放射性核素肝胆显像在新生儿阻塞性黄疸诊断中的应用进展

新生儿阻塞性黄疸是儿科临床常见的一类疾病,病因复杂,其鉴别诊断仍然是一个难点。放射性核素肝胆显像对新生儿阻塞性黄疸尤其是先天性肝外胆管闭锁和新生儿肝炎综合征的诊断和鉴别诊断具有较大的临床应用优势。在放射性核素肝胆显像剂中以标记放射性同位素锝(99Tcm)发展最快,具有适宜的半衰期(6.02 h)和(140 keV)低能γ射线。目前,多数99Tcm标记的肝胆显像剂受高胆红素的影响,诊断的准确性普遍不令人满意。探讨具有肝摄取率高,排泄时间短,胆红素影响小的99Tcm标记的肝胆显像剂,将是一个新的研究课题。     

^99mTc-MIBI肝胆动态显像对先天性胆道闭锁的诊断价值

目的评价99m锝-甲氧基异丁基异腈（^99mTc-MIBI）肝胆动态显像在先天性胆道闭锁（BA）诊断中的临床应用价值。方法 52例患儿静脉注射^99mTc-MIBI后,用SPECT进行肝胆动态显像,并经手术病理和临床随访结果证实。结果在17例最终诊断为BA的患儿中,^99mTc-MIBI肝胆显像全部检出,灵敏度、特异度和准确性分别为100%、80.9%、92.3%。结论 ^99mTc-MIBI肝胆动态显像是无创、安全、有效的检查方法,对于BA的诊断,有较高的临床应用价值。     

术前减黄改善阻塞性黄疸大鼠肝功能的机制研究

目的探讨术前减黄改善阻塞性黄疸大鼠肝功能的机制。方法检测阻塞性黄疸大鼠(阻塞10d)-胆管外引流组(ED组)及对照组(SO组)引流的0、1、4、7、10、14d的肝功能,并通过反转录-聚合酶链反应法检测两组肝组织胆盐输出泵(BSEP)、多药耐药蛋白2(MRP2)、Na+信赖性的牛磺酸/钠共转运蛋白(NTCP)基因的表达。结果阻塞10d后ED组MRP2、NTCP基因表达减弱,与SO组相比差异有统计学意义(P<0.05),但BSEP基因表达略增强,开放引流后ED组肝功能各项指标均明显改善,引流后MRP2、NTCP基因表达明显增强,引流14d与SO组相比差异无统计学意义(P>0.05)。结论术前减黄改善阻塞性黄疸大鼠肝功能的机制可能是增加单位体积膜转运蛋白表达。     

放射性核素肝胆显像诊断先天性胆道闭锁的临床价值

目的:回顾性评价99mTc-EHIDA肝胆显像诊断先天性胆道闭锁(BA)的临床价值。方法:应用SPECT仪器对59例临床上持续黄疸的新生儿和婴儿进行99mTc-EHIDA肝胆显像,并经手术病理诊断及随访确诊。结果:最终诊断为BA的34例患儿中,99mTc-EHIDA肝胆显像全部检出;非BA组25例中23例为真阴性,2例为假阳性,灵敏度为100%,特异性92%,准确度96.6%。结论:99mTc-EHIDA肝胆显像是一种无创、安全、有效的检查方法,有助于明确病因,预测治疗效果,对于BA的诊断有较高的临床价值。     

Canadian Paediatric Society discusses certification, neonatal and terminal care at annual meeting

Cholescintigraphy with N-substituted iminodiacetic acid (HIDA) labelled with technetium-99m is a new noninvasive technique for evaluation of the hepatobiliary system. The significance of nonvisualization of the gallbladder by this method in comparison with standard radiologic examinations was studied. In 43 healthy subjects the gallbladder was visualized by the two methods. By contrast, all 27 patients in whom the gallbladder was not visualized by cholescintigraphy had cholecystitis. When visualization failed to occur, a repeat cholescintigraphic study after an injection of cholecystokinin demonstrated the status of the cystic duct. Visualization excludes cystic duct obstruction and acute cholecystitis, whereas persistent nonvisualization indicates cystic duct obstruction.     

