经内镜胆管引流术375例评价

为评价经内镜胆管引流术在梗阻性黄疸、急性化脓性胆管炎等疾病中的应用效果，在１４１６例次逆行性胰胆管造影检查（ＥＲＣＰ）中，发现有胆道梗阻、胆道感染或为预防胆道感染即时行经内镜胆管引流术３７５例。结果成功３６２例，成功率为９６．５％；其中鼻胆管引流（ＥＮＢＤ）２２５例，塑料内支撑管引流（ＥＲＢＤ）９１例，金属支架引流（ＥＭＢＥ）４６例；其疗效满意率分别为９１．６％、９１．２％、９７．８％。早期胆管炎发生率分别为０．９％、５．５％、２．２％。结果提示经内镜胆管引流术是减除梗阻性黄疸、治疗急性化脓性胆管炎、预防ＥＲ－ＣＰ后感染和防止结石嵌顿安全而且有效的方法。     

可膨式金属胆道支架解除恶性胆管梗阻的中长期疗效

为总结经内镜放置可膨式金属胆道支架（ＥＭＢＥ）的中远期疗效，回顾了７６例恶性胆管梗阻接受ＥＭＢＥ治疗患者的资料，并与同期５３例次放置普通塑料支架的疗效进行对比。结果前者操作成功率９３．８％，与操作有关的并发症发生率６．６％，黄疸消除率为８７．０％，金属支架的平均通畅期为３１０天，明显高于塑料支架的８５天（Ｐ＜０．０１），患者平均存活期为２１０天。随访患者中有１６例（３４．８％）发生支架阻塞，平均发生时间１８５．５天。结果表明可膨式金属胆道支架的平均通畅性能显著优于普通塑料支架，可持久有效解除恶性肿瘤所致的肝外胆管梗阻，为提高ＥＭＢＥ的疗效必须严格掌握适应证     

二甲基硫脲对心肌细胞抗过氧化氢损伤的实验研究

为探讨二甲基硫脲（ＤＭＴＵ）保护心肌细胞抗过氧化氢（Ｈ２Ｏ２）损伤。３２瓶培养乳鼠心肌细胞随机分４组，每组８瓶：（１）对照组；（２）Ｈ２Ｏ２（５ｍｍｏｌ）组；（３）ＤＭＴＵ（２０ｍｍｏｌ）组；（４）Ｈ２Ｏ２（５ｍｍｏｌ）＋ＤＭＴＵ（２０ｍｍｏｌ）组。在３７℃、５％ＣＯ２的ＭＥＭ培养４小时。结果发现：（１）与对照组比，Ｈ２Ｏ２组乳酸脱氢酶（ＬＤＨ，Ｕ／１００ｍｌ）释放多（２８２．３８±４７．２８比７７．２５±１８．２５，Ｐ＜０．０１）、ＴＢＡ反应物（ＴＢＡＲＳ，ｎｍｏｌ／ｍｇＰｒ．）产生多（２．２５±０．５３比０．７９±０．３６，Ｐ＜０．０１）；（２）与Ｈ２Ｏ２组比，Ｈ２Ｏ２＋ＤＭ－ＴＵ组ＬＤＨ释放少（９９．２５±４１．８８比２８２．３８±４７．２８，Ｐ＜０．０１）；ＴＢＡＲＳ产生少（０．５９±０．１８比２．２５±０．５３，Ｐ＜０．０１）；此外，我们还发现ＤＭＴＵ组超氧化物歧化酶（ＳＯＤ，μｇ／ｍｇＰｒ．）比对照组高（８．４９±３．６５比１．９２±１．４０，Ｐ＜０．０１）。ＤＭＴＵ能保护心肌细胞抗Ｈ２Ｏ２损伤，机制与灭活羟自由基（·ＯＨ）、保护ＳＯＤ活性有关     

