清醒状态下兔Oddi括约肌肌电活动检测模型的建立

目的：建立清醒状态兔Oddi括约肌（SO）肌电检测的动物模型,研究其肌电活动特征。方法：将成年家兔麻醉后,于胆囊底部置管一根;将十二指肠大乳头对系膜缘与间置的空肠袢远端吻合,空肠袢关闭后与胆囊内置管分别埋置于皮下,恢复14d后用环状电极进行清醒状态下SO肌电检测。对其消化间期、进食后、外源性胆囊收缩素（CCK）泵注下SO肌电幅值、频率及每分钟运动指数进行分析。结果：利用该模型可以在清醒状态下稳定记录到SO肌电活动,表现为慢波恒定基础上快波的周期性变化,进食后SO的快波增强,外源性CCK对兔SO的肌电有兴奋作用。结论：清醒状态下SO肌电活动检测更能反映括约肌的功能状态,这为今后研究病理状态下SO的活动提供了技术平台。     

跨越壶腹部支架对犬胆道压力和Oddi括约肌病理学影响的实验研究

目的:探讨跨越壶腹部支架置入后犬胆道压力和Oddi括约肌(sphincter of Oddi,SO)病理学的变化机制.材料与方法:选取成年实验犬5只,建立经皮经肝胆囊穿刺和跨越壶腹部置入金属支架的模型,应用胆道测压的方法比较支架置入前和支架置入5周后十二指肠压(duodenal pressure,DP)、SO基础压(sphincter of Oddi basal pressure,SOBP)、收缩幅度(sphincter of Oddi contractive amplitude,SOCA)、收缩间期(sphincter of Oddi duration,SOD)以及胆总管压(common bile duct pressure,CBDP)的变化.同时,应用胶原纤维染色观察支架置入后SO的病理变化.对实验所获得的计量资料采用配对t检验进行比较,P<0.05为差异有统计学意义.结果:以DP作为零点,获得其他各项指标的相对值结果.支架置入前SOBP、SOCA、SOD、CBDP分别为:13.69±4.29mmHg、42.65±8.50mmHg、6.69±1.46s、12.98±2.86mmHg;支架置入5周后分别为:10.58±3.98mmHg、31.95±9.00mmHg、4.47±1.21s、7.43±2.20mmHg,其中SOCA较支架置入前降低,SOD相比支架置入前缩短,两者的差异均有统计学意义(P<0.05).而CBDP明显低于支架置入前,差异具有统计学意义(P<0.05).支架置入5周后,壶腹部SO肌层中发生了不同程度的纤维化、腺体病变和炎性反应等病理变化.结论:跨越壶腹部植入支架5周后,SO运动功能的减弱以紧张性收缩的减弱为主,而基础性收缩仍然存在.CBDP虽然下降,但仍高于正常的DP,并保持与之的压力梯度,从而为抑制肠胆反流提供了可能.而壶腹部SO肌层中则发生了不同程度的纤维化、腺体病变和炎性反应等病理变化.     

高胆固醇对Oddi括约肌舒缩性与[Ca2+]i的影响

目的探讨高胆固醇对Odd i括约肌张力及细胞内钙离子浓度的影响。方法新西兰兔16只随机分为2组,对照组8只,实验组8只,分别对对照组及实验组兔行Odd i括约肌测压、造影、胆管括约肌(SO)细胞中钙离子浓度测定。结果对照组兔血清胆固醇浓度<3 mmol/L,实验组兔血清胆固醇浓度约30 mmol/L左右;胆管造影显示实验组造影剂排空时间延迟,Odd i括约肌狭窄;Odd i括约肌近侧段基础压力测定,对照组和实验组分别为1.56 kPa和3.41 kPa(P<0.01),Odd i括约肌高压带(HPZ)压力分别为9.24 kPa和19.27 kPa(P<0.0.1);SO细胞中钙离子浓度测定显示实验组较对照组升高。结论高胆固醇血症可引起细胞内钙离子浓度升高及Odd i括约肌张力持续升高。     

闭塞膈下动脉对兔膈肌运动功能影响的实验研究

目的 观察膈下动脉闭塞后缺血对膈肌生理特性的影响.方法 结扎闭塞新西兰大白兔右侧膈下动脉,制作兔右侧膈肌缺血的模型,并随机分为3组,分别于24 h、48 h和1周后观察双侧膈肌运动变化和病理变化.结果 ①闭塞右侧膈下动脉24 h、48 h,右侧膈肌运动幅度分别为(3.53±0.76)mm、(3.44±0.70)mm;与术前和术后左侧运动幅度及术前右侧膈肌运动幅度相比明显减低,差异均有统计学意义(P＜0.05).②闭塞右侧膈下动脉24 h、48 h,右侧膈肌运动幅度与膈肌缺血区重量有相关性(r24 h =-0.874;r48 h=-0.906).③1周后观察膈肌运动功能均恢复正常.结论 闭塞膈下动脉可以引起膈肌可逆性缺血改变,但不会引起膈肌大面积坏死及膈肌运动功能的永久损伤.     