Value of serum gamma-glutamyltransferase activity in the diagnosis of hepatobiliary disease

Serum gamma-glutamyltransferase activity (GGT) has been measured in 150 patients with a variety of hepatobiliary disorders. GGT concentration was significantly higher in patients with "cholestatic" liver disease than in those with "hepatic" disorders, although there was considerable overlap. Measurement of GGT alone did not allow differentiation of intrahepatic cholestasis from extrahepatic cholestasis. However, GGT/serum bilirubin ratios were significantly higher in patients with intrahepatic cholestasis when compared with patients with extrahepatic biliary obstruction. Estimation of serum concentration of GGT appears to be a sensitive screening test both for alcohol consumption and for hepatobiliary disease. However, measurement of GGT concentration has only limited value in the differential diagnosis of hepatobiliary disease, although it may help in the differentiation of "hepatitic" and "cholestatic" liver disease.     

肝内外胆管结石64排CT数据三维重建及其临床意义

目的 研究64排螺旋CT数据肝脏及其管道系统三维重建在肝胆外科中的临床意义.方法 利用胆道结石病人的肝脏64排螺旋CT扫描数据.用程序和人工方法对图像进行分割.采用Mimics软件进行三维重建,重建出的肝脏及其管道模型分别以STL格式输出.然后导入到FreeForm Modeling System进行修饰和平滑.将肝脏和其内的各个管道系统及结石进行配准.结果 重建的肝脏模型能真实反映肝脏的实际体积和肝脏的解剖标志,并且通过调节肝脏的透明度可同时显示肝脏和肝内的动脉、静脉、门静脉、部分腹部血管、胆道系统及其内的结石等,肝内、外胆管结石的大致位置及个数清晰可见,肝内、外胆管的扩张及狭窄情况一目了然,形态逼真,立体感强.同时还能对模型放大、缩小和旋转等其他全方位观察的操作.结论 肝脏及其管道系统三维重建有利于术前规划及术中取净结石,对胆道狭窄和扩张进行恰当的处理.对减少术后结石的残留和复发有重要意义.     

ERCP对成人先天性胆管囊肿的诊断及治疗价值

目的:评价经内镜逆行胰胆管造影(ERCP)对成人先天性胆管囊肿诊断和治疗的价值。方法:ERCP检查24例成人先天性胆管囊肿,并对其中11例合并梗阻性黄疸和化脓性胆管炎的病人及时行内镜下鼻胆引流术(ENBD)治疗。结果:按Todani的分类标准,ERCP检查发现Ⅰ型胆管囊肿14例(58.3%)、Ⅳa型8例(33.3%)、Ⅴ型即Caroli’s病2例(8.3%),其中包括囊肿癌变3例,胰胆管合流异常(APBDJ)4例。ERCP对胆管狭窄范围的判断及APBDJ的诊断优于CT及B超。ERCP治疗10例,包括胆管结石4例,胆管狭窄2例,胆管炎2例,囊肿癌变2例。ERCP治疗后1周内病人血白细胞计数、总胆红素、丙氨酸氨基转移酶、碱性磷酸酶明显下降。结论:成人先天性胆管囊肿Ⅰ型最为常见,胆管囊肿癌变率高、易合并相关的肝胆系统疾病。ERCP对胆管囊肿及APBDJ的诊断和分类较B超和常规CT检查更为直观、准确。ENBD治疗可迅速缓解梗阻性黄疸和化脓性胆管炎病人的症状,为进一步手术治疗创造良好的条件。     

婴儿肝炎综合征与胆道闭锁鉴别诊断方法的比较

回顾性评价了经手术或尸检诊断的１１例胆道闭锁和随访了２６例黄疸消失的婴儿肝炎综合征患儿十二指肠液的颜色、放射性核素肝胆显像、Ｂ超肝胆检查结果．以十二指肠液透明无色诊断胆道闭锁，十二指肠液黄色诊断婴儿肝炎综合征，正确率为９４．６％．以肠道有无放射性示踪剂来鉴别胆道闭锁与婴儿肝炎综合征，正确率为８１．１％．Ｂ型超声波肝胆检查有无胆囊鉴别胆道闭锁与婴儿肝炎综合征，正确率为７８．０％．结果表明，观察十二指肠液颜色是简单、快速、可靠的鉴别方法．     

ANIMAL MODEL OF SUPPURATIVE CHOLANGITIS AND BILIRUBIN CHOLANGIOLITHIASIS

Suppurative cholangitis (SC) and bilirubin cholangiolithiasis (BC) are twin diseases of the same etiology and one of the most serious epidemic diseases in China. It seems that the biliary stasis and infection of enterogenous bacteria are two of the most important pathogenic factors in these diseases. This paper presents the successful produc- tion of the model of SC and BC by mimicking these two factors. The model is based on a thorough knowledge of the anatomy of the experimental ani mal's hepatobiliary system and an appropriate design of the experimental operative procedures for making partial obstruction and bacterial contamina tion in a part of the biliary tree. In the anticipatory experiment typical pathological changes of suppura- tive cholangitis were displayed in all the involved hepatobiliary system of the survival rabbits, and bilirubin gallstones appeared in the gallbladders and the extra and intrahepatic bile ducts of more than 80TO of the rabbits. In the repetitive all the sur vivals suffered from cholangitis and bilirubin gall stones. In the comparative tests, the animals, that only had operative trauma, bacterial contamination or partial or complete obstruction in their biliary trees, did not demonstrate simultaneous pathological changes of SC and BC. In this paper, the current situation of the animal models of gallstone forma tion, the basis and essentials of making models, and     

