3D-VIBE与3D-FLASH序列肝胆特异期Gd-EOB-DTPA增强MR胆道成像显示胆道系统图像质量及检出病变

目的 对比三维容积内插值体部检查(3D-VIBE)与三维T1W快速扰相小角度梯度回波(3D-FLASH)序列肝胆特异期(HBP)钆塞酸二钠(Gd-EOB-DTPA)增强MR胆道成像(CE-MRC)显示胆道系统图像质量及检出病变的差异。方法 回顾性分析101例接受3D-VIBE与3D-FLASH序列HBP Gd-EOB-DTPA CE-MRC患者，包括30例肝移植术后、18例胆道系统疾病及53例肝脏疾病或MRI未见明显异常者，对3D-VIBE-CE-MRC与3D-FLASH-CE-MRC所示胆道系统图像质量进行主观评分及客观评估；对比18例胆道系统疾病3D-VIBE-CE-MRC与3D-FLASH-CE-MRC表现的差异，以及30例肝移植术后患者3D-VIBE-CE-MRC、3D-FLASH-CE-MRC及MR胰胆管成像(MRCP)所测狭窄处胆管直径的差异。结果 3D-FLASH-CE-MRC胆道系统图像质量主观评分高于3D-VIBE-CE-MRC(P<0.05)。3D-FLASH-CE-MRC胆道系统信噪比及对比信噪比均高于3D-VIBE-CE-MRC(P均<0.01)。3...     

超声在胆道出血性疾病诊断中的应用

目的探讨超声在胆道出血性疾病诊断中的应用价值。方法对20例肝外伤性患者的胆囊内移动性异常回声的形态、大小、回声水平及其演变进行记录分析,总结胆道出血性疾病的胆囊积血声像图特征及演变规律。结果胆囊积血图像分为3种类型:弥漫细小回声型;成堆等回声型;成团强回声型。胆囊积血完全消失最短时间在外伤后3个月,最长时间在外伤后9个月。结论结合病史及超声对胆囊积血的监测,能为临床提供胆道出血的存在及胆道出血病情变化的依据,具有实际应用价值,为诊断胆道出血的间接有效的方法。     

胎儿胆道异常的产前超声检查

目的探讨胎儿胆道异常的产前超声表现。方法1995至2005年,采用常规超声对40000例来我院行产前检查的中晚期孕妇行胎儿胆道异常筛查,对部分胎儿胆道异常病例行三维超声重建,并对胎儿胆道异常者行产前及产后随访。结果本组共检出31例胆道异常胎儿,其中胆总管囊肿2例,胆囊内强回声29例。在29例胆囊内强回声胎儿中,27例胆囊内强回声具有胆囊结石的声像表现,2例类似胆囊内浓缩胆汁的声像表现,除3例失访外,余26例胆囊内强回声均在产前及产后随访中消失。结论超声检查能较好地显示胎儿胆道异常,并能动态监测其转归,是诊断胎儿胆道异常的首选方法。     

Ultrasonic diagnosis of biliary tract dyskinesia

Ultrasonic sectoral scanning was used to determine the type of biliary tract dyskinesias in the course of digestion. 89 patients with different gastroenterological diseases were examined. 21 healthy subjects made up the control group. The process of gallbladder contraction was conventionally divided into 3 phases. In practically healthy subjects, the first phase was marked by gallbladder contraction from the neck down to the bottom while the gallbladder assumed an optimally suitable form for prolonged contraction. The second phase involved rapid contraction (during 15 min the gallbladder size reduced by 28.8%). The third phase involved slow contraction (during 30 min the gallbladder decreased in size by another 29%). 5 types of dyskinetic disorders were distinguished. This permitted diagnosing the focus of pathology within the system of the biliary tract together with administering the differentiated treatment.     

Gastrointestinal manifestations of graft-versus-host disease: diagnosis and management

The number of bone marrow transplantations performed to treat diseases such as leukemia, lymphoma, and aplastic anemia has been increasing during the past 2 decades. Improvements in histocompatibility testing, transfusion support, conditioning regimens, and antibiotics have dramatically improved survival after transplantation. As more patients survive the acute phase of bone marrow transplantation and leave major medical centers for their homes, healthcare providers across the country are caring for these patients and their transplantation-associated complications. Graft-versus-host disease (GVHD) of the skin, liver, and gastrointestinal tract are complications that patients may experience months after transplantation. As clinicians, advanced practice nurses encounter these patients in clinics, hospitals, and intensive care units, whether it be for specific GVHD-associated problems or other health conditions. This article reviews the current standards of care for the prevention, diagnosis, and treatment of GVHD of the gastrointestinal tract.     

