超声对胆管癌术前分期诊断探讨：关于壁浸润程度诊断

由于超声在显示胆管肿瘤的同时，也能显示胆管壁的形态及与邻近脏器组织的关系，因此有望对胆管癌术前分期作出诊断。本文根据肿瘤与胆管壁的关系、胆管壁形态、连续性、尤其外侧缘的形态改变等指标，确定了胆管癌壁浸润的三个程度，即未侵及浆膜下及浆膜层（以下简称浆膜）（S1），侵及浆膜（S2），侵及浆膜外（S3）的超声诊断标准;井报告了经超声显示出肿瘤，并经手术病理确认的61例胆管癌壁浸润程度的超声诊断结果。根据此标准，超声诊断正确率分别为S1达69％;S2达78％;S3达56％;总诊断正确率达67％（41／61）。本文还讨论了胆管壁受侵不同程度的声像图特征及提高诊断率的要点。超声对胆管癌壁浸润程度的判断为胆管癌术前分期诊断提供了重要依据。     

超声对胆管癌分期诊断探讨:对血管浸润的诊断

目的：探讨超声对胆管癌浸润血管的诊断价值,提高手术切除率。方法：回顾性分析了５２例胆管癌资料,重点观察局部肿瘤与相邻血管关系,并设定了超声对血管浸润的诊断指标。结果：手术病理证实胆管癌３７％（１９／５２）门脉受侵。超声评价胆管癌门脉受侵的敏感性、特异性及诊断正确率分别为５６％（９／１６）、８９％（３２／３６）和７９％（４１／５２）;超声分级低于病理分级者占１５％（８／５２）,高于病理分级者占６％（３／５２）;彩色超声亦有助于肝动脉分支的观察评价。结论：超声是一种较好的评价胆管癌周围血管受侵及其程度的方法,其无创伤及特异性高,有推广应用价值。     

超声对胆管癌术前分期诊断探讨肝脏及胆囊浸润的超声诊断

为了进一步探讨应用超声诊断胆管癌对周围组织脏器侵及的可行性，我们对中上段胆管癌肝浸润（５５例）、胆囊浸润（５６例）进行了回顾性分析。确定了肝浸润的四个程度：未受侵Ｌｉ（一），可疑受侵Ｌｉ（±），受侵Ｌｉ（＋），明显受侵Ｌｉ（）；胆囊受侵亦分为四个程度；未受侵Ｇｉ（一），可疑受侵Ｇｉ（±），受侵Ｇｉ（＋），明显受侵Ｇｉ（）。根据此标准，并与手术及病理结果对照，超声诊断总的正确率分别为７４％、７７％，其中Ｌｉ（）及Ｇｉ（）均得到正确诊断；同时讨论了胆囊大小的临床意义，认为胆囊大小不能作为判断梗阻部位及胆囊受侵的唯一依据；并分析了超声诊断胆囊受侵假阳性较高的主要原因。总之，超声对于判断胆管癌侵及周围组织脏器有价值，为术前分期提供了依据     

体表超声对胃癌浸润深度的诊断

目的：探讨体表超声对胃癌浸润深度诊断价值。方法：为前瞻性研究。对159例胃癌术前行体表超声检查，并与手术及术后病理结果比较。结果：超声对胃癌浸润深度总诊断符合率为74．2％，对T1、T2、T3和T4诊断符合率分别为53．8％、71．4％、84．1％和67．8％，T1诊断率最低；浸润深度过深判断与肿瘤伴炎症、溃疡疤痕形成有关。超声对肝脏及胰腺受侵诊断符合率较高，分别达80．O％及73．5％；十二指肠、横结肠、脾及脾门受侵诊断符合率较低，膈肌受侵超声不易诊断。病变厚度及长度与肿瘤浸润深度有一定关系。结论：体表超声有助于判断胃癌浸润深度，可成为胃癌术前分期常规检查方法。     

