Diagnostic significance of bile cytology in obstructive jaundice

Cytological examination of exfoliated cells in the bile or irrigated fluid from a percutaneous transhepatic choledochal drainage (PTCD) tube and other jaundice-reducing fistula was performed in 59 patients with obstructive jaundice. Malignant cells were found in 22 of 27 patients with choledochal cancer, 5 of 17 patients with pancreatic cancer, 3 of 6 patients with gallbladder cancer, and one of 5 patients with other malignancies. Exfoliated malignant cells were found at a higher rate in the washed fluid of the PTCD tube than in the pure bile aspirated from the PTCD tube. Half of the positive cases were diagnosed as such upon the first cytological examination, and the remaining in second or subsequent cytological examinations. The cytological appearance of cells in the washed fluid or bile reflected the type of cancer cells found by touch-smear of the lesion and also the histological type. This method requires no special technique and facilitates accurate diagnosis in patients with malignant lesion of the choledochal duct.     

MRCP�Թ����Ի������ϼ�ֵ

目的 探讨磁共振胰胆管造影（MRCP）对梗阻性黄疸的诊断价值。方法 对248例梗阻性黄疸病人行MRCP扫描。对MRCP影像诊断与手术病理诊断结果或随访结果进行对比分析。结果 MRCP对梗阻性黄疸的定位诊断率可达100%;对胆道结石大多能明确诊断。对胆管炎性狭窄,胰腺炎可以进行诊断,但有一部分病例可误诊为胆管占位,胰腺占位,对胆管癌及壶腹癌诊断较可靠。结论 MRCP能判断梗阻性黄疸的具体梗阻部位,根据影像特征基本可以推断病变性质。     

Schwannoma of common bile duct causing obstructive jaundice

Benign schwannomas arise from neural crest-derived Schwann cells. Schwannomas occurring in the biliary tract become clinically symptomatic due to their compression on the extra hepatic biliary tract causing obstructive jaundice. Their preoperative diagnosis is extremely difficult. We report a 38-year-old male who presented with pain abdomen and jaundice. Computed tomography of abdomen showed extra luminal compression of common bile duct (CBD) possibly by a lymph nodal mass. Resection of the CBD, gall bladder and the mass compressing the CBD with Rouxen-Y hepaticojejunostomy was performed. The final histopathology was reported as a schwannoma.     

磁共振胰胆管水成像对恶性梗阻性黄疸的诊断价值

目的探讨磁共振胰胆管水成像(MRCP)对恶性梗阻性黄疸的诊断价值。方法回顾性分析33例恶性梗阻性黄疸病人MRCP,测量其胆总管直径、胰管直径和胰胆管的汇合角度。结果恶性梗阻性黄疸病人的MRCP成像中胆总管直径、胰管直径和胰胆管的汇合角度与对照组有显著的差异。结论MRCP是一种简单、安全、无创的影像学技术,对恶性梗阻性黄疸的诊断有较高的价值。     

Eosinophilic cholangitis with obstructive jaundice mimicking bile duct carcinoma

A 55-year-old male who presented with obstructive jaundice and radiographically documented extrahepatic biliary tract obstruction is reported. Eosinophilic infiltration of the gallbladder, common bile duct, intrahepatic bile ducts, and bone marrow was observed. Eosinophilic cholangitis, a rare inflammatory condition that clinically resembles a biliary malignancy, should be taken into consideration in the differential diagnosis in the evaluation of presumed neoplasm of the bile ducts.     

Electron microscopic assessment of bile regurgitation of humans in extrahepatic obstructive jaundice

Thirty-seven patients were studied on the anatomic routes of bile regurgitation into the blood stream by electron microscopy. The aim was to identify the relationship between the clinical results and pathway of bile regurgitation. These patients were classified into 3 groups; recovered, delayed, and fatal. Transcellular, paracellular, direct communication, necrotic hepatocyte and ruptured ductule pathway were found. In the recovered group, the transcellular pathway was most frequent with an incidence of 54.17%, and a direct communication pathway was found to be 54.55% in the fatal group with a significant difference between that of the recovered and delayed group. Long-duration bile duct obstruction creates bile regurgitation by way of direct communication between the canaliculi and Disse's space, and usually with a poor prognosis, since the serum bilirubin reached the high level of 22.65 mg%. Therefore, it is better to relieve the intrabiliary pressure as early as possible to prevent the jaundice from producing the irreversible change of hepatic canaliculi and Disse's space.     

ERCP在梗阻性黄疸诊治中的价值

目的：评价经内镜逆行胰胆管造影（ERCP）对梗阻性黄疸的诊治价值。方法：75例病因不确切梗阻性黄疸患者均行ERCP检查,并与MRCP对比分析ERCP诊治结果。结果：ERCP对梗阻性黄疸病因诊断符合率84.0%（63/75）,明显高于MRCP诊断符合率53.3%（40/75）,差异有统计学意义（P〈0.05）。ERCP、MRCP对胆系结石所致梗阻性黄疸诊断符合率分别为92.1%（35/38）、78.9%（30/38）,差异无统计学意义（P〉0.05）。对胆系结石以外的病因所致梗阻性黄疸,ERCP诊断符合率为80.0%（28/35）,明显高于MRCP28.6%（10/35）,差异有统计学意义（P〈0.01）。10例胆总管结石患者在ERCP下取石成功。结论：在明确梗阻性黄疸病因方面的作用,目前MRCP尚不能取代ERCP。ERCP对于部分梗阻性黄疸患者具有一定治疗作用。     

Value of preoperative drainage of the bile ducts in obstructive jaundice]

Hepato-biliary surgery for obstructive jaundice is associated with high morbidity and mortality rates. Experimental and clinical studies on obstructive jaundice revealed endotoxaemia, coagulation disorders and depressed immune function. Many studies have been carried out to identify the operative risk factors. The serum bilirubin level seemed to be a significant factor. Biliary decompression via a percutaneous or endoscopic retrograde approach was therefore proposed to improve the surgical outcome. The first retrospective studies have suggested a reduction of morbidity and mortality. Subsequent randomized studies have not confirm the benefit of preoperative biliary drainage because of procedure-related complications. The article reviews the literature on preoperative biliary drainage and proposes the indications, choice of method and optimal duration of biliary drainage.     