干扰素对人甲状腺细胞表面抗原表达的影响

目的研究干扰素（ＩＦＮα、ＩＦＮγ）及激素对人正常甲状腺细胞表面抗原表达的影响,以探讨ＩＦＮα导致自身免疫性甲状腺病（ＡＩＴＤ）的可能机制。方法应用ＩＦＮα、ＩＦＮγ、促甲状腺激素（ＴＳＨ）及催乳素（ＰＲＬ）,刺激体外培养的来自６名正常人的甲状腺细胞,通过免疫荧光染色及流式细胞仪测定其表面抗原—ＨＬＡＤＲ、细胞间粘附分子１（ＩＣＡＭ１）、Ｂ７．１和甲状腺过氧化物酶（ＴＰＯ）的表达。结果（１）ＩＦＮα明显诱导甲状腺细胞表达ＩＣＡＭ１、Ｂ７．１和ＴＰＯ（分别为Ｐ＜０．０１、Ｐ＜０．０１、Ｐ＜０．０５）;（２）ＩＦＮγ明显诱导甲状腺细胞表达ＨＬＡＤＲ、ＩＣＡＭ１,但对Ｂ７．１的表达无促进作用（Ｐ＜０．０１、Ｐ＜０．０１、Ｐ＞０．０５）;（３）ＰＲＬ显著诱导甲状腺细胞表达ＩＣＡＭ１、Ｂ７．１和ＴＰＯ（Ｐ＜０．０５、Ｐ＜０．０１、Ｐ＜０．０１）。结论协同刺激信号对ＡＩＴＤ的发生起着关键作用。ＩＦＮα显著诱导甲状腺细胞表达协同刺激信号（Ｂ７．１）和自身抗原ＴＰＯ,可能是临床应用ＩＦＮα诱致ＡＩＴＤ的致病原因之一。ＰＲＬ在产后甲状腺炎发病和发展中的作用应予以关注     

不同起搏方式对病窦综合征患者远期效果的影响

为了解不同起搏方式对病窦综合征特别是慢－快综合征患者心功能及房性心律失常的影响，利用超声心动图、体表心电图及Ｈｏｌｔｅｒ检查，对２１１例病窦综合征患者采用自身对照方法进行回顾性分析。结果发现：生理性起搏（ＡＡＩ／ＤＤＤ）组术后左室射血分数（ＬＶＥＦ）、心输出量（ＣＯ）明显增加（ＡＡＩ：５３．５±６．１％ｖｓ４７．２±７．８％，４．９５±０．５７Ｌ／ｍｉｎｖｓ４．２０±０．６２Ｌ／ｍｉｎ；ＤＤＤ：５２．５±６．８％ｖｓ４４．３±０．１％，５．１２±０．７１Ｌ／ｍｉｎｖｓ４．４１±０．３８Ｌ／ｍｉｎ；Ｐ均＜０．０１），左房内径（ＬＡＤ）无明显变化；ＤＤＤ组Ｅ／Ａ比值明显增加（０．９８±０．０９ｖｓ０．８７±０．１５，Ｐ＜０．０１），ＡＡＩ组Ｅ／Ａ比值呈增加趋势（Ｐ＝０．０５７）。房性心律失常发生率明显减少（１５．９％ｖｓ５０％，Ｐ＜０．０１）。非生理性起搏（ＶＶＩ）组术后ＬＶＥＦ、ＣＯ明显下降（４４．１±４．７％ｖｓ４８．３±４．３％，３．７７±０．４２Ｌ／ｍｉｎｖｓ４．１７±０．８５Ｌ／ｍｉｎ，Ｐ均＜０．０１），ＬＡＤ明显增大（３９．２６±２．３７ｍｍｖｓ３６．８１±２．３５ｍｍ，Ｐ＜０．０１），Ｅ／Ａ比值呈?     

逆行胰胆管造影对梗阻性黄疸的诊断价值

ＥＲＣＰ对梗阻性黄疸的诊断价值。３２例梗阻性黄疸做逆行胰胆管造影（ＥＲＣＰ），与Ｂ超和ＣＴ进行对比，探讨对其定位与病因的诊断价值。结果：恶性胆道梗阻１８例（５６．３％），良性梗阻１４例（４３．７％）。ＥＲＣＰ、Ｂ超及ＣＴ定位诊断率分别为９３．７％、８７．５％与８１．３％，三者比较差异无显著性（Ｐ＞０．０５）；病因诊断率分别为９０．６％、６２．５％与５６．３％，ＥＲＣＰ与Ｂ超和ＣＴ比较差异显著（Ｐ＜０．０５）；误诊率分别为９．４％、９．４％与３．１％，三者比较无显著性差异（Ｐ＞０．０５）。ＥＲＣＰ对梗阻性黄疸的病因诊断率明显优于Ｂ超和ＣＴ，对梗阻性黄疸是一种安全且不可缺少的诊断方法。     

