ERCP在梗阻性黄疸病因鉴别诊断中的应用

目的:探讨逆行胰胆管造影术(endoscopic retrograde cholangiopancreatogahpy,ERCP)在梗阻性黄疸的病因鉴别诊断中的应用价值.方法:行ERCP检查并经术后或病理检查确诊的梗阻性黄疸患者49例,其中40例行ERCP、B超、CT检查,比较分析三者的诊断符合率.结果:40例患者同时行ERCP、B超、CT检查,三种影像学诊断符合率分别为77.7%、35.72%、64.77%,其中ERCP对梗阻性黄疸病因的诊断率明显高于B超及CT检查(P<0.05).结论:ERCP在梗阻性黄疸的病因鉴别诊断中具有较高的诊断价值.且优于B超和CT检查.     

lactulose和glutamine对梗阻性黄疸大鼠空肠黏膜的影响

目的:研究梗阻性黄疸时空肠黏膜的变化及lactulose和glutamine对梗阻性黄疸大鼠空肠黏膜的影响．方法:Wistar大鼠84只,随机分为4组．通过手术结扎切断大鼠胆总管得到梗阻性黄疸模型．对梗阻性黄疸大鼠分别经胃灌注lactulose和glutamine药物,比较给药前及给药后5,10 d各组大鼠空肠黏膜绒毛高度变化,同时与未行胆管结扎的假手术对照组进行比较．结果:无论胆总管结扎与否,给药前各组空肠黏膜的绒毛高度无明显差异．胆总管结扎后大鼠空肠黏膜高度减低(5 d:q=4．32,P<0．01;10 d:q=11．03,P<0．01);应用生理盐水组大鼠的空肠黏膜绒毛高度明显低于应用lactulose和glutamine组大鼠的空肠黏膜绒毛高度,且应用glutamine组与胆总管未结扎组相近(5 d:q= 3．62,P>0．05;10 d:q=3．83,P>0．05);而应用lactulose和glutamine的2组大鼠空肠黏膜绒毛高度无明显差异(P>0．05)．结论:结扎大鼠胆总管可导致其空肠黏膜萎缩．经胃肠道应用lactulose或glutamine对胆道梗阻所致的大鼠空肠黏膜萎缩均具有保护作用,且二者对肠黏膜的保护作用无明显差异．     

热应激预处理对梗阻性黄疸大鼠T细胞亚群的影响

目的:研究热应激预处理对梗阻性黄疸大鼠细胞免疫功能的影响.方法:将30只Wistar大鼠随机均分为3组:假手术组(S组)、胆总管结扎组(B组)、热应激预处理 胆总管结扎组(P组).术后1wk处死大鼠穿刺心脏取血,用流式细胞仪检测各份血液标本的T淋巴细胞(CD4 、CD8 )分类及胆红素含量.结果:胆总管结扎后1wk,大鼠血胆红素明显升高,CD4 减少,CD4 /CD8 下降;热应激预处理组的CD4 、CD4 /CD8 下降不明显,但与胆总管结扎组比较有显著差异(52.60±3.27vs43.52±2.23,2.37vs1.96;P<0.01).鼠T细胞亚响,目前尚关报道.结论:热应激预处理可改善梗阻性黄疸大鼠的细胞免疫功能.     

新生儿梗阻性黄疸的常见病因及处理原则

新生儿梗阻性黄疽是小儿外科常见的严重疾病。其病因比较复杂，发病后患者常首先就诊于小于内科，但诊断和鉴别诊断较为困难。此类疾病在内科反复鉴别诊断和激素保守治疗过程中常延误了手术时机，因此处理比较棘手。     

内镜下胆管支架置入引流术治疗恶性梗阻性黄疸18例体会

恶性梗阻性黄疸（MOJ）是指由原发性胆管癌、胰腺癌、肝癌等或其他部位癌肿淋巴结转移压迫胆管而引起的梗阻性黄疽,临床床确诊时已无法手术切除,多采用姑息治疗。为了延长这些患者的生存时间、提高其生活质量。2003年3月～2005年5月,我们对不能实施手术切除的18例MOJ患者行内镜下胆管支架置入引流术,效果满意。现报告如下。     