氧化低密度脂蛋白在慢性梗阻性黄疸大鼠肝脏中的表达与意义

目的 探讨氧化低密度脂蛋白在慢性梗阻性黄疸大鼠中的表达与肝脏纤维化的关系.方法 60只SD大鼠被随机分成对照组（A组）和慢性梗阻性黄疸组（B组）两组,每组每时段6只.分别于造模后第1、2、3、4、5周抽取大鼠静脉血检查肝功能,显微镜目镜刻度下测量大鼠胆总管直径,免疫荧光法检测氧化低密度脂蛋白在肝脏的表达,放射免疫法检测肝纤维化三项,光学显微镜观察肝组织的病理改变.第4周行胆总管十二指肠吻合再通.结果 慢性梗阻性黄疸组大鼠术后总胆红素升高,胆总管直径扩张,组织病理学检查显示肝细胞变性,并有纤维增生性改变.与对照组比较,慢性梗阻性黄疸组肝组织氧化低密度脂蛋白的表达增强,肝纤维化三项术后第3周起明显升高.胆总管与十二指肠端侧吻合再通后黄疸缓慢消退.术后第3周氧化低密度脂蛋白的表达及肝纤维化三项差异有统计学意义（P 〈 0.05）.结论 慢性梗阻性黄疸大鼠肝组织氧化低密度脂蛋白的表达增强,与肝脏的纤维化的程度相关.     

Decreased clearance of Escherichia coli from the bile in rats with obstructive jaundice

Clearance of Escherichia coli from the bile was studied in 4 normal Sprague-Dawley rats and 4 rats with 3 weeks of obstruction of the common bile duct. 125I-radiolabelled heat-killed E. coli were injected into the common bile duct and the radioactivity of the bile monitored for 2 h. The radioactivity declined exponentially during the first 10 min. Bile samples collected from 2 to 15 min after injection showed higher amounts of radioactivity in all rats with biliary obstruction than in the normal rats. However, the clearance rate was higher in normal than in obstructed rats (p less than 0.05). It was, therefore, concluded that the bacteria were cleared off the bile rapidly in normal rats by the function of a liver and/or a biliary tree. The present data, concerning the kinetic study of bacterial clearance from the biliary tract, indicates that the impaired clearance of bacteria in chronic biliary obstruction might be crucial for the development of biliary sepsis.     

Neurofibroma of the bile duct: a rare cause of obstructive jaundice

Neurofibromas of the common bile duct are extremely rare. The lack of specific clinical or radiological features makes preoperative diagnosis in the absence of histology difficult. We report the case of a female patient who presented with obstructive jaundice and evidence of a common bile duct stricture on imaging. She underwent an exploratory laparotomy, and intraoperative frozen section confirmed clear margins and a benign lesion. Excision of the extrahepatic bile duct and A Roux-en-Y hepaticojejunostomy was performed. We discuss the clinical features and management of neurofibromas of the bile duct in light of the literature.     

Endotoxemia in obstructive jaundice. Observations on cause and clinical significance

Perioperative endotoxemia was detected in 24 of 40 patients who underwent operation for obstructive jaundice (bilirubin level greater than 5.8 mg/dl). Endotoxemia was associated with an increased admission serum bilirubin level (p less than 0.05) and white blood cell count (p less than 0.05) and a decreased hematocrit value (p less than 0.05), but there was no significant association with other established preoperative risk factors. Patients with preoperative endotoxemia had a decreased immunoglobulin M anti-J5 endotoxin titer (p less than 0.05) and a decreased serum bile acid concentration (p less than 0.05). Preoperative endotoxemia was associated with reduced creatinine clearance before and after operation (p less than 0.05). There was no association between endotoxemia and clinical sepsis, gram-negative infection, or small-bowel colonization. Patients who died had increased preoperative serum fibrin degradation products (p less than 0.05).     

Mechanism of retardation of obstructive jaundice: pathological investigation of alteration in bile flow

The morphological and functional alterations of hepatocytes were investigated on autopsy cases of human obstructive jaundice and experimentally common bile duct ligated rats. The livers were morphologically observed by light and electron microscopes, and in order to make clear the mechanism of bile flow, horse radish peroxidase (HRP) was injected in male Wistar rats from the inferior mesenteric vein and administered in retrograde from the common bile duct. In the extrahepatic bile duct obstruction, bile canaliculi were dilated and canalicular microvilli were decreased in number and showed bleb formation, and pericanalicular filamentous structure formed thick network. Injected HRP as a tracer was not presented in the laminar and intercellular space of hepatocytes, and administered HRP in retrograde was presented in the intercellular space through tight junction from bile canaliculi and presented pericanalicular cytoplasmic vesicles. These results suggest that extrahepatic bile duct obstruction induces morphological change in pericanalicular regions and the functional abnormality in the membrane structure of hepatocytes may be persistent cholestasis.