MDS患者白细胞介素2受体表达研究

本实验以２８例ＭＤＳ（ＲＡ１８例、ＲＡＥＢ和ＲＡＥＢ－Ｔ１０例）和１０例ＡＮＬＬ为研究对象，采用ＡＰＡＡＰ和ＥＬＩＳＡ法检测患者外周血单个核细胞（ＰＨＡ刺激前后）的ＭＩＬ－２Ｒ和培养血清中ＳＴＬ－ＩＲ，结果表明：经ＰＨＡ刺激培养４８ｈ后，ＭＤＳ和ＡＮＬＬ患者Ｔａｃ抗原阳性率明显低于正常人（Ｐ＜０．０１）ＲＡＥＢ和ＲＡＥＢ－ｔ组Ｔａｃ＋率比ＲＡ低，与ＡＮＬＬ差异无显著性（Ｐ＞０．０５）；血清中ＳＴＬ－２Ｒ在ＭＤＳ各亚型中均高于正常对照组（Ｐ＜０．０５），其中以ＲＡＥＢ及ＲＡＥＢ－ｔ为著。认为ＭＤＳ患者免疫反应及监视能减弱；ＳＴＲ－２Ｒ与ｍＩＬ－２Ｒ无相关；ＩＬ－２Ｒ表达异常可能与造血抑制有关。     

肺心病患者红细胞免疫功能与活性氧关系的研究

目的：探讨肺心病患者红细胞免疫功能。方法：对３０例肺心病急性加重期患者采用化学比色法测定血清超氧化物歧化酶（ＳＯＤ）及丙二醛（ＭＤＡ），用红细胞酵母菌花环法测定红细胞免疫粘附功能。结果：肺心病急性加重期血清ＳＯＤ下降，ＭＤＡ升高，红细胞膜表面的Ｃ３ｂ受体（ＲＢＣＣ３ｂＲ）下降，红细胞免疫复合物（ＲＢＣＩＣ）升高，与健康对照组比较均具有显著差异（Ｐ＜００５，Ｐ＜００１）。直线相关分析：ＳＯＤ与ＲＢＣＣ３ｂＲ呈显著正相关（Ｐ＜００１），ＭＤＡ与ＲＢＣＣ３ｂＲ呈显著负相关（Ｐ＜００１），ＳＯＤ、ＭＤＡ与ＲＢＣＩＣ无线性相关关系。结论：肺心病急性加重期活性氧的增加是引起红细胞免疫粘附功能下降的一个重要原因。     

实验性大肠癌肠粘膜细胞增殖力学的变化规律及其意义

应用流式细胞光度术（ＦＣＭ）和银染核仁形成区（Ａｇ－ＮＯＲ）自动图像分析技术，对二甲基肼（ＤＭＨ）诱发Ｗｉｓｔａｒ大鼠大肠癌发生过程中的细胞增殖力学，进行了定量研究。结果表明，在注射ＤＭＨ第７、１４、２１和２８周时，肠粘膜增殖指数（ＰＩ）分别为１６．８３±１．８６、２４．２２±２６２９、２９．７０±７．１３和３１．８４±３．５５，均显著高于正常大鼠的１２．２０±２．６０（Ｐ＜０．０１）；Ａｇ一ＮＯＲ颗粒数在正常大鼠肠粘膜上皮细胞为３．６±０．７，而在上述诱癌不同时期则分别为５．７±ｌ．０、６．０±０．８、６．８±２．３和５．４±１．０（Ｐ＜０．０１）。这些变化不仅可作为大肠癌发生的早期生物学特征，而且还有助于确定实验动物的患癌易感程度。     

骨质疏松症患者骨密度和几种骨代谢参数的关系分析

目的探讨骨质疏松症（ＯＰ）患者骨密度（ＢＭＤ）和几种骨代谢参数相互关系及其在ＯＰ发病中的作用与诊断中的意义。方法随机选择绝经后妇女７４例，根据ＢＭＤ分为ＯＰ组、非ＯＰ组，以绝经前妇女３１例为对照组，将３组中ＢＭＤ与白细胞介素－６（ＩＬ－６），雌二醇（Ｅ２），骨钙素（ＢＧＰ），碱性磷酸酶（ＡＬＰ），血清钙（Ｃａ）和磷（Ｐ）等进行比较。结果ＢＭＤ与骨代谢参数的表现为：ＢＭＤ与ＩＬ－６、ＢＧＰ、ＡＬＰ呈负相关（ｒ分别为－０．５５８，－０．５３２，－０．４１９），与Ｅ２呈正相关（ｒ＝０．４０５），与Ｃａ和Ｐ无显著性相关关系（ｒ分别为０．０７３，０．０８０），结果显示：随血清雌激素水平下降ＢＭＤ减少，ＢＭＤ减少时，血清ＩＬ－６、ＢＧＰ、ＡＬＰ水平则升高。结论ＩＬ－６高表达与ＯＰ发病以及雌激素减少有关，血清雌激素水平下降可能导致ＩＬ－６分泌增多，ＩＬ－６水平升高，则可能是引起骨丢失原因之一     

