术中胆道造影在胆系结石手术中的应用

胆系结石可以是肝外胆管结石、肝内胆管结石、胆囊结石 ,可单发亦可几种情况组合存在 ,对于不同的情况采取的手术方式不同 ,术中造影方法也不尽一样。1　常用手术方法1 1　对于单纯肝外胆管结石 ,胆管上、下端通畅 ,无狭窄或其他病变 ,可采用胆总管切开取石术加T管引流术 ;若伴有胆囊结石或胆囊炎 ,可同时切除胆囊 ,手术中应将T管妥善固定 ,防止受压扭曲脱落。1 2　对于胆总管扩张 2 .5cm以上 ,下端有炎性狭窄等梗阻性病变 ,上端胆管通畅无狭窄 ,结石呈泥沙样不易取尽 ;有结石残留或结石复发者 ,可行胆肠吻合术 (胆肠内引流术 ) ;对于胆总…     

胆系手术致心率加快死亡一例

患者,女,52岁,因上腹疼痛5～6年住院。入院后查体,T37℃,P80次／分,BP110／70mmHg。腹部无压痛及反跳痛,B超示胆囊结石、胆囊萎缩。血清钾为3．9mmol／L。心电图未见异常改变。在全麻下行腹腔镜胆囊切除术,术中发现胆囊十二指肠瘘,遂转手术切除胆囊,并行十二指肠漏修补术。术中病人窦性心律,心率达110次／分,病人返回病房后达160次／分,但血压正常。经吸氧、西地兰静脉推注等对症处理始终未能控制心率,后转为室性心动过速,直至室颤,48h后患者因心力衰竭而死亡。尸检见左肺萎缩,     

220例教职工胆囊炎和胆系结石的B超检查分析

目的：探讨我校教职工胆囊炎、胆系结石的发病情况，以便做好预防工作。方法：选择我校教职工1487例行胆系B超检查，结合病史进行分析。结论：我校教职工中胆囊炎、胆系结石发病率分别为9.8％和5％，随年龄增大呈上升趋势，与地理环境、生活条件及饮食习惯有关，但与高脂血症关系最为密切。     

腹腔镜胆囊切除术中胆道造影的应用体会(附238例报告)

目的 探讨腹腔镜胆囊切除术中经胆囊管胆道造影的临床意义.方法 总结2002年8月～2006年8月施行腹腔镜胆囊切除术中经胆囊管胆道造影238例治疗情况.结果 223例造影效果满意,成功率93.7%.术中造影发现胆总管结石31例,全组无并发症发生.结论 腹腔镜胆囊切除术中经胆囊管胆道造影方法是安全可行的,能及时发现胆总管病变,极大地降低了术后胆管并发症的发生.     

胆系结石的B超诊断价值

对B超在胆系不同部位结石症诊断中的价值进行分析,并探讨提高胆管结石诊断率的方法。方法对82例B超检查的胆石症患者,按结石部位的不同将术前B超检查结果与术后结果进行对照。结果B超对胆囊结石诊断准确率较高,对胆管结石,尤其是胆总管下段结石及多部位结石,检出率较低。结论B超对胆囊结石的诊断率明显高于胆管结石,通过改变操作方法可进一步提高胆管结石诊断率。     

胆系静脉造影前的观察与护理

胆系静脉造影是将造影剂注入静脉后,经肝脏排泄至胆系内,同时显示胆管及胆囊的检查方法,细心观察与周到的护理是造影成功的关键.1 严格掌握适应证和禁忌证     

胆道蛔虫残体合并胆道结石B超诊断与手术结果对比分析

我们从1993年至2005年,经B超诊断胆道蛔虫残体合并胆道结石,行胆囊切除,胆道切开取石、取虫,胆总管探查下T管引流18例,无漏诊、误诊。术前术后诊断符合率达100%。现报告如下:     

胆系静脉造影前的观察与护理

胆系静脉造影是将造影剂注入静脉后,经肝脏排泄至胆系内,同时显示胆管及胆囊的检查方法,细心观察与周到的护理是造影成功的关键。     

B超诊断胆道结石与手术结果的分析

胆道系统结石包括胆囊结石、胆总管结石和肝内胆管结石,是一种常见的多发病。诊断胆道结石的方法很多,如腹部平片、逆行胆道造影、CT等,但上述方法均有不足之处,腹部平片对比较疏松的结石和泥沙样结石不显影,逆行胆道造影手续烦琐,不容易做,而CT费用高昂,不是所有患者易接受。利用B超检查,简单、方便,费用低,能比较准确地判断结石的部位、大小,因而作为目前诊断结石和首选方法。现将我院自1997年4月至2008年9月,术前由B超检查提示胆囊炎并胆囊结石、胆总管结石、肝内胆管结石28例与外科或十二指肠镜下取石的结果对照分析如下。     

