倪爱民ＣｈｅｎＺｈｏｎｇ－ｗｅｉ...     

磁共振胰胆管成像诊断胰胆管合流异常的价值

目的 探讨磁共振胰胆管成像（MRCP）诊断胰胆管合流异常（APBDU）的价值。资料与方法 分析11例患者的MRCP、轴面T2WI及T1WI。测量共通管长度和胆总管宽度,观察APBDU的形式,以及胆管内有无结石和肿瘤等相关疾病。将观察结果与B超及内镜逆行性胰胆管造影（ERCP）检查和／或外科手术所见对照。结果 10例胆总管囊肿型APBDU包括胆管囊状扩张7例,梭形扩张3例;1例非囊肿型APBDU表现为胆总管轻度扩张。胆总管最大直径范围是12～90mm,平均34mm。APBDU的合流形式包括A型7例,B型4例,在MRCP图像测量的共通管长度范围是18～30mm,平均23mm。轴面T2WI显示胆总管或胰管突然蝌蚪或逗点样增粗5例。APBDU相关疾病包括胆囊／胆管结石6例,胆管肿瘤1例,胰腺炎5例。对7例切除的病变胆管和胆囊标本进行病理组织学检查,均有慢性炎症改变。结论 MRCP检查有助于发现和诊断APBDU,轴面T2WI和B超检查阴性结果不能完全排除本病。     

Choledochal cyst and anomalous pancreaticobiliary ductal union in adults: radiological spectrum and complications

Choledochal cyst and anomalous pancreaticobiliary ductal union (APBDU) are considered to be embryologically related to each other, and their complications are clinically important. This article illustrates the key imaging features of choledochal cysts and APBDU and their various associated abnormalities and complications. Complications of common bile duct are more common in APBDU with choledochal cyst, and complications of gallbladder are more common in APBDU without choledochal cyst.     

MRCP在梗阻性黄疸中医辨证分型中的应用研究

目的:探讨磁共振胆胰管成像(MRCP)在黄疸中医辨证分型中的应用价值。方法:对72例梗阻性黄疸患者进行MRI及MRCP检查,同时进行中医辨证分型,并与临床诊断、化验结果或手术和病理结果对比分析。结果:72例梗阻性黄疸病例中医辨证阳黄30例,主要以结石、炎症、先天囊肿为主;阴黄42例,主要以肝内、肝外肿瘤为主,并发现肝外胆管扩张程度阴黄高于阳黄。前者以重度和中度黄疸为主,占38/42,且形态以软藤状为主,占38/42;后者以轻度和中度黄疸为主,占28/30,且形态以枯枝状为主,占17/24。结论:MRCP图像清晰,能清楚显示扩张肝内胆管、胆总管、胆囊的形态、部位以及与周围组织结构的关系,对梗阻性黄疸中医辨证分型的诊断具有一定指导价值。     

Multicystic biliary hamartoma mimicking intrahepatic bile duct cancer

Although multicystic biliary hamartoma of the liver is a rare entity, recently several case reports have been described. The criteria proposed by Zen et al. include the presence of honeycomb-like nodules located around the hepatic capsule that are close to the hepatic falciform ligament and characteristically protrude from the liver.In this report, we present a case of multicystic biliary hamartoma, which also features intrahepatic bile duct dilatation, and could therefore mimic a malignant neoplasm such as bile duct carcinoma. Our case highlights the potential difficulties in differentiating between multicystic biliary hamartoma and bile duct carcinomas under such circumstances.     

Bile duct carcinoma in a focal dilatation of the intrahepatic bile duct

A 40 year old male with bile duct carcinoma arising in a localised dilatation of the intrahepatic bile duct is presented. The patient presented with recurrent upper abdominal pain, fever and jaundice. Computed tomography showed a localised duct dilatation and ultrasound clearly demonstrated a tumor mass arising within the bile duct. At surgery, papillary adenocarcinoma was confirmed. This case suggests that the tumour arose from the pre-existing cyst. A localised dilatation of the bile duct on computed tomography and ultrasound may harbour a bile duct carcinoma.     

Animal model of bile duct dilatation created with minimally invasive surgery

RATIONALE AND OBJECTIVES: The purpose of the study was to evaluate a method of producing obstruction of the common bile duct and concomitant biliary duct dilatation in an animal model. MATERIALS AND METHODS: Laparoscopic placement of a double-balloon occlusion device was used to produce common bile duct obstruction and bile duct dilatation in pigs. RESULTS: One week after the procedure, common bile duct obstruction and dilatation of the biliary tree were demonstrated with either percutaneous transhepatic cholangiography or percutaneous cholecystography. CONCLUSION: The use of this method is technically feasible and provides a useful subacute and chronic animal model of common bile duct obstruction and dilatation of the biliary tree for percutaneous interventional training and research purposes.     