肝叶(段)切除治疗肝内胆管结石并狭窄的体会

目的探讨肝内胆管结石并／或胆管狭窄行肝叶（段）切除治疗的疗效。方法对53例肝内胆管结石并／和胆管狭窄行肝叶（段）切除及胆管整形胆囊带蒂肝胆管修补术,其中左半肝切除3例,左肝外叶切除38例,左肝外叶下段切除7例,右肝前叶下段切除3例,右肝后叶不规则切除2例,同时行胆管整形6例,胆囊带蒂肝胆管修补2例。结果除术后切口感染5例、残余结石7例、胰漏2例、左侧胸腔积液1例、右侧胸腔积液1例外,其余37例均无异常;全组无1例手术死亡。结论对肝内胆管结石并狭窄的患者,在术前经B超、CT、逆行胰胆管造影（ERCP）等检查充分了解肝内胆管结石分布、胆管狭窄情况后,拟定周密治疗方案,可确保手术成功,并取得满意疗效。     

B超在肝胆疾病普查中的临床价值

目的 在B超普查中早期诊断原发性肝癌，达到早期手术切除原发灶、提高患术后5年存活率；以及发现其他常见肝胆疾病。方法 我厂40岁以上在职职工三年内(每年一次)5890例，空腹B超检查。使用仪器为SONOLINE Prima实时黑白超声诊断仪。腹部探头频率根据受检查体型选用(肥胖型用2．6MHz，瘦小型用5．0MHz，普通型用3．5MHz)。结果 5890例中超声检查发现原发性肝癌5例。存活4例。同期我院病人肝胆B超检查8884例，发现肝癌8例，均已死亡。结论 B超既能检出早期原发性肝癌，又能查出诸多良性的、或有恶变倾向的隐匿性肝胆疾病，并针对其随访复查。达到防癌检查的目的。     

The clinical experience with hepatocyte transplantation for the treatment of hepatic insufficiency

Hepatocyte transplantation represents a supplementary strategy for treating liver diseases. Several methods including extracorporeal devices, cell transplantation and implanted tissue-engineered units were proposed as liver support before liver transplantation. The ability to repopulate the liver with healthy and disease-resistant hepatocytes opens up new possibilities for correcting genetic disorders and treating patients with chronic liver diseases. Some results of experimental and clinical therapy of liver diseases are summarized in this review.     

新疆察布查尔锡伯自治县锡伯族胆囊疾病的流行病学调查

目的:了解新疆察布查尔锡伯自治县锡伯族胆囊疾病的患病率及其危险因素。方法:采用典型抽样后再随机抽样的方法对察布查尔锡伯自治县两个乡18岁以上居民进行调查。依据该地区人口学资料,计划按人口比例1/28随机调查800人,应用统一制定的新疆地区胆囊疾病危险因素调查表,对研究对象进行入户问卷调查,同时预约腹部B超检查肝脏和胆囊。结果:803名居民参加调查问卷填写,其中资料完整者609名成为调查研究对象,调查应答率为75.8%。新疆察布查尔锡伯自治县锡伯族胆囊疾病的患病率为79.3%,其中单纯急或慢性胆囊炎、胆囊结石、胆囊息肉及胆固醇沉积或结晶的患病率分别为57.1%、13.8%、7.4%、1.0%。多项Logistic回归分析显示,锡伯族胆囊疾病的危险因素为BMI≥25 kg/m2、不吃或偶尔吃早餐、睡眠时间短及饮茶习惯(OR值分别为4.221,3.500,3.219,2.401,P值均<0.05)。结论:新疆察布查尔锡伯自治县锡伯族人群中胆囊疾病的患病率高于全国水平,胆囊疾病的发生与肥胖、不吃或偶尔吃早餐、睡眠时间短和饮茶习惯有关,而与性别和年龄无关。     

肝移植术后胆道并发症的超声诊断

目的探讨超声在肝移植术后胆道并发症诊断和治疗中的价值.方法 13例实施肝移植术后临床拟诊胆道并发症患者,以二维超声检查移植肝内外胆管及肝周情况,彩色多普勒超声评估肝动脉血流,并与其他影像学检查相对比.结果超声检出胆道梗阻者10例(其中2例行超声引导PTC);胆漏者3例(其中2例在超声引导下置管引流);有肝动脉血栓并发胆道梗阻者3例.结论超声在肝移植术后胆道并发症的诊治中有着重要应用价值.     