茵栀黄口服液辅助治疗新生儿胆道闭锁21例疗效研究

目的 探讨茵栀黄口服液治疗胆道闭锁的临床疗效及安全性。方法 将42例胆道闭锁患儿随机分为对照组和治疗组,各21例。对照组采用肝门空肠吻合术（Kasai手术）及药物常规治疗,治疗组在此基础上于手术前后口服茵栀黄口服液。观察两组患儿的临床疗效,于治疗前后检测血生化指标和细胞因子水平,并记录药品不良反应;随访半年,观察胆管炎的发作情况及肝纤维化程度。结果 治疗后,治疗组总有效率为90.48%,明显高于对照组的71.43%（P〈0.05）;两组患儿治疗后血生化指标和细胞因子水平均较治疗前明显降低,且治疗组比对照组下降更显著（P〈0.05）;治疗组出现药品不良反应3例,症状均较轻微;随访半年,治疗组和对照组胆管炎发生率分别为9.52%和23.81%,肝纤维化异常率分别为9.52%和28.57%,但差异无统计学意义（P〉0.05）。结论 胆道闭锁新生儿在行Kasai手术及常规药物治疗的基础上,加用口服茵栀黄口服液,可显著提高临床疗效,调节患儿免疫功能,且不良反应较少,值得推广。     

Biliary Excretion of Bisacodyl and Picosulphate in Man: Studies in Gallstone Patients after Biliary Tract Surgery

Abstract: Bisacodyl (=BIS) and picosulphate (=PICO) have been given perorally to postoperative gallstone patients, who have undergone biliary tract surgery with the insertion of an indwelling T-tube. The doses corresponded to 7.7 mg of their common free diphenol desacetylbisacodyl (=DES). The bile was sampled in hourly fractions from the external limb of the T-tube; these fractions were analysed by a modification of the HPLC method previously used to study biliary excretion in the rat. In the BIS-patients (n=8), DES in conjugated form occurred in significant concentration already in the first fractions; peak excretion values equivalent to 4–8 μg DES/ml bile were reached in 2–5 hours. Unchanged BIS could not be detected, and the concentration levels of unconjugated DES were insignificant. The PICO-patients (n=8) on the other hand showed low DES concentrations (conjugated+free≤0.5 μg DES/ml) in all fractions, or low initial concentrations followed by a more or less pronounced rise in the later fractions. These results are, qualitatively, as in the rat. However, the dose fractions excreted in bile (assuming a total hepatic output of 50 ml/hour) seem smaller than those to be expected from rat experiments, at least as far as BIS is concerned.     

舒芬太尼用于全髋置换手术后患者自控静脉镇痛35例

目的 观察舒芬太尼用于全髋置换手术后患者自控静脉镇痛的临床镇痛效果和不良反应.方法 选择全身麻醉下行全髋置换手术且进行自控静脉镇痛的患者70例,随机均分为两组.对照组使用0.5 g/L吗啡,试验组使用1.5μg/mL舒芬太尼,背景剂量2 mL/h,单次给药剂量1 mL,锁定时间8 min.观察患者术后2,8,24,48 h的镇痛效果,记录镇痛泵使用情况、不良反应以及是否使用其他镇痛药物.结果 试验组视觉模拟评分在术后48 h低于对照组(P<0.05);两组患者口述评分的差异无统计学意义(P>0.05);对照组有2例患者因镇痛不全而肌肉注射哌替啶50mg;两组患者恶心、呕吐的发生率比较无统计学差异(P>0.05),均未出现嗜睡、呼吸抑制等其他不良反应.结论 舒芬太尼可安全有效地用于全髋置换手术的患者自控静脉镇痛,镇痛作用确切且略优于吗啡,不良反应与吗啡相似.     

