The Effect of Calcium Dobesilate on Liver Damage in Experimental Obstructive Jaundice

Purpose/Aim of the study: Inflammation and oxidative stress are two significant factors affecting the degree of liver damage in obstructive jaundice. The aim of this study was to evaluate the effect of calcium dobesilate (CaDob), an effective antioxidant and anti-inflammatory drug, on damage to liver caused by experimental obstructive jaundice. Materials and Methods: 30 rats in total were randomly placed into three groups, each group consisting of 10 rats. The sham group (Group 1) only received solely laparotomy. In the control group (Group 2), ligation was applied to the biliary tract and no treatment was implemented. In the CaDob group (Group 3), following ligation of the biliary tract, 100 mg/kg/day CaDob was implemented via an orogastric tube for a 10–day period. Liver tissue and blood samples were taken for histopathological and biochemical examination. Results: The CaDob group had significantly lower test values for serum liver functions when compared to the control group. Statistically lower levels of tissue malondialdehyde (MDA) and fluorescent oxidation products (FOP) were detected in the CaDob group, and the CaDob group had significantly higher levels of sulfydryl (SH) than the control group. Histopathological scores in the CaDob group were found out to be statistically less than the scores the control group received (p < 0.05). Conclusions: CaDob treatment repaired the histpatological changes induced by bile duct ligation. The hepatoprotective effects of CaDob can be associated with its antioxidant properties of the drug.     

胃癌术后梗阻性黄疸的手术治疗

目的总结胃癌术后梗阻性黄疸的手术治疗效果。方法对15例胃癌术后梗阻性黄疸患者施行再手术治疗,其中根治性切除术5例,姑息性减黄术10例。结果1例行残胃切除 肝外胆道切除 胆道和消化道重建的患者术后7d死于胆瘘,其余患者黄疸平均于术后16.8(5～27)d消退。生存期平均12.9个月(7d～66个月),其中根治性切除平均24.8个月(7d～66个月),姑息性减黄手术平均7.0(2～17)个月。结论对胃癌术后梗阻性黄疸患者,条件许可时施行根治性切除术可提高根治率,延长生存时间;对无法根治者施行减黄手术可缓解症状,提高生存质量。     

黄芪对梗阻性黄疸大鼠肝功能的保护作用

目的:探讨黄芪注射液对实验性梗阻性黄疸大鼠肝功能的保护作用及作用机理.方法:SD大鼠行胆总管结扎后分别用3 mL黄芪注射液或生理盐水腹腔注射.术后测定血浆内皮素(ET-1)、血清超氧化物歧化酶(SOD)、丙二醛(MDA)含量,同时测定谷丙转氨酶(AST)、直接胆红素(DB)和总胆汁酸(TBA)浓度,并对肝脏行光镜下病理形态学观察.结果:血浆ET-1、血清MDA浓度在梗阻10 d即升高,随胆道梗阻时间延长进一步升高,SOD在梗阻10 d即下降,同时伴有血清AST、DB和TBA的升高和肝脏病理形态学的进行性改变.黄芪治疗组ET-1及MDA显著低于对照组,而SOD显著高于对照组,并能改善肝组织病理形态.结论:大鼠梗阻性黄疸时,血浆ET-1水平升高及氧自由基损害可能是肝损伤的原因,黄芪通过降低ET-1水平、抗氧化作用对梗阻性黄疸大鼠的肝脏起保护作用.     