胆管癌的超声与CT诊断对比分析

目的为了评价超声与CT检查在胆管癌诊断中的临床应用价值。方法回顾经手术病理证实的46例胆管癌超声与CT诊断资料，并进行对比分析。结果定位准确率：超声92％，CT96％；定性准确率(即能明确显示肿块)：超声78．6％，CT75．3％。结论超声与CT对胆管癌的整体诊断率相当，定性诊断(明确显示肿块)则B超优于CT，两对不同部位的胆管癌诊断各具优势，互相补充，可提高胆管癌的确诊率，而超声是胆管癌初步筛查的首选检查方法。     

肝内胆管癌并肝脓肿的超声诊断及其临床价值

目的：探讨肝内胆管癌合并肝脓肿（CHA）的声像图特征。方法：CHA患者11例。其中男2例，女9例，平均年龄52．2岁。使用仪器为Aloka-650、1200超声诊断仪，探头频率3.5MHz。超声探查肝内胆管有无扩张及胆管内有无实体回声，肝内有无异常回声区等，并与手术病理进行对照。结果：本组CHA超声诊断符合率81．8％（／11）。11例肝内胆管癌声像图表现为团块型8例（72．7％），栓塞型2例（18．2％），厚壁型1例（9．1％）。脓肿位于肿瘤内的占45．5％（5／11），均发生于团块型胆管癌；脓肿位于肿瘤外的占54．5％（6／11），于团块型、栓塞型、厚壁型胆管癌均见发生。结论：提高对CHA的声像特征的认识，对提高胆管癌的超声诊断率有重要的意义。超声检查时一旦发现患者出现肝脓肿的声像表现，尤其是合并胆道结石时，应高度注意是否患有肝内胆管癌，以便及时正确诊断并使患者得到早期手术治疗。     

超声微探头对浸润型胃癌的诊断价值

目的探讨超声微探头（ultrasound miniature probe,UMP）对浸润型胃癌的诊断价值。方法通过胃镜下对可疑浸润型胃癌进行UMP检查,并与术后及病理结果进行比较,判断UMP的诊断正确率。结果53例UMP,病理及手术证实为中低分化腺癌46例,胃MALT淋巴瘤6例,Mentrier病1例。UMP诊断正确率86.7%。结论UMP是当前应用于浸润型胃癌最有价值的诊断方法。     

超声对肝外胆管癌的诊断价值

目的评价超声在肝外胆管癌中的诊断价值。方法对43例经手术及病理证实的胆管癌进行超声分析。结果依超声显像将胆管癌分为四类：乳头型，闭块型，狭窄型，截断型，诊断符合率86.0%。结论超声对胆管癌定位，定位诊断率均较高，只有重要的临床应用价值。     

经直肠腔内超声在肛肠病变诊断上的应用

目的：探讨肛管直肠病变的声像图表现。方法：应用经直肠腔内超声对486例肛肠病变进行研究，其中肛管直肠周围囊肿15例，脓肿283例，肛瘘165例，直肠癌23例；所有病例均行手术治疗，并获病理证实。结果：直肠腔内超声对肛管直肠周围囊肿诊断正确率为100％（15／15），脓肿诊断正常率为98％（277／283），对病变范围的诊断正确率：囊肿为90％（12／15），脓肿为73％（209／283）。对肛瘘的诊断正确率为52％（87／165）。对直肠癌的诊断正确率为82％（19／23）。结论：直肠超声对囊肿、脓肿诊断有很高的准确性，但对脓肿范围的确定存在一定误差。对肛瘘的诊断准确性相对较低。对性病肉芽肿与直肠癌早期的鉴别诊断有待提高，直肠超声诊断肛肠病变对指导临床治疗与随诊有重要价值。     

卵巢纤维瘤的超声诊断探讨

目的：探讨术前超声诊断卵巢纤维瘤的价值。材料与方法：回顾性分析我院1990－2000年10年间经手术病理证实的28例卵巢纤维瘤的声像图特征。结果：①提出卵巢纤维瘤可分为衰减型和混合回声型两型。②术前超声对卵巢纤维瘤的诊断率为85．71％,较临床诊断率明显为高（57．14％）。③超声对衰减型纤维瘤诊断率较高,可达95．45％。而对混合回声型纤维瘤诊断率较低,仅50％。④纤维瘤的彩色血流显示率为33．33％,其中衰减型较高为66．67％。⑤腹部加阴道超声检查（87．50％）对卵巢纤维瘤的诊断较单纯腹部超声检查（85．00％）更高。结论：术前超声,尤其是腹部与阴道超声联合检查,对卵巢纤维瘤具有较高的诊断率,对临床制定手术方案具有重要参考价值。     

