经皮胆道造瘘胆道镜取石、球囊扩张术治疗复发肝内胆管结石46例临床观察

目的 探讨经皮胆道造瘘胆道镜取石、球囊扩张术治疗复发肝内胆管结石46例的临床价值。方法 回顾2015 年1月~2018年12月我院经皮胆道造瘘取石,球囊扩张术治疗复发肝内胆管结石患者46例的临床资料。结果 在46例复发肝内胆管结石患者中,完全取尽结石者43例（93.5%）,术后胆道出血6例（13%）,胆漏1例（2.2%）,胆管炎4例（8.7%）,发热8例,呕吐5例。无死亡病例,随访2年,6例（12.2%）结石复发。结论 经皮胆道造瘘胆道镜取石、球囊扩张术治疗复发肝内胆管结石取得良好的效果,取石安全有效,且微创,可作为胆道结石治疗手段的有效补充。     

经皮肝穿刺胆管置管引流术治疗肝内型重症急性胆管炎

作者自 1985年 1月以来 ,采用经皮肝穿刺胆管置管引流术 (ＰＴＤ)治疗肝内型重症急性胆管炎 13例 ,取得满意疗效 ,报道如下。临床资料本组男 5例 ,女 8例 ,年龄 2 1～ 57岁。全部病例符合 1983年中华外科学会重庆会议制定的重症急性胆管炎的诊断标准〔1〕,均为原发性肝胆管结石、肝胆管狭窄所致。本组 13例中 ,9例因重症急性胆管炎分别行急诊胆道探查、Ｔ管引流术 (2例 )或急诊床旁ＰＴＤ(7例 ) 〔2〕,术后因重症急性胆管炎的病情无缓解或缓解后又加重 ,经Ｔ管或ＰＴＤ导管行胆道造影明确肝内胆管仍存在梗阻性病变 ,故再次对梗阻性病变的胆…     

经皮肝穿刺胆管引流术在急性化脓性胆管炎中的应用

目的 探讨经皮肝穿刺胆管引流术在急性梗阻性化脓性胆管炎治疗中的作用.方法 对20例采用经皮肝穿刺胆管引流术急救减压治疗的急性梗阻性化脓性胆管炎患者临床资料进行分析.结果 20例行经皮肝穿刺胆管引流术治疗后,休克得到迅速纠正,全身情况得到改善,病情趋于稳定.1例因多发节段性重症胆管炎引流效果不明显而中转手术.结论 经皮肝穿刺胆管引流术是急性梗阻性化脓性胆管炎最为直接、简便易行、安全、疗效确切、成功率最高的低损伤性减压措施,避免了病情危重情况下的紧急手术,为择期手术争取了时间,是急性梗阻性化脓性胆管炎的一种新的治疗途径.     

多镜联合应用治疗急性胆管炎临床研究

目的 探讨利用十二指肠镜、腹腔镜、胆道镜联合治疗急性胆管炎的微创治疗方法. 方法 从2001年10月至2004年12月共收治胆管结石诱发急性胆管炎患者34例,先经十二指肠镜行鼻胆管引流术(ENBD),待病情缓解后,根据患者条件和结石情况分别行十二指肠镜下网篮取石、腹腔镜下胆总管切开取石、腹腔镜下胆总管切开胆道镜下取石等二镜、三镜联合治疗. 结果 ENBD全部成功,本组无死亡,首次急诊内镜取石取净6例,二次内镜取石5例(其中二镜联合9例),三镜联合21例,中转开腹2例. 结论 急性胆管炎早期治疗十分重要,应用十二指肠镜能缓解胆管炎的症状,减少死亡率,采用多镜联合应用治疗急性胆管炎的胆道结石是一种微创、安全、有效的方法,避免了急诊手术的风险.     

