Endoscopic methods in the diagnosis and treatment of mechanical jaundice of non-neoplastic etiology

The authors analyse the results of treatment of 255 patients with obstructive jaundice of nonneoplastic origin. Various endoscopic methods were used. Endoscopic interventions were carried out in the first two days in 79.8% of cases. Laparoscopic cholecystostomy was conducted in 138 patients; jaundice was relieved in 3 to 20 days in 95% of cases. It is shown that the best results of operative treatment of patients with acute cholecystitis complicated by choledocholithiasis are produced in concurrent use of laparoscopic cholecystostomy and endoscopic papillosphincterotomy.     

The application of hemosorption in the treatment of patients with obturative jaundice after cholecystectomy

In 47 patients there was applied the hemosorption (HS) in complex of treatment of obstructive jaundice (OJ) after cholecystectomy. The jaundice duration was 4-6 weeks at average. Choledocholithiasis, the papilla magna duodeni stenosis, choledochal cicatricial stricture were the most frequent causes of OJ. There were conducted 73 HS procedures. In 2 h the level of general bilirubin, cholesterol, urea, creatinine, biliary acids, phenols, middle molecular weight peptides, the alkaline phosphatase activity had lowered significantly. Positive changes of the indices were noted. One-two day term after the HS conduction is optimal one for the radical operation performance.     

Immunologic reactivity of patients with obstructive jaundice of non-neoplastic etiology

Immunity values were studied in patients with obstructive jaundice of cholelithic etiology. The number of immune cells was reduced and the formation of antibodies was deficient in these patients in the preoperative period. The degree of immunodeficiency correlated with the duration of jaundice and the degree of bilirubinemia. The level of autoantigens was also increased. An operation promotes still greater suppression of immunity. The values of immunity were normalized earlier in patients who had received immunomodulation therapy.     

Post-traumatic hepatic dysfunction as a major etiology in post-traumatic jaundice.

Thirty-eight patients who had sustained acute trauma, profound hemorrhagic shock, and massive transfusion were studied prospectively to determine the predominant etiologic factors in the development of post-traumatic jaundice. An analysis of clinical and biochemical factors occurring in association with each bilirubin peak in the postoperative course found the jaundice related to transfusion and surgery in 11 instances, to sepsis and septicemia in 15 instances, and to hepatic dysfunction in 23 instances. Results indicated that admission estimates of SGOT and LDH levels, the height of the bilirubin peak and the postoperative day on which it occurs, and the white cell count and GGT at the time of the peak may be of use in the differential diagnosis. Four case reports were used to emphasize the fluctuating pattern of jaundice and the different etiologic factors that may predominate. Light and electron microscopy from three patients illustrated the structural alterations that accompany the biochemical impairment of liver function and enable a more precise appreciation of this syndrome. Hepatic dysfunction appears to be implicated in a high proportion of patients who develop post-traumatic jaundice, which frequently occurs as part of a spectrum of multiple organ failure.     

Transcutaneous electric stimulation of the liver and bile ducts during active enterosorption in combined surgical treatment of obstructive jaundice of nontumorous etiology

The influence of transcutaneous electrostimulation of liver and biliferous ducts while conduction of desintoxication using chitinous enterosorbent "Mikoton" on the result of treatment of hepatargy in patients with obstructive jaundice of nontumoral genesis in the early postoperative period was studied.     

Lymphosorption in the combined treatment of jaundice]

Drainage of the thoracic lymph duct and lymphosorption were used in 63 patients with obstructive jaundice of different etiology and cholestatic hepatitis. Lymph was returned into the umbilical vein with transfusion of proteins, glucose, steroid hormones and other preparations.     

经内镜胆道支架置入术姑息性治疗恶性梗阻性黄疸的临床应用

目的 探讨经十二指肠镜放置胆道支架(EMBE、ERBD)和鼻胆管引流姑息治疗恶性梗阻性黄疸的有效性及临床应用价值.方法 回顾性分析2002年6月至2009年3月51例有绝对或相对手术禁忌证的恶性梗阻性黄疸病人成功行经内镜胆道支架置入术的有效率、并发症发生率、支架通畅时间及生存时间.结果 51例病人中,置入金属支架31例,置人塑料支架15例,2例单纯置入鼻胆管引流.其中黄疸指数下降48例,总胆红素从(279.6±143.7)μmol/L一周后下降到(125.7±78.3)μmol/L(P＜0.01).出现急性胰腺炎并发腹痛者3例,高淀粉酶血症9例,发生胆绞痛者1例,贲门撕裂伴大出血1例,并发症发生率27.4%;支架通畅时间119 d;置入支架组随访39例,3个月、6个月生存率达到91%和74%.结论 通过十二指肠镜进行胆道支架置入和有效引流是姑息治疗恶性梗阻性黄疸的有效方法.     

Sunburn from the treatment of neonatal jaundice

A newborn infant with sunburn from the treatment of neonatal jaundice is described. The importance of avoiding the exposure of newborn infants to strong sunlight is emphasized.     

Abnormal choledocho-pancreatico ductal junction related to the etiology of infantile obstructive jaundice diseases.

According to our current radiologic, histopathologic, and experimental studies, the congenital stenosis associated with anomalous choledocho-pancreatico ductal junction is considered to be the most important etiologic factor in congenital biliary dilatation. Furthermore, the possibility of pancreatic juice reflux into the biliary tract due to the abnormal choledocho-pancreatico ductal junction, which could lead to obstructive cholangiopathy, was suggested in relation to the pathogenesis of congenital biliary atresia.     

腹腔镜胆肠吻合术治疗恶性梗阻性黄疸

目的 :探讨腹腔镜胆囊空肠吻合术治疗恶性梗阻性黄疸的效果。方法 :5例晚期胰腺癌经腹腔镜和腹腔镜超声探查分期后行腹腔镜胆囊空肠吻合及胃空肠吻合术 ,3例采用吻合器、2例行手工缝合完成手术。结果 :5例腹腔镜手术均顺利完成 ,平均手术时间 1 2 0min ,平均住院 7d ,无腹腔镜手术并发症 ,平均随访 8个月生存良好。结论 :腹腔镜胆肠吻合术治疗恶性梗阻性黄疸疗效可靠 ,可作为微创姑息治疗的新途径。