2776例公职人员消化器官能量测评结果分析

目的评价公职人员消化器官的健康状态,探讨健康维护策略。方法对2 776例人体能量监测仪数据进行分析,重点分析各消化器官的能量状态,得出各消化器官亚健康状态的患病率,并对男、女各消化器官亚健康状态的患病率差异进行统计推断。结果公职人员各消化器官亚健康状态的患病率由高到低依次为:胰(42.54%)、大肠(41.14%)、食管(39.09%)、直肠(36.70%)、肝(35.69%)、十二指肠(31.52%)、小肠(29.07%)、胃(28.18%)。男女在食管、十二指肠、小肠、直肠方面的亚健康患病率差异无统计学意义(P0.05);肝、胰亚健康状态的患病率女性高于男性(P0.05);胃、大肠亚健康状态的患病率女性显著高于男性(P0.01)。结论公职人员消化器官处于亚健康状态的比例不低,要注意合理膳食。女性比男性更多存在肝、胰、胃、大肠的亚健康状态。     

Regional renal and splanchnic blood flows during nicotine infusion: effects of alpha and of combined alpha and beta adrenergic blockade

Renal (cortex and medulla) and splanchnic (duodenum, liver, pancreas and spleen) blood flows were measured with 25-mu radioactive microspheres in anesthetized, open-chest dogs. The effects of nicotine (36 micrograms/kg/min i.v.) before and after selective alpha adrenergic blockade (phenoxybenzamine, 1 mg/kg i.v.) and before and after combined alpha and beta adrenergic blockade (phenoxybenzamine, 1 mg/kg i.v. and propranolol, 1 mg/kg i.v.) were evaluated. Before adrenergic blockade, nicotine increased arterial pressure (+82%) but had heterogeneous directional effects on regional blood flows: pancreas (-64%), duodenum (-33%), kidney cortex (-31%), kidney medulla (-17%), liver (+5%) and spleen (+71%). Vascular conductance was reduced in kidney cortex (-61%), kidney medulla (-57%), duodenum (-59%), liver (-46%) and pancreas (-79%) and was not altered in spleen. Selective alpha adrenergic blockade prevented the hypertensive response to nicotine, but heterogeneous changes in regional flows persisted: pancreas (-40%), spleen (-40%), kidney medulla (-35%), kidney cortex (-31%), liver (+50%) and duodenum (+74%). After combined alpha and beta adrenergic blockade, nicotine increased systemic arterial pressure (+75%) and decreased vascular conductance in all tissues. Results indicate: 1) a heterogeneous influence of nicotine in renal and splanchnic circulations associated with regional differences in activities of alpha and beta adrenergic receptors and 2) a potent nonadrenergic vasoconstrictor response in these circulations to nicotine after blockade of alpha and beta adrenergic receptors.     

Hypotonic duodenography — Too often performed but of too little value?

Hypotonic duodenography was compared with conventional barium examination in 68 patients (70 examinations) with clinically suggested or verified disease of the pancreas or duodenum. In 13 cases (18.5%) conventional examination demonstrated the duodenal anatomy better than hypotonic duodenography. In nine cases (13%) hypotonic duodenography was superior and in 48 cases (68.5%) both techniques were diagnostically equal.It is concluded that, in only a few cases, does hypotonic duodenography add any diagnostic information to that which can be obtained with properly performed conventional examination of the duodenum.     