黄芪对梗阻性黄疸大鼠肾功能的保护作用

目的:探讨黄芪对梗阻性黄疸大鼠肾功能的保护作用及机理.方法:SD大鼠胆总管结扎后分2组,每组20只,术后分别用3 mL黄芪或生理盐水腹腔注射.假手术组20只.术后10 d、20 d(每小组n=10)心脏取血测定血浆内皮素(ET-1)、血清超氧化物歧化酶(SOD)和丙二醛(MDA)含量,同时测定血清肌酐(Cr)尿素氮(BUN)和直接胆红素(DB),对肾脏行病理形态学观察.结果:血浆ET-1、血清MDA浓度在梗阻10 d即升高且随胆道梗阻时间延长进一步升高,SOD在梗阻10 d即下降,同时伴有血清Cr、BUN、DB的升高和肾脏病理形态学的进行性改变.黄芪治疗组ET-1及MDA显著低于对照组,而SOD显著高于对照组,并能改善肾组织病理形态.结论:大鼠梗阻性黄疸时血浆ET-1升高及氧自由基损害是肾损伤的原因,黄芪通过降低ET-1水平、抗氧化作用对梗阻性黄疸大鼠肾脏起保护作用.     

婴儿梗阻性黄疸诊断与治疗探讨

目的：探讨ECT对婴儿梗阻性黄疸诊断、及鉴别诊断的价值，对临床治疗方法进行评价。方法：应用ECT核素对22例己诊断为梗阻部位和性质。结果：8例胆道延时，核素显像为胆汁淤滞型阻塞型黄疸。其中5例因黄疸加重行经套针胆囊内置管加压冲洗治愈，3例药物治愈。14例为先天性胆道闭锁（肝外型8例、肝内型6例），有肝胆显像，但肠道不显像。其中12例（肝外型8例、肝内型4例）行Kasai手术，术后均有胆汁排出，4例术后死亡，3例因胆瘘再次行肝门空肠吻合术均死亡，手术后存活5例（35%）。另外2例未及手术者死于肝衰竭。结论：ECT核素延迟显像可鉴别梗阻性黄疸的性质和部位。年龄小于60d的胆汁淤滞性黄疸患儿先应以药物抗感染、保肝、中药、利胆素及地塞米松适量应用治疗2周，如胆红素升高则手术治疗。先天性胆道闭锁患儿应在适当药物治疗尽早手术。     

内皮素在大鼠梗阻性黄疸肝脏损伤中的作用

目的：观察大鼠胆管梗阻后内皮素在肝组织及血液中的分泌状况及甘胆酸的变化，探讨内皮素与甘胆酸之间的关系。方法：用放射免疫法观察大鼠胆管梗阻后5、10、15、20、25天时血及肝组织中内皮素含量，组织病理切片观察肝脏的病理改变。结果与结论：内皮素含量随梗阻性黄疸后时间延长而递增,与甘胆酸升高水平呈正相关（P＜0.01），说明内皮素可能是参与梗阻性黄疸致肝脏损伤的重要因素之一。     

改良胆肠Roux-en-Y吻合术在治疗恶性梗阻性黄疸中的应用

目的探讨改良Roux-en-Y胆肠吻合术治疗胆道恶性梗阻的效果及临床应用价值。方法回顾性分析36例胆道恶性梗阻需行胆肠吻合术患者的临床资料,其中行改良Roux-en-Y胆肠吻合术21例（改良组）,同期行经典Roux-en-Y胆肠吻合术15例（经典组）。改良Roux-en-Y胆肠吻合术在传统袢式吻合的基础上作了两项改进：①不切断空肠,输入袢和输出袢之间行侧侧吻合;②近段输入袢空肠结扎,阻断肠内容物进入肠道。观察两组手术时间、肠功能恢复时间、住院时间、返流性胆管炎减黄疗效及并发症发生情况。结果改良组术中胆肠吻合时间、术后住院时间及肠功能恢复时间明显缩短,返流性胆管炎发生率显著减少,差异有统计学意义（P〈0.05）,两组术后减黄效果均明显,但组间比较无明显差异（P〉0.05）。结论改良Roux-en-Y胆肠吻合术操作简单、术后恢复快,尤其适用于高龄无法行根治性手术的恶性胆道肿瘤患者,值得临床推广应用。     