源头控制用于中重度急性胆道感染治疗

目的探讨源头控制原则在中重度急性胆道感染治疗中的应用价值。方法回顾性分析2004年1月至2014年6月应用外科源头控制原则处理的48例因胆石病、胆道肿瘤所致中重度急性胆道感染病人的临床资料。结果急性胆囊炎20例行经皮经肝胆囊穿刺引流术,急性胆管炎28例中6例行内镜十二指肠乳头括约肌切开术＋内镜鼻胆管引流术（endoscopic naso-biliary drainage,ENBD）,21例行ENBD,1例行胆管内支架置入术。引流术后病人寒战、发热、腹痛、腹膜炎等症状、体征迅速缓解,感染中毒症状得到有效控制,肝功能渐趋正常。全组未出现并发症,无死亡病例。结论应用源头控制原则处理中重度急性胆道感染安全、微创、有效、并发症少,为后续进一步治疗创造了有利条件,具有重要的临床应用价值。     

经皮经肝胆囊穿刺引流术在高龄、高危患者的应用

目的 探讨经皮经肝胆囊穿刺引流术(percutaneous trarlslaepatic gallbladder drainage,PTGBD)在高龄、高危患者中的应用.方法 我院2008年8月至20010年10月对20例老年急性结石性胆囊炎伴有严重疾病的患者,先行PTGBD术,待合并疾病得到控制且胆囊炎症消退后,再择期行腹腔镜胆囊切除术(LC)或开腹胆囊切除手术(OC).结果 本组20例全部成功行PTGBD,治疗后腹痛发热等症状均迅速缓解,无出血、胆漏等并发症.结论 在患者手术条件较差的情况PTGBD下能有效缓解症状,待合并疾病得到控制且胆囊炎症消退后,再择期行LC或OC,能提高治愈率,降低死亡率,是对高龄高危胆囊炎患者治疗方式的一项有益补充.     

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随着微创和内镜技术的发展 ,内镜下Oddi括约肌切开术 (EST )和内镜下经鼻胆管引流术 (ENBD)因其能简单快速地解决问题而且创伤小 ,痛苦少的优势被越来越多地应用到急性胆道疾病的诊治中 ,并取得了很好的临床效果。现将我院自 1996～ 2 0 0 2年急诊行EST及ENBD治疗胆道疾病的情况介绍如下。1　临床资料共计 70例 ,其中男性 3 1例 ,女性 3 9例。平均年龄56 8岁。所有病例均有腹痛、寒战、发热、黄疸等急性胆管炎表现。其中胆总管结石 40例 ,胆总管结石合并肝内胆管结石2 0例 ,胆道蛔虫 5例 ,胆管末端良性狭窄 5例。以上病例均经彩超、C…     

PTCD技术在急性重症胆管炎治疗中的应用

目的 探讨经皮肝穿刺胆管引流术(PTCD)在急性重症胆管炎治疗中应用价值.方法 回顾性分析45例急性重症胆管炎患者围手术期处理的资料.结果 45例原发病均为胆道结石,经过内科保守治疗后(＜12 h)无效者行急诊开腹手术18例;行PTCD胆道减压27例,27例先行PTCD,待病情稳定后再行手术治疗,无死亡,术后感染率14.8％,结石残留率22.2％;18例行急诊手术,病死率27.8％,术后感染率50.0％,结石残留率38.9％.经检验,二者以上指标间差异均有统计学意义(P＜0.05).结论 PTCD技术是急性重症胆管炎一种有效的治疗手段,可广泛应用于临床.     

胆总管十二指肠舌形切除吻合术治疗老年胆管结石

目的: 探讨胆总管十二指肠舌形切除吻合术治疗老年胆管结石的临床价值. 方法: 回顾分析我院经胆总管十二指肠舌形切除吻合术治疗36例老年胆管结石患者的临床资料. 结果: 术后未发生电解质紊乱和手术死亡.术后发生严重并发症2例(心衰和胸腔积液).手术时间为(50±5)min,术后住院(13±2)d.术后第10天钡餐检查显示逆流入胆管的钡剂在6~10 min内完全排空.随访7~84个月,均无胆管炎和胆管盲端综合征发生,4例2年后死于非胆道疾病,2例发生胆道蛔虫.B超检查未发现结石或胆管异常.24例钡餐检查结果如前述. 结论: 胆总管十二指肠舌形切除吻合术是老年胆管结石首选的内引流术式.     