肝胆管结石合并支气管胆瘘的外科治疗

目的:探讨肝胆管结石合并支气管胆瘘的外科治疗策略.方法:回顾性分析1983年5月～2009年5月间湖南省人民医院肝胆医院收治的8例肝胆管结石并支气管胆瘘患者的临床治疗经过.结果:本组8例患者全部经外科手术清除病灶,通畅引流后,6例治愈、1例效果不佳、1例死亡.结论:肝胆管结石合并流出段胆管的狭窄和梗阻是支气管胆瘘发生的...     

肝胆手术后胆漏的原因、预防和治疗

目的:探讨肝胆手术发生胆漏的原因、处理和预防措施。方法:对肝胆手术后发生胆漏的15例患者的发病特点、发生机制、处理方法和预防措施进行回顾性分析。结果:经不同口手术、介入B超腹腔置管引流和内镜治疗后患者均痊愈。结论:肝胆手术后发生胆漏的原因是多方面的,胆漏的发生重在预防,处理手段应个体化、多元化综合应用。     

肝胆显像剂~(99m)Tc-PHMT的制备和临床初步应用

试制了肝胆显像剂~(99m)Tc-PHMT,临床试用表明具有肝胆通过快,尿路排泄少和拮抗胆红素能力强的特点。1例血清胆红素高达22mg%的患者亦获得了较满意的肝胆显像结果。     

胆道术后胆管测压作用的研究

目的 :研究胆管测压在胆道术后判断病情 ,改善食欲及指导医疗护理等方面的作用。方法 :胆管内置管术病人 2 3例 ,将术后胆道下端无梗阻的 12例设为A组 ,其余 11例为B组。分别经胆管引流管检测餐前餐后胆管压力 ,记录 2 4小时胆汁引流量 ,记录食欲评分 ,进行相关分析。根据胆管压力调整引流管高度 ,或将胆汁注入消化道 ,了解食欲改善情况。结果 :B组餐后胆压明显升高 (P <0 0 1) ,A组变化不显著 (P >0 0 5 ) ;B组食欲评分明显低于A组 (P <0 0 1) ,食欲评分与胆汁引流量呈负相关关系 (r=- 0 6 9,P <0 0 1) ;将胆汁注入消化道后 ,食欲评分升高 (P <0 0 1)。结论 :胆道术后胆管测压在肝胆外科临床医疗护理中起重要作用     

~(99m)Tc-(Sn)-吡哆醛色氨酸肝胆显象剂的制备及应用

作者制备了~(99m)T_C-(Sn)-吡哆醛色氨酸肝胆显象剂。通过动物实验发现其核素物理特性适合于显象条件;血液清除快、肝胆排泄迅速、泌尿道浓度小、毒性低、具有较强的抗胆红素能力。经初步临床应用证实其为一较理想的肝胆显象剂。     

MRCP在胰胆管肿瘤诊断中的应用

目的：研究MRCP在胰胆管肿瘤诊断中的应用价值。方法;回顾分析了21例疑有胰胆管肿瘤病人的常规MR扫描及MRCP。结果：21例病人全部成功地进行了MRCP检查,胰胆管肿瘤主要表现为胰胆管的梗阻,某些病例可表现为特征的“双管征”。结论：MRCP是一种简单,安全,无创的影像学技术,在对胰胆管肿瘤的诊断中具有较高价值,其图像质量不低于ERCP,诊断价值高于ERCP。     