达芬奇机器人系统在高龄重度梗阻性黄疸患者中的应用

目的总结达芬奇机器人手术系统在高龄重度梗阻性黄疸患者中的治疗经验。方法第二炮兵总医院肝胆胃肠病研究所在2009年1月至2011年5月期间共行机器人手术209例,其中高龄重度梗阻性黄疸患者47例(机器人组),同期开腹手术患者44例(开腹组),对比观察患者疾病分布,术前、术中及术后等相关指标,对其结果进行归纳分析。结果 2组患者基线一致(P>0.05)。机器人组46例在机器人辅助下完成手术,手术完成率达97.87%(46/47),1例中转开腹,中转率为2.13%(1/47);手术方式包含肝胆胰外科所有手术方式,且其中1例肝门部胆管癌患者因血清胆红素水平极高(375μmol/L),急诊行肝门部胆管癌切除+肝门-空肠Roux-en-Y吻合术;术后有7例患者出现并发症,总体并发症发生率为14.89%(7/47);围手术期死亡1例,死亡率为2.13%(1/47);术后3个月生存率为78.15%;术后15 d和术后3个月体力状况评分分别为42.87±18.61和58.51±23.86;腹部切口总长度为(6.30±1.70)cm。开腹组所有患者均完成手术,其中急诊手术4例;术后13例患者出现并发症,总体并发症发生率为29.55%(13/44),围手术期死亡2例,死亡率为4.55%(2/44);术后3个月生存率为72.36%;术后15 d和术后3个月体力状况评分分别为37.15±13.64和45.27±18.96;腹部切口总长度为(26.73±3.07)cm。2组总体并发症发生率、术后15 d和术后3个月体力状况评分及切口总长度比较,差异均有统计学意义(P<0.05)。结论达芬奇机器人手术系统对于高龄重度梗阻性黄疸患者的治疗是安全、有效的,其创伤小,操作灵活精准,术后恢复快,拓展了外科手术的年龄界限,扩大了手术适应人群。     

The Effects of Dimethylsulfoxide in Experimental Obstructive Jaundice

Material and methods: Thirty rats were divided into three groups, as sham, control and DMSO groups. Laparatomy was performed on each animal in the control and DMSO groups and common bile ducts were ligated. Common bile duct was observed but was not ligated for the rats in the sham group. Saline solution injection (1.5 mg/kg/intraperitoneally (ip)) was begun on the first day of surgical procedure and repeated once a day for the next 5 days. The same procedure was performed with DMSO (1.5 mg/kg/ip) instead of saline in the DMSO group. The rats were sacrificed on the postoperative seventh day, at which time venous blood and liver tissue specimens were taken. Main outcome measurements: On the 7^th postoperative day, the bilirubin, AST, ALT, ALP and GGT levels of the control and DMSO groups were significantly higher in comparison with the sham group (p < 0.01). On the 7^th postoperative day, the erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels of the control and DMSO groups were significantly lower than those of the sham group (p < 0.01), but there was no statistical difference between the two groups (p > 0.05). Erythrocyte and liver malondialdehyde (MDA) levels in the control and DMSO groups were significantly higher compared with the sham group (p < 0.01). However, the MDA levels were significantly lower in the DMSO group compared to the control group (p < 0.01).

Conclusion: It is stated that free oxygen radicals seem to play a role in the liver tissue injury, secondary to obstructive jaundice. In our experimental study, exogenic DMSO seems to have decreased lipid peroxidation and to have improved some of the parameters of liver tissue injury due to the obstructive jaundice in rats.     