Antibiotics in the Biliary Tract: A Review of the Pharmacokinetics and Clinical Outcomes of Antibiotics Penetrating the Bile and Gallbladder Wall

Biliary tract infections (BTIs), including cholangitis and cholecystitis, are common causes of bacteremia. Bacteremic BTIs are associated with a mortality rate of 9–12%. The extent to which antibiotics are excreted in the bile and the ratio of their exposure to the minimum inhibitory concentration of the infecting organism are among the important factors for the treatment of BTIs. This review updates health care professionals on the distribution of antibiotics in the common bile duct, gallbladder, and gallbladder wall. Antibiotic efficacy in treating BTIs based on the latest available clinical studies is also discussed. The efficacy and pharmacokinetics of 50 antibiotics are discussed. Overall, most antibiotic classes exhibit biliary penetration that translates into clinical efficacy. Only seven antibiotics (amoxicillin, cefadroxil, cefoxitin, ertapenem, gentamicin, amikacin, and trimethoprim/sulfamethoxazole) had poor biliary penetration profiles. Three antibiotics (ceftibuten, ceftolozane/tazobactam, and doripenem) had positive clinical outcomes despite the lack of pharmacokinetic studies on their penetration into the biliary tract. Conflicting efficacy data were reported for ampicillin despite adequate biliary penetration, whereas conflicting pharmacokinetic data were reported with cefaclor and moxifloxacin. Even in the absence of supportive clinical studies, antibiotics with good biliary penetration profiles may have a place in the treatment of BTIs.     

235例胆道感染病原菌组成及其耐药性分析

目的:了解胆道感染的病原菌组成及耐药现状,为临床医师合理使用抗菌药物提供依据。方法:对235例胆道感染患者的胆汁进行细菌培养鉴定及药敏分析。结果:胆汁病原菌检出率为61.7%,其中革兰阴性杆菌占59.3%,革兰阳性球菌占38.9%,假丝酵母菌占1.8%。细菌构成比中,前4位病原菌分别为肠球菌属37.7%、大肠埃希菌29.3%、克雷伯菌属18.6%、铜绿假单胞菌5.4%。主要革兰阴性杆菌对亚胺培南和阿米卡星敏感,肠球菌属对万古霉素、氯霉素、氨苄青霉素、青霉素、高浓度庆大霉素敏感。产超广谱β-内酰胺酶的大肠埃希菌和克雷伯菌属共检出30株,产酶率为37.5%。结论:胆汁细菌培养与药敏分析可为临床合理应用抗菌药物提供依据。     

小檗碱、巴马汀和药根碱在“三明治”培养大鼠原代肝细胞中的胆汁外排特征

目的研究小檗碱、巴马汀和药根碱在大鼠原代细胞的胆汁外排特征。方法建立"三明治"培养大鼠原代肝细胞(sandwich cultured rat hepatocytes,SCRH)模型,分别加入小檗碱、巴马汀、药根碱,在含Ca²⁺和无Ca²⁺缓冲液中孵育,采用UPLC-MS/MS分别测定3种生物碱的细胞蓄积量,计算胆汁排泄指数和胆汁清除率,评价小檗碱、巴马汀、药根碱在大鼠原代细胞的胆汁外排特征;并考察P-gp、Mrp2抑制剂对3种活性成分在SCRH细胞模型中的外排转运影响。结果随着孵育时间的延长,3种生物碱的细胞蓄积量增加,且含Ca²⁺条件下的细胞蓄积量与无Ca²⁺条件下相比具有明显差异;P-gp抑制剂环孢素A、维拉帕米均能减少小檗碱、巴马汀、药根碱的胆汁排泄,且呈浓度依赖性,Mrp2抑制剂MK571、丙磺舒对3种生物碱的胆汁排泄无明显影响。结论小檗碱、巴马汀、药根碱均经过胆汁外排,P-gp介导了3种生物碱的胆汁外排,Mrp2未参与其胆汁排泄。     

Pharmacokinetics of Uridine Following Ocular,Oral and Intravenous Administration in Rabbits

The pyrimidine nucleoside uridine has recently been reported to have a protective effect on cultured human corneal epithelial cells, in an animal model of dry eye and in patients. In this study, we investigate the pharmacokinetic profile of uridine in rabbits, following topical ocular (8 mg/eye), oral (450 mg/kg) and intravenous (100 mg/kg) administration. Blood and urine samples were serially taken, and uridine was measured by high-performance liquid chromatography-tandem mass spectrometry. No symptoms were noted in the animals after uridine treatment. Uridine was not detected in either plasma or urine after topical ocular administration, indicating no systemic exposure to uridine with this treatment route. Following a single intravenous dose, the plasma concentration of uridine showed a bi-exponential decay, with a rapid decline over 10 min, followed by a slow decay with a terminal half-life of 0.36 ± 0.05 h. Clearance and volume of distribution were 1.8 ± 0.6 L/h/kg and 0.58 ± 0.32 L/kg, respectively. The area under the plasma concentration-time curves (AUC) was 59.7 ± 18.2 μg·hr/ml, and urinary excretion up to 12 hr was ~7.7% of the dose. Plasma uridine reached a peak of 25.8 ± 4.1 μg/ml at 2.3 ± 0.8 hr after oral administration. The AUC was 79.0 ± 13.9 μg·hr/ml, representing ~29.4% of absolute bioavailability. About 1% of the oral dose was excreted in the urine. These results should prove useful in the design of future clinical and nonclinical studies conducted with uridine.     