豚鼠壶腹Cajal样细胞的分布及Oddi括约肌肌电活动观察

目的 研究成年豚鼠壶腹处Cajal样细胞(ICLC)的分布及Oddi括约肌(SO)的肌电活动.方法 取成年豚鼠壶腹全层铺片,c-Kit免疫细胞化学染色观察ICLC的分布情况;采用黏膜接触电极记录豚鼠SO的肌电活动.结果 壶腹的外侧壁和内侧壁均可观察到c-Kit阳性ICLC,位于环形和纵行平滑肌层内以及两层平滑肌之间.肌内的ICLC细胞呈梭形.肌间的ICLC胞体呈椭圆形或三角形,发出3个以上的有分支的突起,这些细胞相互连接排列成网络状,与十二指肠的肌间丛Cajal间质细胞(IOCs)十分相似.在壶腹外侧壁的内面ICLC与十二指肠的深肌丛ICCs相似.壶腹的内侧壁肌层有大量的ICLC,与平滑肌细胞平行走行.在壶腹开口处,ICLC围绕开口形成一个ICLC环.在SO记录到自发节律性的肌电活动波.结论 壶腹内的ICLC可能参与SO自主节律性运动的调控并与SO运动障碍的发生有关.     

99Tcm-DTPA直接肠道灌注检测肠胆反流

目的 探讨用放射性核素检查判断T型管引流术后患者是否存在肠胆反流及其与Oddi括约肌运动功能之间的关系.方法 胆道术后留有T型管患者78例,用99Tcm-DTPA判断是否存在肠胆反流,并根据结果将患者分为反流组及对照组,随机选取53例用胆道镜测量患者的十二指肠压(DP)、Oddi括约肌基础压(SOBP)、收缩波幅(SOCA)、收缩频率(SOF)、收缩间期(SOD)及胆总管压(CBDP).结果 78例患者中,有28例检测到十二指肠胆道反流(35.9%),反流组SOBP、SOCA、CBDP[分别为(-2.48±7.85)、(32.63±25.22)和(-1.34±5.18)mm Hg,1 mm Hg=0.133 kPa]明显低于对照组[分别为(11.65±10.88)、(91.54±63.21)和(6.38±7.26)mm Hg,P＜0.001].结论 Oddi括约肌运动功能不良与肠胆反流的发生密不可分.     

第四脑室给药对家兔呼吸和肾交感神经放电的影响

 目的 应用现代电生理学技术研究脑干交感中枢和呼吸中枢之间的关系.方法 在乌拉坦静脉麻醉和自主呼吸条件下,记录肾交感神经放电和膈肌肌电,观察第四脑室注射尼可刹米和吗啡对家兔呼吸、交感神经放电的影响.结果 与对照组相比,注射尼可刹米可引起呼吸呈浅快型,肾交感神经放电的积分幅度升高(P<0.01)和其呼吸节律更加明显;注射吗啡可导致呼吸呈浅慢型,肾交感神经放电的积分幅度明显升高(P<0.01),交感神经的呼吸节律性放电频率变化与呼吸频率变化一致.结论 脑干呼吸中枢和交感中枢间存在着重要的神经联合结构,交感活动的呼吸节律源于呼吸中枢.     

健康成年人膈肌呼吸运动的动态MRI初步研究

目的探讨动态呼吸MR成像对研究膈肌运动的可行性。方法运用单次激发快速自旋回波(SSTSE)序列,对35例健康志愿者(男21例,女14例)进行MR动态扫描,并在1~2个深慢呼吸周期内采集图像。利用电影回放的方法获得膈肌运动的最高点和最低点,进而测量膈肌的运动幅度。比较左右侧膈肌的呼吸动度,与肺功能结果进行比较,利用时间距离曲线描述膈肌的运动特点。结果左、右侧膈肌动度的平均值为12.81 mm和9.11 mm。膈肌的动度与肺功能指标FVC、FEV1以及FEV1/FVC、MVV和SVC之间具有明显的相关性。结论左右侧膈肌动度之间的差异有统计学意义,动态呼吸运动成像能够很好的评价膈肌运动,具有潜在的临床应用价值。     