Results of Vacuum Assisted Wound Closure Application

In recent past, various methods have been used for wound treatment purpose. In this study, we aimed to compare our results established from the vacuum-assisted wound closure method, which has gained popularity day by day, with the literature. A total of 48 patients, who received vacuum-assisted wound closure treatment in our clinic between 2007and 2010, were included in this study. Etiological distribution of the patients was as follows: 32 traumatic, 6 pressure sore, 9 diabetic, and 1 iliac disarticulation. All cases were evaluated in terms of age, gender, etiology, period of treatment, and size of the wound. In the patients studied, 42 were men (87.5 %) and 6 were women (12.5 %). Mean age of the patients was 39.6 years (11–61 years). All of our traumatic patients suffered from open fracture. After the vacuum-assisted wound closure application, wound size reduced by 28.8 %, while the mean area of the surface of the wound was 94.7 cm² (13.7–216.3 cm²) on average. After the wounds became ready for surgery, 15 of them were treated with split-thickness grafting, 9 of them were treated with secondary suture, 18 of them were treated with full-thickness grafting, and 6 of them were treated with flap. Average period of the application of vacuum-assisted wound closure was 11.6 days (7–15 days). Results of vacuum-assisted wound closure can be regarded as satisfactory when cases are selected properly. This system has three different effect mechanisms. Firstly, it increases local blood flow on the wound bed. Secondly, cell proliferation is triggered following the mechanic stress. Thirdly, vacuum removes the proteases from the environment which obstructs healing. Therefore, it is intended to prepare alive wound bed which is required for subsequent soft tissue reconstructions.     

磁共振胆胰管成像对梗阻性黄疸的临床诊断价值

目的探讨磁共振胆胰管成像(magnetic resonance cholangiopancreatography，MRCP)对梗阻性黄疸的临床诊断价值。方法对22例梗阻性黄疸病人行MRCP检查，根据手术情况及病理检查结果评价MRCP诊断率。结果MRCP检查的定位诊断率为100．0％(22／22)，良性疾患定性诊断率为87．5％(14／16)，恶性梗阻性黄疸定性诊断符合率为75．0％(6／8)，总的定性诊断符合率达81．8％(18／22)。结论MRCP是一种简单、安全、方便的检查方法，对梗阻性黄疸的临床诊断有重要价值，值得临床推广应用。     

梗阻性黄疸大鼠脂多糖结合蛋白的变化及其意义

目的　探讨梗阻性黄疸大鼠脂多糖结合蛋白在不同梗阻时间的变化及其增敏机理。方法　将 80只雄性Wistar大鼠随机分为梗阻性黄疸组 (OJ组 ,n =4 0 )和假手术组 (SO组 ,n =4 0 ) ,分别于胆总管结扎手术前及手术后 5d、10d、15d、2 0d检测两组大鼠血清中脂多糖结合蛋白及血浆中内毒素、TNF α和IL 6水平 ,每组每一时相点各取 8只大鼠。结果　OJ组大鼠在胆总管结扎术后 10d ,其血清中脂多糖结合蛋白值为 ( 11.2 5± 2 .4 1)mg/L ,较SO组〔( 5 .32± 1.35 )mg/L〕明显升高 (P<0 .0 5 ) ,且随着梗阻时间的延长而进一步升高。相关分析显示 ,血清脂多糖结合蛋白与血浆内毒素、TNF α和IL 6在大部分时相呈明显正相关。结论　梗阻性黄疸时血清脂多糖结合蛋白水平升高 ,其增敏作用在梗阻性黄疸多器官损害中可能具有重要的作用。由此提示 ,通过降低血清中脂多糖结合蛋白 ,阻断其增敏作用 ,可为防治梗阻性黄疸提供一种新的思路     

恶性梗阻性黄疸根治性切除术后急性肾功能衰竭的预防

目的探讨恶性梗阻性黄疸根治性切除术围手术期肾功能的保护及急性肾功能衰竭（ARF）的预防。方法为降低ARF的发生率，从2004年起本治疗小组在ARF的预防方面采取了一系列措施，包括预防内毒素血症，术前减黄，充分扩容，营养支持，甘露醇、速尿的使用，预防弥散性血管内凝血等。分2个阶段回顾性分析从2000～2007年8年间（第1阶段：2000年1月至2003年12月；第2阶段：2004年1月至2007年12月）本治疗小组行根治性切除术的恶性梗阻性黄疸患者206例围手术期ARF的发生率，并引入了最新的ARF分级标准（RIFLE标准）对ARF进行分级。结果第2阶段恶性梗阻性黄疸的根治性切除率从第1阶段的44．8％提高到57．1％（P〈0．05），围手术期ARF的发生率从15．1％下降至6．7％（P〈0．05），其中ARF危险及损害阶段的发生率在第1阶段与第2阶段比较差异无统计学意义（P〉0．05），而ARF衰竭阶段发生率则由10．5％降至2．5％（P〈0．05），因此ARF发生率的降低主要是通过将急性肾功能损害控制在早期阶段而避免其向衰竭阶段发展，从而使围手术期的死亡率从16．3％降至5．8％（P〈0．05）。结论通过最新的RIFLE标准对ARF进行分级统计，说明我们在围手术期所采取的预防措施有效地控制了恶性梗阻性黄疸患者围手术期ARF的发生和发展。     