胆道镜术后置管灌洗溶石治疗肝内胆管结石

目的 探讨胆道镜术后经置管振荡灌洗溶石治疗肝内胆管结石的疗效.方法 选取25例肝内胆管多发结石需行胆道镜多次取石的患者,其中17例进行胆道镜术后置管灌洗溶石治疗,作为治疗组;8例作为对照组.分别测定两组胆汁中胆红素浓度、两组B超下残余结石最大径变化,统计两组胆道镜平均操作次数.结果 治疗组胆汁中胆红素浓度大于对照组(P<0.01);B超测量治疗组灌洗后残石最大径均值小于对照组(P<0.01);治疗组平均胆道镜操作次数少于对照组(P<0.05).结论 胆道镜术后置管灌洗溶石可提高治疗肝内胆管结石的疗效.     

杭州健康女性定量骨超声测定原发性骨质疏松

目的 评价杭州健康女性骨超声速度(SOS)值随增龄减少和骨质疏松患病率，建立杭州地区女性骨超声速度值参考数据库。方法 定量超声法测定1208例杭州地区健康女性桡骨远端(RAD)，第3指骨近节(PLX)，第V跖骨(MTR)和胫骨中段(TIB)的超声速度值。结果 RAD、PLX、MTR和TIBSOS峰值(Peak of SOS)均出现在40-45岁，TJB的SOS峰值出现在35—40岁，此后随年龄增长而下降。绝经后妇女在绝经后早期和晚期各有1个SOS快速减少期，前见于桡骨近端，平均年减少率为2．4％，后见于胫骨中段，平均年减少率为1．8％。各部位骨SOS累积减少率随年龄增长而增加，到85岁4部位累积减少为13％-18％。60岁以后骨质疏松性症(OP)检出率为45％-70％，OP检出率以桡骨远端最高，60-70岁平均为67％，第3指骨近端次之约50％，胫骨中段最低为36％；75岁以后分别为70％，65％和45％。结论 全身各部位骨超声速度值到达峰值的年龄不同，峰值也各有差异。绝经后妇女骨超声速度值随年龄增加减少较快，应予激素和补钙治疗，桡骨远端为本地区SOS检测和OP检出的敏感部位。     

Importance of echocardiography in prognosis of surgical outcomes in cholecystitis in elderly patients

The authors propose to use more often echocardiography (EchoCG) in examination of elderly (over 60 years) of age patients with cholecystitis that permits to increase surgical activity to 92.4%. Left ventricular ejection fraction is the most informative. When this fraction is lower than 45% surgery must be recommended on vital indications only. EchoCG was used in 155 patients with cholecystitis, 131 of them were operated. 2 (1.52%) patients died due to acute cardio-vascular insufficiency and pulmonary artery thromboembolism.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

目的 评价脊髓胶质细胞在小鼠骨癌痛形成中的作用.方法 健康雄性C3H/He小鼠40只,周龄8～10周,体重18～22 g,随机分为4组(n=10):假手术组(S组)、骨癌痛组(B组)、PBS组(P组)和米诺环素组(M组).S组跟骨骨髓腔内注射PBS 10 μl;余3组跟骨骨髓腔内注射含2×105个骨纤维肉瘤细胞的PBS 10 μl制备骨癌痛模型,于造模前即刻开始PBS组鞘内注射PBS 5μl,M组鞘内注射米诺环素(用PBS溶解为0.2 mmol/L)5μl,1次/d,连续11 d.于造模前1 d、造模后即刻、3、5、7、9、11 d时测定机械痛阈;于造模后3、7、9、11 d机械痛阈测定结束后测定冷痛阈.痛阈测定结束后处死小鼠,取脊髓组织,测定神经胶质纤维酸性蛋白(GFAP)和CD11b的表达水平.结果 与S组比较,B组和P组造模后3-11 d时、M组造模后3、5 d时机械痛阈升高,B组、P组和M组造模后7～11 d时冷痛阈升高,脊髓CD11b和GFAP表达上调(P<0.05).与B组比较,M组造模后3-11 d时机械痛阈降低,造模后7-11 d时冷痛阈降低,脊髓CD11b和GFAP表达下调(P<0.05).结论 脊髓胶质细胞(星形胶质细胞和小胶质细胞)的激活参与了小鼠骨癌痛的形成.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.