经内镜胆道引流治疗胆道梗阻

目的：进一步提高经内镜胆道引流术的成功率。方法：总结1998年1月至2001年9月对320例胆道梗阻患者行十二指肠镜下各种胆道引流术的经验，其中鼻胆管引流术（ENBD）242例，胆道内置管引流术（ERBD）43例，胆道金属支架术（EMBE）35例。结果：305例得到成功引流，胆道梗阻症状缓解；失败15例。其中ENBD失败10例，经调整鼻胆管位置或重新置管获得成功；ERBD失败3例，2例选用合适长度的支架后引流成功，1例经努力仍未成功改用经皮肝穿刺胆道引流；EM-BE失败2例，其中1例金属支架未超出肿瘤狭窄段，经原金属支架再套入另一金属支架而成功，另1例支架放置1月又出现胆道阻塞，经原金属支架通道再放入塑料支架而恢复通畅引流。结论：经内镜引流治疗胆道梗阻疗效确切，及早分析内镜引流失败原因并采取相应的对策，绝大多数引流失败是可以避免或补救的。     

Early treatment of biliary lithiasis in biliary pancreatitis

Since 1982, 38 consecutive patients with biliary pancreatitis were treated prospectively in order to prevent recurrent migration of gallstones. Removal of the stones was achieved by "early surgery" i. e. within the first week after admission or by endoscopic sphincterotomy in patients with severe pancreatitis. Gallstones were visualized by ultrasonography in 31 patients (82 p. 100). Microlithiasis was present in 14 (37 p. 100) and was missed at ultrasonography in 7 patients. According to Ranson's prognostic signs, only 4 patients had 4 or more signs. These 4 patients and 2 additional patients aged more than 85 underwent urgent retrograde cholangiography and endoscopic sphincterotomy. No complications could be attributed to this technique. Among the 4 patients with severe pancreatitis, 3 developed an abscess which required delayed surgery without further complications. The 32 other patients underwent a biliary operation within the first week after admission. Common bile duct calculi were present in 14 patients being discovered by cholangioscopy in 6. One patient died after operation and one was reoperated on for a pseudocyst on day 40. No recurrent attack of pancreatitis was observed in either group. Our study suggests that slightly delayed biliary operation with cholangioscopy during the same hospitalization can be performed safety in patients with mild pancreatitis. In patients with severe attack and/or poor general condition, endoscopic sphincterotomy is a safe technique and deserves wider consideration in the management of severe acute pancreatitis for which delayed drainage of pancreatic necrosis may occasionally be required.     

The finest branches of the biliary tree might induce biliary vascularization necessary for biliary regeneration

BACKGROUND/AIMS: The finer branches of the biliary tree play an important role in biliary regeneration. They are consistently escorted by microvessels. Defects in the vascularization of these structures could impair bile duct regeneration. Therefore, we investigated the pattern of the escorting microvessels during the development of bile duct loss in the human liver, using chronic rejection as a model. METHODS: The number of interlobular bile ducts, bile ductules and extraportal biliary cells with and without escorting microvessels and the expression of VEGF-A were studied in follow-up biopsies of 12 patients with chronic rejection and 16 control patients with acute rejection without progression to chronic rejection. RESULTS: The controls showed a proliferation of bile ductules at 1-week and 1-month. Proliferation of bile ductules without microvessels preceded proliferation of bile ductules with microvessels. Proliferation of the microvascular compartment followed biliary proliferation. This sequence of events was not observed in the chronic rejection group, in which all biliary structures decreased in time. VEGF-A expression was increased at 1-week and 1-month in both groups. CONCLUSIONS: An immediate proliferative response of the finer branches of the biliary tree followed by proliferation of the microvascular compartment after biliary injury seems to be a prerequisite for bile duct regeneration.     

The effect of biliary decompression on antibiotic biliary excretion

BACKGROUND/AIMS: Raised biliary pressure may affect antibiotic biliary excretion. We evaluated whether biliary decompression for patients with biliary obstruction could improve antibiotic biliary excretion. METHODOLOGY: Eight patients with common bile duct obstruction undergoing endoscopic nasobiliary drainage were evaluated. During endoscopic cannulation, biliary pressure above the obstruction and antibiotic concentrations in the bile and peripheral blood were determined 60 min after the intravenous antibiotic (panipenem) administration. RESULTS: Biliary pressure was initially elevated above normal in all the patients, but normalized after biliary drainage for 5 to 7 days. At the initial endoscopic retrograde cholangiopancreatography, the aspirated bile contained low or undetectable levels of the antibiotic, but the mean bile panipenem concentration and the mean bile/plasma ratio of panipenem concentrations significantly improved after biliary decompression. CONCLUSIONS: The results suggest an important role of biliary pressure in determining antibiotic transfer into the bile.     