钝性与穿透性膈肌损伤临床比较研究

膈肌损伤约占创伤的5%～7%,由于腹部钝性暴力使腹内压瞬间急剧升高,下胸肋骨对膈肌的机械作用,以及穿透伤时锐器的直接损伤导致膈肌破裂,分为钝性与穿透性膈肌损伤.其早期诊断面临巨大挑战,而且其并发症和病死率高.手术前难以做准确诊断,成功处理有赖于对临床高度可疑者进行仔细的胸部X线、CT检查和尽早的手术探查.由于膈肌损伤机制不同,各有其临床特点和处理上的特殊性,本文就穿透性和钝性膈肌损伤的临床处理研究进展做一比较讨论,以期进一步提高膈肌损伤的救治水平.     

基于小波变换和Canny算子的膈肌运动规律自动检测方法研究

目的 探索基于小波变换和Canny算子的膈肌运动规律自动检测方法.方法 采用小波变换对实时采集的患者自由呼吸状态下的胸部透视序列图像进行增强,对增强后的图像使用Canny算子实现膈肌边缘提取,通过Matlab编程跟踪患者图像中膈肌的位置变化,建立患者膈肌的呼吸运动曲线.结果 平静自由呼吸状态下,自动检测膈肌运动规律曲线与手工测量的曲线在幅度和周期上比较一致.患者在一次XVI Motion-ViewTM透视过程中约包含6～7个呼吸周期.膈肌头脚方向运动幅度不完全一致,大小为6.7 ～8.0 mm,平均为7.4 mm.同一患者不同分次间呼吸周期差异不明显,但在患者情绪激动或者由于自身原因如咳嗽等引起的剧烈呼吸运动时,则会产生明显差异.结论 与手工测量方法相比,小波变换和Canny算子的膈肌检测方法能自动有效检测患者呼吸运动变化,分析时间短、精度高.     

胆汁流动伪影的MR胆胰管成像表现

目的：探讨MR胆胰管成像(MRCP)上胆汁流动伪影的影像表现。方法 回顾性分析85例胆总管正常和95例胆总管扩张患者的MRCP资料,在MRCP原始薄层图像上观察记录胆汁流动伪影的表现,采用x2检验对各组胆汁流动伪影的发生率进行比较,采用Spearman等级相关分析检验胆总管直径和伪影表现形式的关系。结果 胆总管正常组流动伪影发生率38.8％ (33/85),扩张组流动伪影发牛率83.2％( 79/95),差异有统计学意义(x2 ＝37.512,P＝0.000)。胆总管直径(ψ)≤4mm时无流动伪影,4 mm ＜ψ≤8 mm时,流动伪影主要表现为单线征(52.6％,30/57)。胆总管轻度扩张时,流动伪影主要表现为三线征(85.7％,36/42);中度扩张时主要表现为多线征(84.6％,22/26),各组间表现差异有统计学意义(x2＝284.561,P＝0.000)。随胆总管直径增加,伪影的表现形式不同,二者有相关性(r ＝0.553,P＝0.000)。结论 胆总管正常组可以发生流动伪影;胆总管扩张组流动伪影发生率高于正常组;胆汁流动伪影的表现形式与胆总管直径有相关性。     

Diameters of the common bile duct in adults and postcholecystectomy patients: a study with 64-slice CT

This study aims to collect data by multidetector computed tomography (MDCT) on the diameter of the normal common bile duct (CBD) and the diameter of CBD after cholecystectomy. In this retrospective study, CBD measurements were performed on axial oblique images, perpendicular to the long axis of the distal CBD. The mean diameter of the normal CBD was measured in 604 patients without cholecystectomy. The patients were divided into 6 groups according to their age. Analysis of variance (ANOVA) was used to compare data obtained from the six age groups. The mean diameter of the CBD of 46 patients who had cholecystectomy was calculated. The results were compared with age matched control group by Student's t test. The largest diameter of CBD ranged from 1.8 to 11.8mm. The mean of the largest diameter of 604 subjects was 4.77 ± 1.81. The diameter of the CBD significantly increased with age. Mean largest CBD diameters of postcholecystectomy subjects (7.28 ± 2.37) were significantly greater than age matched control group. In conclusion the diameter of CBD shows a considerable increase with age. The largest diameter of the CBD is up to 6mm in most of the subjects. An upper limit of 8mm appears reasonable after the age of 50; and an upper limit of 10mm seems appropriate for cholescystectomized subjects.     