1974－2015年上海市杨浦区肝胆系统恶性肿瘤死亡趋势分析

目的利用上海市杨浦区1974－2015年肝胆系统恶性肿瘤的死亡数据,分析肝癌和胆道癌症死亡趋势变化及影响因素。方法应用Joinpoint回归模型分析上海市杨浦区肝癌和胆道癌症死亡趋势,应用年龄-时期-队列（APC）模型评估年龄和队列因素对肝癌和胆道癌症死亡率的影响。结果 1974－2015年杨浦区共报告肝癌死亡9 866例,男女比例为2.7∶1,粗死亡率为23.09/10万,标化死亡率为18.87/10万;胆道癌症死亡2 173例,男女比例为1∶1.7,粗死亡率为5.04/10万,标化死亡率为3.82/10万。Joinpoint回归分析显示1974－2015年肝癌标化死亡率呈下降趋势,而胆道癌症标化死亡率呈上升趋势。在APC模型中,随着年龄的增长,肝癌和胆道癌症的死亡风险整体呈上升趋势。总人群中1930年之前出生者肝癌和胆道癌症死亡风险呈上升趋势;1930－1949年出生的男性肝癌、男女性胆道癌症死亡风险呈下降趋势,1949年之后出生者呈上升趋势;而1930年之后出生的女性肝癌死亡风险呈下降趋势。结论 1974－2015年杨浦区肝癌死亡率呈下降趋势,男性肝癌死亡数高于女性;胆道癌症死亡率呈上升趋势,女性死亡人数高于男性;由老龄化因素造成的肝癌和胆道癌症死亡率上升;暴露因素对肝癌和胆道癌症的影响较一致,可能与当时社会经济因素有关。     

The early diagnosis of common bile duct obstruction using cholescintigraphy

The technetium Tc 99m-labeled iminodiacetic acid cholescintigram is an extremely accurate examination for detecting early obstruction of the common bile duct in acutely ill patients suspected of having acute cholecystitis or possible obstruction days to years after cholecystectomy. The examination accurately detected common bile duct obstruction in 63 of 65 patients in these two diagnostic categories (positive predictive value, 96.9%). Sonographic evaluations in 43 of these patients failed to reveal ductal dilatation or other abnormality in 26 cases (false-negative rate, 63.4%), and was nondiagnostic because of overlying bowel gas in two cases. The success of the radionuclide examination is attributed to its ability to detect functional impedance to bile flow hours to days before anatomic ductal dilatation occurs, and occasionally even before the alkaline phosphatase level and other liver chemistry values suggest the presence of an obstruction.     

Serum Lactic Dehydrogenase, Leucine Aminopeptidase and 5-Nucleotidase Activity: Observations in Patients with Carcinoma of the Pancreas and Hepatobiliary Disease

Serum lactic dehydrogenase, leucine aminopeptidase, 5-nucleotidase and alkaline phosphatase activities were investigated in a number of diseases involving the hepatobiliary system.

Leucine aminopeptidase was found to be a sensitive indicator of biliary obstruction, serum 5-nucleotidase slightly less sensitive, and alkaline phosphatase appreciably less sensitive. Leucine aminopeptidase and 5-nucleotidase activities were often increased by malignant infiltration of the liver and primary hepatic disease even in the absence of jaundice.

Serum lactic dehydrogenase was frequently increased in primary hepatic disease and malignant disorders but was not apparently affected by bile duct obstruction per se. Thirty-five of 45 patients with proved malignancy had increased lactic dehydrogenase levels.

The highest leucine aminopeptidase levels were encountered in carcinoma of the head of the pancreas. The frequent increase in both serum lactic dehydrogenase and leucine aminopeptidase activities in patients with carcinoma of the head of the pancreas suggests that these combined estimations are useful laboratory procedures in the diagnosis of malignant extrahepatic obstruction.

     

胆管灌洗在超声胆管造影中的应用价值

目的 进一步完善超声胆管造影(B-CEUS)的操作步骤,探讨胆管灌洗在超声胆管造影中的应用价值.方法 选取2016年4月至2017年4月于中南大学湘雅医学院附属海口医院超声医学科接受IB-CEUS的21例肝门部梗阻患者,先不经胆道灌洗步骤注入超声造影剂(UCA)进行胆管造影,待UCA效果消退后经引流导管灌洗肝内胆管系统,再行胆管造影.比较患者灌洗前和灌洗后肝内1级和3级胆管(肝段胆管)的即刻显影率.结果 胆管灌洗前,患者1级胆管1例显示不满意,20例显示满意,胆管灌洗后,21例患者1级胆管均显示满意,灌洗前后1级胆管即刻显示率比较,差异无统计学意义(P>0.05);胆管灌洗前,患者3级胆管6例显示不满意,15例显示满意,灌洗后,1例显示不满意,20例显示满意,灌洗前后3级胆管即刻显示率比较,差异有统计学意义(P<0.05).结论 在进行IB-CEUS前加入胆管灌洗这个步骤可以提高IB-CEUS中3级胆管的显示率,从而有望更精确的诊断胆管疾病.