Liver failure in an obese middle-aged woman after biliointestinal bypass

Obesity is considered an emerging epidemic that is often associated with non-alcoholic fatty liver disease. Among the therapeutic options for morbid obesity, bariatric surgery plays an important role when conventional therapies fail. The effects of bariatric surgery on liver function and morphology are controversial in the literature. Liver failure has been reported after jejunoileal bypass (JIB), biliopancreatic diversion and gastric bypass. Biliointestinal bypass (BIB) is considered an effective procedure among recently introduced bariatric surgery techniques. It is a clinically safe, purely malabsorptive operation in which the blind intestinal loop of the JIB is anastomosed to the gallbladder, allowing a portion of bile to transit into excluded intestinal tract. BIB is the only procedure, to our knowledge, to have no liver side effects reported in the literature. We report the case of a young obese woman who developed liver failure 8 mo after BIB. She had a rapid weight loss (70 kg) with a reduction in body mass index of 41% from January to September 2012. Because of a severe hepatic decompensation, she was referred to a transplantation centre. We strongly believe that the most important pathogenetic mechanism involved in the development of liver injury is the rapid weight loss that produced a significant fatty liver infiltration.     

多药耐药相关蛋白-3、4基因在人胆囊胆固醇结石中表达的半定量研究

目的通过半定量RT-PCR的方法研究多药耐药相关蛋白-3、4(MRP3、MRP4)基因在患胆固醇结石病人的胆囊中与非结石人群胆囊中表达的异同。方法用半定量RT-PCR的方法研究MRP3、MRP4在胆固醇结石病人与无结石人群胆囊上皮组织中的表达的异同。结果在患胆固醇结石的胆囊组织中,MRP3和MRP4同时表达,而且表达水平均显著高于正常胆囊;另外,MRP3的表达水平显著高于MRP4(P<0.001)。在正常(对照组)胆囊组织中,仅有MRP3表达,而未能检测到MRP4。结论胆固醇结石病人的胆囊组织中MRP3、MRP4蛋白的表达高于无胆固醇结石人群,提示它们可能促进人胆囊胆固醇结石形成。     

超声造影鉴别诊断胆囊良恶性病变的价值

目的 探讨超声造影在鉴别诊断胆囊良恶性疾病中的价值.方法 回顾分析应用对比脉冲序列成像技术和SonoVue超声造影检查117例胆囊病变的特征,比较胆囊良恶性病变常规超声和超声造影的诊断符合率.结果 除胆泥无造影剂进入外,胆囊良恶性病灶在达峰时多表现为高增强、富血供;消退时胆囊癌为低增强,良性病灶多为等增强.对于胆囊癌,常规超声的诊断符合率为65.38%,超声造影为92.31%;胆囊良性病灶,常规超声的诊断符合率为82.41%,超声造影为93.41%.结论 超声造影可提高超声诊断胆囊疾病的准确率,可鉴别胆泥沉积与胆囊癌,了解胆囊癌侵犯胆囊壁的程度及肝内转移情况,但对于腺瘤和单发息肉以及直径小的胆囊癌鉴别较困难.     

Aquaporins in the hepatobiliary tract. Which, where and what they do in health and disease

The biological importance of the aquaporin family of water channels was recently acknowledged by the 2003 Nobel Prize for Chemistry awarded to the discovering scientist Peter Agre. Among the pleiotropic roles exerted by aquaporins in nature in both health and disease, the review addresses the latest acquisitions about the expression and regulation, as well as physiology and pathophysiology of aquaporins in the hepatobiliary tract. Of note, at least seven out of the thirteen mammalian aquaporins are expressed in the liver, bile ducts and gallbladder. Aquaporins are essential for bile water secretion and reabsorption, as well as for plasma glycerol uptake by the hepatocyte and its conversion to glucose during starvation. Novel data are emerging regarding the physio-pathological involvement of aquaporins in multiple diseases such as cholestases, liver cirrhosis, obesity and insulin resistance, fatty liver, gallstone formation and even microparasite invasion of intrahepatic bile ducts. This body of knowledge represents the mainstay of present and future research in a rapidly expanding field.     