Effects of a holmium-166 incorporated covered stent placement in normal canine common bile ducts

PURPOSE: A specially designed self-expandable covered metallic stent incorporated with beta-emitting radioisotope, Holmium-166 (Ho-166), was developed for delivering intraluminal brachytherapy as well as for internal bile drainage in malignant biliary stricture. The purpose of the study was to demonstrate the safety and tissue response of the radioactive metallic stent on the normal canine common bile duct (CBD) prior to the clinical application. MATERIALS AND METHODS: Nitinol self-expandable stents (diameter; 4 mm, length; 20 mm) were covered with polyurethane membrane (50 microm thick) containing 21 to 135 muCi of Ho-166 (mean, 77.9 microCi). To prevent migration of stent, the membrane covered only the middle 1 cm of the stent and the ends of the stent were left uncovered. The stents were placed in the CBD of 20 healthy beagle dogs. For control, non-radioactive covered stents were placed in another three dogs. The dogs were killed 3 to 6 months after stent insertion and histopathologic examination of CBD was performed. RESULTS: There was no stent migration in all cases. Varying degrees of papillary mucosal hyperplasia leading to significant narrowing of the lumen was observed within the lumen of the bare portion and under the mucosal surface of the non-radioactive covered stents. However, fibrosis was noted in Ho-166 coated area, instead of mucosal hyperplasia. Severity of fibrosis was correlated with estimated radiation dose. Despite high dose, there was no perforation of CBD wall. The membrane of Ho-166 coat was disrupted in some cases of 6 months follow-up. CONCLUSIONS: Holmium-166 incorporated covered stents demonstrated fibrosis of CBD wall and inhibition of ingrowth of mucosal hyperplasia without serious complication such as perforation, while control group showed severe mucosal hyperplasia.     

Chronic Extrahepatic Bile Duct Dilatation: Sonographic Screening in the Patients with Opioid Addiction

Objective

One of the best known side effects of using opium is spasm of the sphincter of Oddi, which may increase the diameter of the extrahepatic bile ducts. Ultrasound is the first imaging modality used for evaluating the biliary system because it is commonly available and noninvasive. The principal objective of this study was to measure the common bile duct (CBD) diameter via ultrasonography in opium addicts and to evaluate the relation between the CBD diameter and the period of addiction.

Materials and Methods

This research was an analytical-cross sectional study that was done on 110 opium addicts that were admitted to a drug treatment center. The diameter of the CBD in these cases was measured by ultrasonography and the results were analyzed with other factors like age, the period of addiction and the laboratory findings.

Results

According to the findings, there is a significant increase in the range of the CBD diameter in comparison with normal bile ducts. Also, the mean diameter of the CBD in the different age groups showed a significant difference (p < 0.0001) and there was a significant relation between the CBD diameter and the period of addiction (p < 0.001, r = 0.74); so, with the increased length of the addiction period, the mean CBD diameter increases.

Conclusion

Opium addiction is one of the factors that causes extrahepatic bile duct dilatation, so in these cases, if no obstructing lesion was found on ultrasound examination and the serum bilirobine and alkaline phosphatase levels are normal, then further evaluation is not needed.     

Dynamic test in the echographic evaluation of the common bile duct

Common bile duct (CBD) diameter was measured with ultrasonography in 396 patients (131 had previous cholecystectomy) before and 40 minutes after the ingestion of a fatty meal. CBD diameter reduced in 177 cases, remained unchanged in 175, increased in 44. The increasing of CBD diameter always means obstructive choledochal pathology, caused by stones or other pathologic conditions. Caliber reduction or other pathologic conditions. Caliber reduction is physiologic. When CBD remains unchanged, in 10% of the cases there are stones in the duct.     

Sincalide-augmented quantitative hepatobiliary scintigraphy (QHBS): definition of normal parameters and preliminary relationship between QHBS and sphincter of Oddi (SO) manometry in patients suspected of having SO dysfunction

Sphincter of Oddi (SO) dysfunction presents with vague abdominal pain and/or abnormal liver function tests, and is presumably due to SO stenosis or spasm. Clinical, laboratory, and imaging methods of diagnosis have been less than ideal. Initially, we determined normal quantitative hepatobiliary scintigraphy (QHBS) parameters both pre- and post-sincalide administration. Thirty-one "normals" were analyzed, and post-sincalide common bile duct (CBD) dynamics could be satisfactorily determined in 29 (94%) subjects. Normal values at sincalide-augmented QHBS are reported. Next, 10 patients suspected of having SO dysfunction were studied prospectively using SO manometry and QHBS. The two tests were in agreement in seven cases (4: normal CBD dynamics, 3: abnormal). In one case of advanced SO stenosis, QHBS was abnormal, but SO manometry could not be performed. In the two remaining cases, SO manometry and QHBS gave discordant results. Of greatest importance, no significant correlation existed between the quantitative parameters of these two tests. Sincalide-augmented QHBS is possible and may, in the future, be of value in the diagnosis of SO dysfunction and/or partial CBD obstruction.     