梗阻性黄疸手术应用单纯全麻与全麻复合硬膜外阻滞疗效比较

目的比较单纯全麻和全麻复合硬膜外阻滞在梗阻性黄疸手术中对患者血液动力学变化及术后苏醒的影响。方法选择40例梗阻性黄疸患者,随机分成单纯全麻组(全麻组)、全麻复合硬膜外阻滞组(复合组),每组20例。两组全麻方法相同,复合组在全麻基础上是复合低浓度小剂量硬膜外阻滞。记录入室后、插管时、术中、拔管时的HR、MAP,两组病人麻醉维持用药量及清醒拔管时间,术后躁动情况。结果复合组在插管拔管过程中HR、MAP均较全麻组低且平稳(P<0.05),全麻组拔管反应剧烈,在插管、拔管时各项指标与诱导前比较均显著升高(P<0.05)。全麻组全麻用药芬太尼、异氟醚、维库溴铵等用药量均显著多于复合组(P<0.05)。复合组较全麻组清醒快,拔管时间明显早于全麻组(P<0.05)。复合组发生躁动1例,显著低于全麻组的11例,P<0.05)。结论全麻复合硬膜外阻滞更加适合于梗阻性黄疸病人的麻醉。     

The Effect of Aminoguanidine on Blood and Tissue Lipid Peroxidation in Jaundiced Rats With Endotoxemia Induced With LPS

Obstructive jaundice (OJ) is a severe condition that leads to several complications. One of the important problems in OJ is the increased incidence of endotoxemia, which is the result of bacterial translocation (BT) and defective host immune response. Lipid peroxidation (LP) is an important problem in OJ and sepsis in which nitric oxide (NO) production and inducible nitric oxide synthase (iNOS) activity are increased and antioxidative activity is decreased. Formation of peroxynitrite (ONOO^?) anion leads to cellular damage and apoptosis. In this experimental study, we explore the effect of specific iNOS inhibitor aminoguanidine (AG) on blood and tissue (liver and renal) LP and iNOS levels in jaundiced rats with endotoxemia induced with lipopolysaccharide (LPS). Rats were randomized into six groups; group A, sham; group B, obstructive jaundice (OJ); group C, OJ + LPS; group D, OJ + AG; group E, OJ + LPS + AG; group F, OJ + AG + LPS. Serum malondialdehyde (MDA) and serum myeloperoxidase (MPO) activity and liver and renal tissue MDA, MPO, and Na⁺/K⁺-ATPase activity levels were detected in biochemical methods. Liver and renal tissue iNOS levels were examined immunohistopathologically. Serum and tissue MDA and MPO levels and tissue iNOS expression were increased significantly in groups B, C, and E, while tissue ATPase levels were decreased significantly in the same groups. In the group treated with AG (group D), serum and tissue MDA and MPO levels and tissue iNOS expression were decreased while tissue ATPase levels were increased significantly. In group F, if AG was administrated before LPS, we observed that serum and tissue MDA and MPO levels and tissue iNOS expression were decreased while tissue ATPase levels were increased significantly. Thus, our study showed that AG had a protective effect when it was administrated before LPS, but it failed to prevent tissue iNOS expression and LP if there was established endotoxemia in OJ.     