Carcinoma of the gallbladder associated with clonorchiasis: clinicopathologic and CT evaluation

BACKGROUND: The computed tomographic (CT) features of three cases with pathologically proven adenocarcinoma of the gallbladder associated with clonorchiasis. METHODS: CT scans of three cases with pathologically proven adenocarcinoma of the gallbladder associated with clonorchiasis were retrospectively reviewed. Scans were analyzed for the following parameters: (a) gross morphologic pattern (intralumenal mass lesion, mass replacing the gallbladder, focal or diffuse wall thickening); (b) contrast enhancement of the tumors; (c) associated gallstones or Chlonorchis sinensis worms; (d) direct invasion into the liver; (e) metastasis to adjacent viscera (pancreas, duodenum); (f) the extrahepatic bile duct (dilatation, metastasis, stone, C. sinensis worms); (g) the intrahepatic bile duct (dilatation); and (h) lymphadenopathy and metastasis. RESULTS: The gross morphologic pattern of three cases with carcinoma of the gallbladder was an intralumenal mass lesion (the least common type), whereas the patterns of infiltration and a mass replacing the gallbladder were not identified. Mild contrast enhancement of the tumors relative to the liver was demonstrated in all patients. Gallstones and C. sinensis worms were not visualized in the gallbladder and the extrahepatic bile duct. An unusual metastasis to the distal common bile duct and the pancreas was found in this series. CONCLUSION: Three cases with adenocarcinoma of the gallbladder associated with clonorchiasis showed intralumenal mass lesions within the gallbladder lumen. The cause-and-effect relation between clonorchiasis and gallbladder carcinoma is discussed.     

MRI在胰腺局灶性脂肪浸润的诊断价值

目的探讨胰腺局灶性脂肪浸润的MRI典型表现。方法回顾性分析MRI诊断胰腺局灶性脂肪浸润病人12例,除常规序列外,加扫化学位移成像序列,观察同、反相位图像组织信号变化情况,以确定有无脂肪浸润改变。所有病例MRI检查前均经CT平扫和/或增强扫描,因CT表现缺少特异性,不能明确低密度病灶性质而建议进一步检查,所有病例经随访5～36个月(平均16个月)无明显变化。结果12例胰腺局灶性脂肪浸润主要累及胰头和钩突前部,5例合并不同程度胰腺颈、体、尾部脂肪浸润,但仍以胰头和钩突前部脂肪浸润最明显。胰腺局灶性脂肪浸润区域在常规压脂T1WI、T2WI上9例未见明显异常信号,3例与周围正常胰腺对比呈稍低信号;在化学位移成像序列中,局灶性脂肪浸润区域在同相位上与周围正常胰腺对比呈等或稍高信号,而在反相位上局灶性脂肪浸润区域则较同相位上出现中度到明显不均匀信号下降,从而确立胰腺局灶性脂肪浸润诊断。结论胰腺局灶性脂肪浸润主要累及胰头和钩突前部或以此区域更明显,MRI化学位移成像具有典型表现,对胰腺局灶性脂肪浸润诊断具有重要价值。     

Electrophoretic, kinetic, and immunoinhibition properties of gamma-glutamyltransferase from various tissues compared

gamma-Glutamyltransferase (EC 2.3.2.2) from human liver, kidney, pancreas, and duodenum migrated in acrylamide gels (65 g/L) as a single band with the following decreasing order of electrophoretic mobility: liver > pancreas > kidney > duodenum. The initial velocity kinetic constants of pancreatic and duodenal gamma-glutamyltransferase and of the enzyme in human serum were determined and compared with those we previously established for the enzyme from human kidney, liver, and serum. The greatest differences were in the glycylglycine competitive-inhibition constants: kidney gamma-glutamyltransferase was the most strongly inhibited and pancreatic enzyme the second most strongly inhibited by high concentrations of glycylglycine, with the liver and duodenal isoenzymes only slightly inhibited and the enzyme in serum not inhibited over the concentration range (0-150 mmol/L) of glycylglycine used. Differences between the other kinetic constants of these isoenzymes were much smaller. Human liver gamma-glutamyltransferase was obtained in a highly purified form by a six-step procedure that included papain digestion of the original homogenate. Rabbit antisera raised against this preparation inhibited liver, kidney, and pancreatic gamma-glutamyltransferase activity equally well (78, 76, and 78% inhibition, respectively), but inhibited the hog-kidney enzyme only slightly (1%). We conclude that the polypeptide portions of the isoenzyme molecules are structurally similar but that the carbohydrate moieties differ significantly in structure and topography.     