Congenital cystic dilatation of the common bile duct: relationship to anomalous pancreaticobiliary ductal union.

Thirty patients from 15 to 69 years of age with congenital cystic dilatation of the common bile duct were studied. The diagnosis was made by intravenous cholangiography in 70% of the patients and by percutaneous transhepatic cholangiography and/or endoscopic retrograde cholangiopancreatiography in the entire group. Cystic dilatation was also noted in the intraphepatic bile ducts in 12 patients. A union between the common bile and main pancreatic ducts occurred at a high position in 17 of 18 patients in whom both ducts were adequately opacified, forming an abnormally long common channel. One patient with choledochodele had a normal union. The anomalous unions were of two types: the pancreatic duct entering the common duct and the common duct entering the pancreatic duct. The mode of union was correlated with the degree of extrahepatic bile duct dilatation, age of onset, and frequency and severity of symptoms. It is postulated that the congenital anomaly in the union of the two duct systems is the cause of the disease and the congenital choledochocele has a different etiology.     

Dilatation of the common bile duct secondary to a hydronephrotic kidney

Obstruction of the common bile duct secondary to hydronephrosis is uncommon. We observed common bile duct dilatation secondary to marked right hydronephrosis. Following nephrectomy the common bile duct returned to normal size, confirming the suspicion that the dilatation was due to extrinsic compression.     

胆管癌误诊和漏诊的影像学分析

目的：分析胆管癌误诊和漏诊的原因，评价不同检查方法对肝门区胆管癌诊断的价值，提高胆管癌的影像学诊断和鉴别诊断水平。方法：收集31例临床和病理诊断为胆管癌的病例(ERCP检查31例，B超检查31例，25例CT检查，11例行MRCP检查)，回顾性分析不同检查方法的影像学表现。结果：31例中发生在肝门区的胆管癌25例。2例初次ERCP显示胆管内出血，再次行鼻胆管造影后诊断为胆管癌，4例合并有总胆管结石。6例为总胆管中下段癌。初次诊断准确性为90．3％。11例MRCP中9例显示病变，2例显示不满意，7例显示胆管或胆囊结石。25例CT中23例显示肝内胆管扩张，9例显示肝门区肿块，2例见后腹膜转移淋巴结，1例见肝内多发性转移瘤。12例初次诊断正确(48％)。B超检查23例提示肝内胆管扩张，6例提示总胆管结石，18例诊断为胆囊炎、胆囊结石，8例提示胆管占位(25．8％)。结论：良好的直接胆管造影是诊断胆管癌的金标准，MRCP可以在一定程度上准确显示病变的范围，是ERCP的良好补充，很大程度上取代了诊断性ERCP；CT诊断的关键在于显示扩张的胆管和梗阻的定位，肝门区梗阻多为胆管癌所致。多种影像检查方法的结合明显提高了诊断的准确性，对胆管癌治疗方案的选择有重要价值。     

Bile duct calibre: the discrepancy between ultrasonic and retrograde cholangiographic measurement in the post-cholecystectomy patient

The discrepancy between bile duct measurements obtained by ultrasound and retrograde cholangiography in post-cholecystectomy patients was prospectively evaluated by performing real-time biliary tract sonography on 50 patients 2-3 h prior to endoscopic retrograde cholangiography (ERC). A significant discrepancy was detected (P less than 0.001) which was greatest in 14 patients shown by cholangiography to have duct dilatation without evidence of biliary tract disease (P much less than 0.001). Factors contributing to the discrepancy included: measurement of different regions of the duct by the two techniques, loss of duct wall elasticity producing a 'floppy duct' phenomenon, the capacity of the biliary tract for rapid spontaneous change in calibre, radiographic magnification and ultrasonic underestimation of duct diameter. The sonographic diameters were significantly correlated to the diameters measured by ERC (r = 0.73). Although ERC generally agreed with ultrasound in the diagnosis of duct dilatation (specificity 90%), there was significant disagreement between the two techniques in the detection of non-dilatation, dilated or 'dilatable' systems being missed by ultrasound in 11 out of 21 (52%) of cases in which they were found by ERC. Our results suggest that, in the investigation of the symptomatic post-cholecystectomy patient, direct comparison of bile duct size measured by ultrasound and ERC is of limited clinical value.