梗阻性黄疸对肾脏水通道蛋白-3表达影响的实验研究

目的通过检测梗阻性黄疸(OJ)时大鼠肾脏水通道蛋白-3(AQP-3)基因及蛋白表达的变化,探讨其在早期肾功能损害诊断中的价值。方法将Wistar大鼠40只,随机分为实验组(n=20,建立OJ动物模型)和对照组(n=20,假手术组)。于术后7d和14d,采用全自动生化分析仪检测各组大鼠血总胆红素(TBIL)、直接胆红素(DBIL)、肌酐(Cr)和尿素氮(BUN)水平,并用Western blotting法和RT-PCR法分别检测各组大鼠肾脏AQP-3蛋白和mRNA的表达水平。结果 实验组大鼠术后14d血清TBIL和DBIL水平明显高于术后7d(P=0.000),且均高于相应时相假手术组(P=0.000),而假手术组内两时相间比较差异无统计学意义(P=0.154),证实OJ模型建立成功。血Cr水平在2组内不同时相间和相同时相组间比较差异均无统计学意义(P>0.05)。实验组大鼠术后14d的血BUN水平明显高于术后7d以及假手术组术后14d的水平(P=0.001),而假手术组术后两时相间的差异无统计学意义(P=0.288)。实验组大鼠术后7d及14d的AQP-3蛋白表达水平均明显低于相应时相的假手术组(P=0.033,P=0.000),且术后14d的水平又明显低于同组术后7d水平(P=0.000);假手术组大鼠术后两时相的AQP-3蛋白表达水平间的差异无统计学意义(P=0.059)。实验组大鼠术后7和14d的AQP-3mRNA表达水平明显高于相应时相的假手术组(P=0.000),而两组内不同时相间比较,其差异均无统计学意义(P=0.139,P=0.059)。结论 OJ合并肾功能损害时大鼠肾脏AQP-3mRNA及蛋白表达的变化早于血肌酐及尿素氮的变化,其变化的应用有望提高OJ时肾功能损害的早期诊断率。     

肝切除联合胆肠内引流对梗阻性黄疸大鼠的影响

目的探索在高胆红素血症下,大鼠胆肠内引流联合肝切除对肝功能、肝细胞能量代谢以及肝细胞再生和凋亡的影响。方法雄性成年SD大鼠120只,其中6只大鼠作为假手术(SO)组;20只行70%肝切除,同时行胆总管-十二指肠插管桥接(70%PH组);另94只行胆总管结扎(CBDL)制备梗阻性黄疸模型,建模成功后5d时随机取6只动物作为CBDL组,余下的动物5d后行二次手术,再分为胆肠内引流再通组(BDO-RBF组,20只)、42%PH+BDO-RBF组(20只)及70%PH+BDO-RBF组(25只)。检测CBDL组5d时及二次手术后各组术后24h、72h及7d时肝功能和肝细胞能量代谢、肝组织肝细胞生长因子(HGF)和bcl-2mRNA含量及其蛋白表达、肝细胞增殖指数和凋亡指数的变化。SO组只测定术后0h肝功能和肝细胞能量指标。结果正常大鼠能够耐受70%肝切除,术后肝细胞能量代谢和肝功能迅速恢复正常,肝再生良好、细胞凋亡无明显增多。较之SO组和70%PH组,CBDL导致肝细胞能量代谢恶化、肝功能不良、肝组织HGF和bcl-2mRNA含量减少,肝再生受抑制,细胞凋亡显著增多(P<0.05)。胆肠内引流再通后肝细胞能量代谢可迅速恢复,肝细胞凋亡减少,肝再生活跃。42%+BDO-RBF组及70%PH+BDO-RBF组肝细胞能量代谢同样能够较快恢复,肝再生良好。42%+BDO-RBF组与70%PH+BDO-RBF组间各指标差异均无统计学意义(P>0.05)。结论梗阻性黄疸时,高胆红素血症严重影响肝细胞能量代谢和肝功能,引起肝细胞凋亡增多,肝再生受抑制;及时有效的胆肠内引流能够迅速改善肝细胞能量代谢、肝功能及肝再生,联合肝切除时术前可不需常规胆道引流。