Evaluation of common bile duct diameter using high resolution computed tomography

The visibility rate and mean diameter of the common bile duct (CBD) were determined in 172 patients scanned with a routine abdominal technique on a GE CT/T 9800. Ninety-two (53%) had visible CBDs with the mean diameter measuring 5.3 mm. The visibility rate varied from 45 to 66% in healthy and ill patients, although the CBD diameters were similar (4.5 and 5.1 mm). The CBD was visualized more often in patients after cholecystectomy (87%), and the mean diameter was larger (8.2 mm). Using high resolution CT it seemed that the CBD could be demonstrated more frequently than the previously reported 30%.     

核磁共振胰胆管水成像对腹腔镜胆囊切除术后综合征的诊断价值

目的：探讨磁共振胰胆管水成像(MRCP)对腹腔镜胆囊切除术(LC)后发生胆囊切除综合征(PCS)的诊断价值。方法：对比分析26例LC术后出现PCS和11例未出现PCS的患者的MRCP表现。结果：PCS组的胆总管扩张的发生率为65．38％(17／26)，对照组为18．18％(2／11)。PCS组的胆囊管残留过长的发生率为53．85％(14／26)，对照组为18．18％(2／11)。PCS组胆道结石的发生率为30．76％(8／26)，对照组为0％(0／11)。PCS组1例(3．84％)有胆总管狭窄，对照组没有。结论：对于诊断LC术后出现的PCS，MRCP是一种十分有效的检查方法。     

Common bile duct diameter in an asymptomatic population: A magnetic resonance imaging study

AIM: To measure the common bile duct (CBD) diameter by magnetic resonance cholangiopancreatography (MRCP) in a large asymptomatic population and analyze its some affecting factors.METHODS: This study included 862 asymptomatic subjects who underwent MRCP. The CBD diameter was measured at its widest visible portion on regular end-expiration MRCP for all subjects. Among these 862 subjects, 221 volunteers also underwent end-inspiration MRCP to study the effect of respiration on the CBD diameter. The age, sex, respiration, body length, body weight, body mass index (BMI), portal vein diameter (PVD), length of the extrahepatic duct and CBD, cystic junction radial orientation and location were recorded. The subjects were divided into 7 groups according to age. All of the above factors were compared with the CBD diameter on end-expiration MRCP.RESULTS: Among the 862 subjects, the CBD diameter was 4.13 ± 1.11 mm (range, 1.76-9.45 mm) and was correlated with age (r = 0.484; P < 0.05), with a dilation of 0.033 mm per year. The upper limit of the 95% reference range was 5.95 mm, resulting in a reasonable upper limit of 6 mm for the asymptomatic population. Respiration and other factors, including sex, body length, body weight, BMI, PVD, length of the extrahepatic duct and CBD, cystic junction radial orientation and location, were not related to the CBD diameter.CONCLUSION: We established a reference range for the CBD diameter on MRCP for an asymptomatic population. The CBD diameter is correlated with age. Respiration did not affect the non-dilated CBD diameter.     

内镜对胆囊切除术后胆总管下端狭窄的诊断与治疗价值

目的：探讨内镜对胆囊切除术后胆总管下端狭窄的诊断及治疗价值。方法：89例胆囊切除术后综合征患者行内镜下逆行胰胆管造影（ERCP）。对发现的38例（43％）胆总管下端狭窄患者行内镜下乳头括约肌切开术（EST）等内镜治疗。结果：上腹痛缓解率在单纯胆总管下端狭窄者、合并急性胰腺炎者、合并结石者分别为94．74％、78．83％、88．75％，胆总管内径恢复率在单纯胆总管下端狭窄者、合并急性胰腺炎者、合并结石者分别为100％、92．69％、100％，术后所有患者血ALT，AST，ALP及GGT恢复正常。结论：EST是治疗胆总管下端狭窄有效和首选的治疗方法。