动静脉联合溶栓与静脉溶栓治疗急性缺血性脑卒中的对比研究

目的 评估动静脉联合溶栓治疗急性期缺血性脑卒中的疗效和风险.方法 2010年6月-2013年6月收住符合溶栓适应证且无禁忌证的急性期缺血性脑卒中82例按自愿原则,接受动静脉联合溶栓治疗31例,接受静脉溶栓治疗51例,评估治疗后的临床效果.结果 动静脉联合溶栓组溶栓后Ⅱ~Ⅲ级闭塞血管再通率、早期临床神经功能改善率、3个月较好转归率显著高于静脉溶栓组（P＜0.05）,症状性颅内出血发生率、术后3个月的病死率两组无差异（P＞0.05）.结论 相对于静脉溶栓,动静脉联合溶栓具有与之相似的安全性,且动静脉联合溶栓拥有更好的疗效,但该结果仍有待于大样本的随机、双盲对照试验证实.     

Studies in the Rat on the Absorption,Biliary Excretion,Laxative Action and Interference with Intestinal Transport of some Oxyphenisatin Derivatives

Abstract The free diphenol oxyphenisatin (I) and its sulphuric acid (II) and acetic acid (III) di-esters are compared. I disappered rapidly from the lumen of tied jejunal loops in vivo; its disapperance was associated with an inhibition of normal fluid absorption and an increase in loop tissue wet weight. II disappeared slowly, and did neither inhibit fluid absorption nor cause an increase in wet weight. Large fractions of I conjugates were excreted in the bile 0-6, 6-12 and 12-18 hrs following intragastric administration of I; after II and III much smaller fractions were excreted, and their time pattern differed from that of I. The absorption and biliary excretion experiments when combined indicate that following intragastric administration in the intact rat, the bulk of I will undergo enterohepatic circulation during its small intestinal transit, while II and III pass largely unabsorbed to the colon. In spite of their direct transit, however, the laxative action of both II and III in concious rats was slower in onset than of I. In this respect, II differed strikingly from the sulphuric acid di-ester of desacetyl-bisacodyl (IV), which acted even more promptly than I. As in the jejunum, II was inactive per se in tied colonic loops; liberation of free I being required to elicite inhibition of colonic electrolyte and fluid absorption. The reason for the long laxative latency period of II and III appears then mainly to be slow colonic hydrolysis of these prodrugs. Supplementary experiments supported this view as far as the water soluble II is concerned, and slow hydrolysis is very likely for such a sparingly soluble drug as III.     

美曲伪麻口服溶液治疗感冒所致上呼吸道症状30例

目的评价美曲伪麻口服溶液治疗鼻塞、流涕、咽痛、咳嗽、咯痰等感冒所致上呼吸道症状的疗效和安全性。方法采用随机、双盲、平行对照实验设计，将入选的60例感冒患者随机分为实验组和对照组各30例。实验组给予美曲伪麻口服溶液，每次10 mL，q8 h；对照组给予美敏伪麻口服溶液,每次10 mL，q8 h，疗程均为3～5 d。观察两组临床疗效与安全性。结果实验组与对照组总显效率分别为93.33 %与89.66%，总有效率分别为96.67%和96.55%。实验组和对照组发生不良事件（与药物可能有关）分别为2和3例，发生率分别为6.67%和10.00%。以上结果两组间比较均差异无显著性（均P＞0.05）。实验组和对照组咳痰症状的改善率分别为97.69 %和88.10%,治疗组显著高于对照组（均P＜0.05），美曲伪麻口服溶液对咳痰症状的改善优于美敏伪麻口服溶液。结论美曲伪麻口服溶液治疗感冒所致上呼吸道症状（鼻塞、流涕、咽痛、咳嗽、咯痰）疗效确切，安全性好。