高位胆道梗阻内镜下选择性胆管插管导丝引导方法探讨

目的探讨导丝引导技术在高位胆道梗阻内镜下选择性胆管插管中的应用价值。方法对344例经ERCP诊治的高位胆道梗阻患者,乳头部胆管插管成功后应用导丝直通法、导管导丝法、乳头切开刀法、导管导丝＋导丝弯曲法、导丝α及反α结袢法、导丝旋转法、导丝直通联合取石球囊法及多孔导向导管法等多种导丝引导方法进行选择性胆管深插管,使其通过胆管狭窄段,进入目标胆管。观察插管效果。结果336例高位胆道梗阻患者顺利完成超选择性目标胆管插管,随后完成相应内镜下治疗,总成功率为97．67％。所有患者在插管过程中无合并胆道出血及穿孔等病例。结论高位胆道梗阻内镜下选择性胆管插管中不同导丝引导方法可以提高微创诊疗成功率、缩短操作时间,减少患者痛苦、降低并发症的发生率。     

内镜胆管引流术治疗胆瘘的临床价值

目的　探讨内镜胆管引流术治疗胆瘘的有效性和安全性。方法　回顾性分析2002年11月—2022年11月在解放军总医院第一医学中心诊治的连续性409例胆瘘患者的临床资料，最终纳入53例内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography， ERCP）下行胆管引流术的胆瘘患者，分析患者的一般情况、手术操作情况、治疗结局和不良事件等。将患者分为支架引流组（n=46）与鼻胆管引流组（n=7），比较两组术中特点、手术结果以及手术时间。结果　53例患者中，男36例、女17例，年龄（52.2±12.7）岁，其中58.5%（31/53）的患者继发于胆囊切除术。其临床成功率为83.0%（44/53），手术时间为27.0（13.5，33.5） min，治疗1（1，2） 次，治愈时间89 （47，161） d。ERCP治疗轻度胆瘘相较于重度胆瘘成功率较高［96.4%（27/28）比 68.0% （17/25）， χ2=7.57， P=0.006］。跨瘘口引流相较于非跨瘘口引流治疗胆瘘的成功率更高［91.7% （33/36） 比64.7% （11/17）， χ2=5.95， P=0.015］，而使用较大口径（≥10 Fr）与较小口径（<10 Fr）的支架治疗胆瘘的成功率相近［81.8% （27/33）比84.6%（11/13）， χ2=0.05， P=0.822］。18.9%（10/53）的患者出现不良事件，其中胰腺炎6例、出血2例、胆管炎1例，死亡1例。除1例死亡外，其余9例不良事件均为轻度，且经保守治疗后好转。鼻胆管引流组和胆管支架引流组在临床成功率［6/7比82.6%（38/46）， χ2=0.04，P=0.838］、中位手术时间（28.0 min 比 23.0 min， Z=0.38， P=0.774）方面差异无统计学意义。结论　内镜胆管引流术治疗胆瘘是安全有效的。鼻胆管和胆管支架引流的临床疗效相似，ERCP治疗轻度胆瘘以及跨瘘口引流可能具有更高的临床成功率。     

Intrahepatic biliary papilloma morphologically similar to biliary cystadenoma

A 37-year-old man presented complaining of epigastralgia. Abdominal ultrasonography revealed the presence of a papillary tumor (9 mm in diameter) in the cystic lesion (18 mm in diameter) in hepatic segment 4, which was accompanied by mild intrahepatic bile duct dilatation. Although abdominal computed tomography also showed the cystic lesion, it did not show papillary tumors inside the lesion. Endoscopic retrograde cholangiography showed the communication between the cystic lesion and the left hepatic duct. In addition, mucus was observed in the common bile duct. When transpapillary intraductal ultrasonography was performed through the left hepatic duct using a fine ultrasonic probe, a hyperechoic papillary and lobulated tumor was clearly shown in the cystic lesion. The wall of the cyst was smooth and there was no sign of tumor infiltration. Based on these findings, biliary cystadenoma was diagnosed and an extended left lobectomy was carried out. However, pathological findings postoperatively revealed that the lesion was a localized biliary papilloma, developing and extending to the intrahepatic duct. This case is rare and there have been no published reports describing a biliary papilloma morphologically similar to biliary cystadenoma.