经内镜治疗胆胰疾病278例分析

内镜逆行胰胆管造影术(ERCP)和内镜括约肌切开术(EST)是胆胰疾病重要的诊断和治疗手段。随着该技术的不断发展，单纯性ERCP正逐渐被治疗性ERCP所取代。胆胰疾病的内镜治疗手段包括胰胆管括约肌切开术，网篮或气囊取石术，机械、电解和激光碎石术，内支架置入术，鼻胆管、鼻胰管、鼻胆囊管引流术和胆道镜检查术等。内镜治疗的成功率超过90%，且并发症发生率和死亡率低于经皮和外科手术治疗。对需急诊处理的胆胰疾病患者选择内镜下治疗更为适宜。近年来我科通过内镜治疗各种胆胰疾病278例，现介绍如下。     

胆胰疾病中ERCP相关诊疗研究

经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)是在内镜下经十二指肠乳头插管注入对比剂,从而逆行显示胰胆管的造影技术,其最初用于胆胰管疾病的诊断.近年来随着内镜和放射介入技术的不断发展,ERCP在胆胰疾病的治疗方面也得到不断发展.本文对胆胰疾病中ERCP的相关研究作一概述.     

173例胰胆管疾病患者内镜逆行胰胆管造影术诊治分析

目的 讨论内镜逆行胰胆管造影术(ERCP)及内镜治疗对胰胆管疾病的诊断与治疗价值。方法 回顾分析173例胆胰疾病患者应用十二指肠镜进行诊断和治疗的临床效果。结果 ERCP成功率为93．6％，造影发现胆道结石69例，一次性成功取净结石66例，造影发现胆胰肿瘤20例，5例放置内支架引流。ERCP术后胰腺炎2例，十二指肠乳头肌切开(EST)术后出血2例，均经非手术治疗痊愈。结论 ERCP对于胆胰疾病的诊断明确可靠，内镜下治疗可使部分患者免除外科手术。     

气囊辅助内镜技术诊治消化道复杂手术后胰胆疾病的初步探索

目的 探索消化道复杂手术后胰胆系统疾病内镜诊治的方法.方法 回顾性总结4例复杂消化道手术(2例Roux-en-Y术、2例Whipple术)后进行气囊辅助内镜检查的患者资料,其中1例患者为单纯双气囊小肠镜探查手术后胆肠吻合口,3例为气囊辅助内镜检查结合ERCP技术.结果 1例患者成功实施治疗性ERCP,其余3例患者明确了诊断.4例患者术后均无明显出血、穿孔等操作相关并发症.结论 气囊辅助内镜检查法结合ERCP技术是消化道复杂手术后胰胆疾病重要的诊治手段.     

治疗性经内镜逆行性胰胆管造影术在老年胆胰疾病患者治疗中的应用价值

目的探讨经内镜逆行性胰胆管造影术(ERCP)在老年胆胰疾病诊疗中的应用价值。方法选取行ERCP治疗的患者230例分为老年组及非老年组,两组患者均接受ERCP治疗,对比两组患者胆胰疾病的组成情况、ERCP的操作方式、ERCP的治疗成功率和并发症的发生情况。结果老年组胆源性胰腺炎的发生率显著低于非老年组,而胆管癌的发生率显著高于非老年组(均P<0.05);老年组行经内镜胆道内支架放置术显著多于非老年组(P<0.05);两组患者ERCP成功率及并发症发生率无差异(P>0.05)。结论治疗性ERCP具有成功率高、临床疗效稳定、安全性好,并发症少等优势,是老年胆胰疾病较为理想的治疗方法。     

经内镜逆行性胰胆管造影诊治胆胰疾病610例分析

经内镜逆行性胰胆管造影术(ERCP)是一项为胆胰疾病患者广泛接受的诊断和治疗技术。由于该技术的不断发展及高科技辅助器械的开发研制,使得这项技术应用范围逐渐扩大,治疗性ERCP逐渐取代部分胆胰疾病的外科手术。本文对5年来宁夏医学院第二附属医院610例ER-CP进行分析。1资料和方法1·1一般资料1999-01~2003-01,我们采用内镜进行ERCP诊治610例患者,其中男273例、女337例,年龄20~84岁,平均50·7岁。1·2方法诊断性ERCP采用Olympus TJF-30型十二指肠镜,患者术前禁食6h,检查前肌注阿托品0·5mg,静脉推注安定5~10mg,恶性胆道梗阻性黄疸…     

胆胰疾病磁共振误诊及与ERCP结果比较分析

磁共振胰胆管显影术（MRCP）作为一种无创性诊断技术，其临床应用日趋增多，而经内镜逆行胰胆管造影（ERCP）作为胆胰系疾病的诊断金标准已在临床应用多年。为了评价MRCP和ERCP对胆胰系疾病的诊断价值，我们分析了56例胆胰疾病病例磁共振胰胆管造影（MRCP）误诊情况及与ERCP结果进行比较，报道如下。     

ERCP诊治胆胰疾病的临床应用

目的 探讨经内镜逆行胰胆管造影术(ERCP)在胆胰疾病诊治中的应用和减少并发症发生的方法。方法 术前禁食6h，在全麻或镇静下行逆行胰胆管造影，根据检查结果，选择性镜下治疗。结果 诊断性ERCP逐渐转向较多的治疗性ERCP，ERCP在胆胰疾病诊治中的应用范围扩大。结论 治疗性ERCP是胆胰疾病微创治疗的发展趋势。     

经内镜逆行胰胆管造影术后并发症的防治

经内镜逆行胰胆管造影术(ERCP)已从单纯的诊断技术发展为胆胰疾病的首选治疗措施,但其并发症在一定程度上不可避免,严格掌握ERCP适应证和禁忌证、加强术者的操作技术和术中的准确判断与处理,以及相关药物的合理使用是术后并发症预防和治疗的关键。     

胆胰疾病的内镜诊疗进展

自从1968年Mc Cune首先报道经内镜逆行胆胰管造影(ERCP)获得成功以来,内镜用于胆胰疾病的诊断、治疗得到了迅速的发展。在ERCP的基础上相继开展了内镜下乳头括约肌切开术、Oddi括约肌测压术、内镜胆道取蛔术、内镜鼻胆引流术、内镜胰管栓塞术及内镜置放胆道内支撑管术等。此外,胆道镜、经口胆一胰管镜(PCPS)、超声内镜、腹腔镜的结构和性能近十年亦有了较大的改进;加之激光、微波、电动液压震波碎石、体外震波碎石等技术的引进,更加扩大了胆胰疾病的内镜诊治范围,形成了以十二指肠镜、胆道镜和腹腔镜为主的胆胰内镜外科。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.