血清淀粉样蛋白A水平在慢性阻塞性肺疾病急性加重期的变化及其意义

目的探讨血清淀粉样蛋白A在慢性阻塞性肺疾病急性加重期的变化及其意义,为临床诊疗提供参考。方法选取我院接诊的慢性阻塞性肺疾病急性加重期患者70例．将其分为A组（AECOPDI级）38例和B组（AECOPDⅡ／Ⅲ级）32例,选取同期在我院体检的健康人群30例为健康对照组。对比急性加重期患者、稳定期患者以及健康对照组受试者的血清淀粉样蛋白A以及C-反应蛋白（CRP）水平：对比A组和B组患者的血清淀粉样蛋白A和CRP两个指标的敏感度和特异度;分析痰培养结果和血清淀粉样蛋白A和CRP水平的关系。结果稳定期和急性加重期患者的血清淀粉样蛋白A以及CRP水平均显著高于健康对照组（均P〈0．05）;急性加重期的血清淀粉样蛋白A以及CRP水平均显著高于稳定期（均P〈0．05）;慢性阻塞性肺疾病患者血清淀粉样蛋白A水平显著高于CRP水平（P〈0．05）;B组的血清淀粉样蛋白A在区分急性加重期和稳定期的敏感度和特异度为84％、91％,AUC值=0．92,优于CRP的敏感度和特异度（69％、69％,AUC值=0．79）;有脓性痰或者痰培养结果阳性患者的血清淀粉样蛋白A水平为（79．36±15．72）mg/L,CRP水平为（24．97±6．52）mg／L,均显著高于没有脓性痰且痰培养结果阴性的患者（均P〈0．05）。结论检测血清淀粉样蛋白A对判断慢性阻塞性肺疾病患者病情严重程度有一定的指导意义,同时可以指导临床更有针对性地应用和停用抗生素,值得在临床上进一步推广应用。     

Parasitic diseases of the biliary tract

OBJECTIVE: Parasites residing in the biliary tree include Clonorchis sinensis, Opisthorchis viverrini, Opisthorchis felineus, and Fasciola hepatica. They are willowy, leaf-like, flat flukes dwelling in the bile ducts and gallbladder. Human ascarides, Ascaris lumbricoides, dwelling in the small intestine, inadvertently migrate into the bile ducts and cause biliary obstruction. The purpose of this article is to illustrate typical imaging findings of liver fluke infection and biliary ascariasis. CONCLUSION: Adult flukes of Clonorchis and Opisthorchis measure 8-15 mm and adult flukes of Fasciola measure 20-40 mm in length. The presence of flukes in the bile ducts causes dilatation of the bile ducts, varying degrees of chronic inflammation followed by adenomatous hyperplasia, and bile duct wall thickening. Imaging findings of clonorchiasis and opisthorchiasis include visualization of adult flukes in the bile ducts and gallbladder, diffuse dilatation of the peripheral small intrahepatic bile ducts with no or minimal dilatation of the large bile ducts, and thickening of the bile duct wall. In biliary fascioliasis and ascariasis, adult worms are visualized in the dilated bile ducts and gallbladder.     

磁共振与超声在胆道系统疾病诊断中的价值

 目的 评价磁共振与超声在胆道系统疾病诊断中的价值.方法 收集手术治疗的病例92例,并将其术前的磁共振胆胰管造影(MRCP)及超声结果与手术结果作对比,利用ROC曲线进行分析.结果 超声诊断胆囊炎、胆囊结石价值比磁共振高,但磁共振对胆总管结石的检出率较高.结论 超声在胆道系统病变诊断中应作为首选,而对胆总管直径超过8 mm的病例术前应做MRCP以便正确选择手术方式.     

Iatrogenic biliary tract complications: radiologic features and clinical significance.

Thirteen intrahepatic and 22 extrahepatic biliary tract complications were detected radiologically in 35 adult patients who had undergone cholecystectomy and bile duct exploration. Intraoperative usage of Fogarty balloon catheters to extract biliary calculi without fluoroscopic guidance resulted in focal ectasia or rupture of intrahepatic radicles in two and seven cases, respectively. Metallic surgical instruments such as Bakes dilators and biliary forceps or clamps accounted for most of the common duct injuries; these were manifested as submucosal dissection (two cases), transmural laceration (four cases), or localized trauma with subsequent stricture (three cases). Technical mishaps during T-tube placement led to common duct perforation (four cases) and extraluminal malposition of T tubes (three cases). The remaining complications included choledochoduodenal fistula (three cases), biliovenous fistula (two cases), biloma (three cases), and retained intraductal fragments of biliary drainage catheters (two cases). Knowledge about radiologic features and causal factors of such iatrogenic processes can play a crucial role in their prevention, correct diagnosis, and management.     

64层螺旋CT阴性法胰胆管成像技术对胆道梗阻性疾病的诊断价值

目的探讨64层螺旋CT阴性法胰胆管成像（N-CTCP）对胆道梗阻部位、性质以及受累范围的诊断价值。方法 52例临床诊断为梗阻性黄疸的患者行64层螺旋CT中上腹部平扫和增强扫描,进行多平面重建（MPR）、曲面重建（CPR）及最小密度投影（MinIP）,作出CT诊断并与手术及病理结果进行比较,评估该技术在诊断胆道梗阻部位、性质以及受累范围的诊断价值。结果N-CTCP及重建图像质量优良,对梗阻部位、梗阻性质和胆管壁及周围器官结构受累情况的诊断准确率分别为的100%（52/52）、96.2%（50/52）和100%（52/52）。结论 64层螺旋CT阴性法胰胆管成像是一种有效的检查方法,具有强大的图像后处理功能,对胆道梗阻部位、性质及胆管壁与周围器官结构受累情况的诊断准确率高,具有很好的临床应用价值。