螺旋CT增强扫描对进展期胃癌的局部浸润和淋巴结转移的研究

目的:探讨螺旋CT增强扫描在判定进展期胃癌局部浸润和胃周淋巴结转移上的应用价值。材料与方法:对56例进展期胃癌的局部浸润和胃周淋巴结转移情况进行螺旋CT诊断,并与手术病理对照。结果:依据癌肿对应局部浆膜面征象、脂肪间隙征象、癌肿局部突出征象判定癌肿穿透浆膜的准确度分别为82.14%,60.71%和55.36%。动脉期癌肿线状强化、不均匀强化和团块状强化的穿透浆膜率分别为7.14%,52.17%和89.47%。静脉期癌肿线状强化、不均匀强化和团块状强化的穿透浆膜率分别为7.14%,53.85%和93.75%。螺旋CT增强扫描判定胰腺、横结肠及其系膜、脾受累的准确度分别为87.5%,87.5%和92.86%。支持以直径9mm作为螺旋CT增强扫描诊断胃周淋巴结转移的直径标准(P<0.05)。多种胃癌生物学行为CT影像特征与癌肿对应淋巴结转移率密切相关(P均<0.05)。结论:应用螺旋CT增强扫描检查进展期胃癌的局部浸润和淋巴结转移情况,对于指导手术和制定综合治疗方案具有重要意义。     

Ectopic pancreas bleeding in the jejunum revealed by capsule endoscopy

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy.     

腹腔镜下倒刺缝线与可吸收缝线行十二指肠菱形吻合的效果比较

目的评价环状胰腺患儿在腹腔镜十二指肠菱形吻合术中,予以单向倒刺缝线吻合的安全性及有效性。方法选取2016年1月-2018年4月于成都市妇女儿童中心医院就诊并行腹腔镜十二指肠菱形吻合术治疗的21例环状胰腺患儿进行前瞻性研究。将其按照随机数字表法随机分为两组,实验组8例在术中采用倒刺缝线连续行十二指肠菱形吻合术,对照组13例在术中采用可吸收缝线行十二指肠菱形吻合术。比较两种缝合方式在缝合时间、术中及术后肠瘘发生率、术后引流量和胃肠减压引流量的差异。结果两组患儿均成功于腹腔镜下完成手术,无中转开腹。其中,实验组缝合时间比对照组短,差异有统计学意义[(15.13±1.96)和(17.46±1.61)min,t=-2.97,P 0.05],实验组术后引流液重量明显低于对照组,差异有统计学意义(P 0.05);但术中及术后肠漏的发生率和胃肠引流量两组比较,差异均无统计学意义(P0.05)。结论在腹腔镜下行十二指肠菱形吻合术时,倒刺缝线与传统可吸收缝线相比,具有缝合时间短和术后引流液少等特点,值得临床推广。     

Fluid secretion in the duodenum and intestinal handling of water and electrolytes in Zollinger-Ellison syndrome.

The slow marker perfusion technique was used in five patients with the Zollinger-Ellison syndrome in order to determine the basal and postcibal flow rates of fluids passing the duodenojejunal junction and distal ileum, and the composition of those fluids. Fecal water and electrolyte excretions were also measured. The 24-hr outputs at the ligament of Treitz were markedly increased, while fecal losses were normal or only slightly increased. Thus, the overall intestinal reabsorption of water was 96%. Fasting rates of fluid and electrolyte flow at the ligament of Treitz were also measured during a basal period, followed by a period of continuous gastric aspiration. Removal of gastric secretion had the following effects on the fluid passing through the duodenum: (1) dramatic decrease in flow rate; (2) an increase in osmolality, from hypotonicity to isotonicity; (3) rise of pH, from acid to alkaline values; (4) a decrease of PCO2, from high to normal values. No increase in fasting plasma levels of immunoreactive secretin and motilin was observed in Zollinger-Ellison syndrome, whereas normal subjects respond to acid in the duodenum by a marked rise in the circulating levels of these hormones. These facts suggest that, in Zollinger-Ellison syndrome: (1) the ability of the small bowel and colon to reabsorb water and electrolytes is normal: (2) duodenal dissipation of hydrogen ions is mainly due to intraluminal neutralization by bicarbonate; and (3) stimulation of water and electrolyte secretion by the pancreas is inadequate.