同种异体原位肝移植临床处理策略分析

目的 总结肝移植术临床经验。方法 对7例肝移植患者采取快速切取和修整供肝、加强术中及术后处理策略。结果 7例手术均成功，术后并发急性排斥1例、肺部感染3例、胆道感染2例、肝脓肿1例。结论 完善的手术技术、正确的术后处理是提高肝移植围手术期生存率的关键。     

小剂量乙型肝炎免疫球蛋白与拉米夫定联合使用对肝移植术后乙肝复发的疗效

目的　探讨有效的预防乙肝相关性终末期肝病肝移植术后乙肝复发的有效方法。方法　对 3 4例肝移植后患者进行分组 ,单纯使用拉米夫定组 16例 ;小剂量HBIG与拉米夫定联合使用组 18例 ,全部得到随访。结果　单纯组随访 6～ 3 2月 ,平均 18 1月 ,有 4例术后乙肝复发 ,已死亡 3例 ;联合组随访 3～ 2 0月 ,平均 15 1月 ,仅 1例术后 3月出现HBsAg阳性 ,经积极治疗 4月重新转阴性 ,现已术后 12月 ,肝功能正常。结论　小剂量HBIG与拉米夫定联合使用对乙肝相关终末期肝病肝移植术后乙肝复发有良好的效果 ,单纯使用拉米夫定仍有较高的复发率且有YMDD变异的危险。     

肝脏移植术后胆道并发症超声诊断的临床价值

目的 探讨超声波对肝移植术后胆道并发症的诊断价值。 方法 总结肝脏移植术后109例发生胆道并发症。将其资料的生化指标、胆道“T”型引流管X-线造影、部分患者胆道镜检查结果与超声波检查结果相对照。 结果 肝脏移植术后患者胆道并发症的超声表现不一：（1）胆道轻度扩张、胆道壁增厚、胆道走行迂曲；（2）超声检查发现胆道结石或沉积物的（与X一线造影、胆道镜检查对照）敏感性达95．6％；（3）肝实质内的囊性病变（胆汁瘤）；（4）胆道并发症的患者中46．8％同时发生动脉并发症。 结论 超声检查为肝移植术后胆道并发症的诊断提供了重要的诊断依据。     

1190名健康检查B型超声对肝胆脾肾疾病诊断结果与分析

本文对１９９７年度１１９０名健康检查中，应用Ｂ型超声对肝胆肾疾病诊断的分析。     

Spread of gallbladder carcinoma: CT evaluation with pathologic correlation

Background: To assess the accuracy of computed tomographic (CT) imaging in the detection of spread and staging of gallbladder carcinoma. Methods: CT findings of spread of gallbladder carcinoma in 59 Japanese patients who underwent radical surgery were correlated retrospectively with pathologic findings. Results: The incidence of histologically proven nodal involvement was 54% (32 patients) and the most common spread of gallbladder carcinoma. The sensitivities in CT detection of N1 and N2 nodal involvement were 36% and 47%, respectively; positive predictive values were 94% and 92%, respectively. Direct extension to the liver, extrahepatic bile duct, and gastrointestinal tract or pancreas were histologically confirmed in 24, 18, and five patients. The sensitivities in the CT detection of direct spread to the liver of less than 2 cm, more than 2 cm, the extrahepatic bile duct, and the gastrointestinal tract or pancreas were 65%, 100%, 50%, and 57%, respectively; positive predictive values were 77%, 100%, 90%, and 100%, respectively. The incidence of liver metastases and involvement of interaortocaval nodes were 7% and 16%, respectively. The sensitivities in CT detection of liver metastases and involvement of interaortocaval nodes were 75% and 21%, respectively; positive predictive values were 100% and 86%, respectively. CT could not detect direct spread to omentum and peritoneal seedings. Conclusion: For detecting the spread of gallbladder carcinoma, CT imaging has low to moderate sensitivity; however, CT imaging can help in determining resectability and in planning the treatment, especially in advanced-stage gallbladder carcinoma, because of a high positive predictive value. Received: 5 July 1995/Accepted: 8 August 1995     

肝移植术后肝动脉假性动脉瘤的诊断学特征并文献复习

目的探讨肝移植术后肝动脉假性动脉瘤破裂伴胆道出血的临床诊断学特征。 方法回顾性分析复旦大学附属中山医院肝外科收治的1例肝移植术后伴发胆管吻合口狭窄，反复行经内镜逆行性胆道支架引流(ERBD)术后，肝假性动脉瘤破裂伴胆道出血患者的诊疗经过，并复习相关文献。 结果患者因"反复发热伴黄疸1个月余"于2017年7月6日入院，患者肝移植术后4年，多次行ERBD。患者入院行经皮肝穿刺胆管造影检查发现肝右动脉显影，肝动脉造影确诊肝右动脉假性动脉瘤，破溃至胆道，行肝动脉假性动脉瘤栓塞术和经皮肝穿刺胆道引流术(PTCD)，术后发热及黄疸症状明显改善。 结论肝移植术后，有医源性有创治疗史患者，不明原因反复发热伴持续黄疸时，需术后定期行CT血管成像(CTA)检查作为随访，排除肝假性动脉瘤破裂胆道出血可能。