梗阻性黄疸的内镜介入治疗

建立通畅有效的胆道引流，是治疗胆管疾病的基本原则之一，特别对梗阻性黄疸，更是如此。外科治疗是传统的方法，而内镜介入治疗以其独特的方法，也能有效的解除胆道梗阻，本组介入治疗5例梗阻性黄疸，现报告如下：     

PTC在老年梗阻性黄疸病因诊断中的应用（附37例X线与手术病理对照分析）

目的探讨PTC在老年人梗阻性黄疽病因诊断中的诊断价值。方法回顾性分析了45例老年人梗阻性黄疽的经皮肝穿刺胆道造影(PTC)．其中37例有完整的手术和病理检查资料，结果PTC穿刺成功率高，达97.3％(36／37)，且相当安全。PTC对梗阻性黄疽中非肿瘤性病因和肿瘤性病因诊断符合率分别为93.3％(14／15)和86．4％(19／22)，总的诊断符合率为89．2％(33／37)．而US和CT的诊断符合率则分别为44％(11／25)和65％(13／20)。结论PTC对梗阻性黄疽的病因诊断价值高于US和CT．目前在老年人梗阻性黄疽的病因诊断中仍是一种相当有价值的诊断方法。     

宫颈鳞癌胰腺转移致梗阻性黄疸1例报告

<正>临床上,胰腺恶性肿瘤大部分为原发肿瘤,胰腺转移癌少见^[1]。胰腺转移癌与胰腺原发肿瘤鉴别困难,极易造成误诊,延误治疗。目前,胰腺转移癌国内外尚无统一治疗标准,原发肿瘤的生物学特性和针对原发肿瘤的综合治疗是决定其预后的主要因素,个体化差异较大。近期,笔者接诊1例宫颈鳞癌胰腺转移患者,现将病例资料及经验总结报告如下。     

肝包虫破入胆道致梗阻性黄疸围手术期护理

包虫病在新疆伊犁地区是高发病,以肝包虫发病最高,约占70%.肝包虫囊肿破入胆道引起梗阻性黄疸和胆道感染较为少见.本院自1994年至1997年收治918例肝包虫病,其中破入胆道致梗阻性黄疸胆道感染22例,占同期肝包虫治疗的2.39%,现将手术护理体会浅谈如下.     

胆囊切除术后致梗阻性黄疸1例

女，29岁。因胆囊息肉在吉林省某医院行胆囊切除术，于术后第3天开始出现巩膜及全身黄染，且逐渐加重，时有恶心。未吐。在当地医院给予保肝、消炎、对症治疗，2个月不见好转。全身皮肤及巩膜黄染加重，伴有腹痛，腹胀．尤以餐后为重。同时尿呈豆油色，间断出现陶土样便，全身瘙痒，为明确诊断转到我院治疗。查体：T36．4℃，P84次／min，R18次／     

肝棘球蚴病合并胆瘘梗阻性黄疸1例

本文报道1例肝棘球蚴病合并胆瘘、梗阻性黄疸患者的诊断与治疗。     

Mechanism of pancreatic hypersecretion in dogs with obstructive jaundice

Summary Pancreatic exocrine function in experimental obstructive jaundice was examined using dogs. Outputs of pancreatic juice, bicarbonate and amylase were greater in dogs with obstructive jaundice than in control dogs. To further examine the hypersecretory mechanism in obstructive jaundice, we examined pancreatic exocrine secretion stimulated by secretin and pancreozymin in both the isolated perfused pancreas and pancreatic dispersed cell culture. The perfused pancreas stimulated with secretin and pancreozymin in dogs with obstructive jaundice showed higher secretion of volume, bicarbonate and amylase than in control dogs. Dispersed pancreatic cells of jaundiced dogs stimulated by secretin and pancreozymin released more bicarbonate and amylase into the media than dispersed cells of control dogs. These data suggest pancreatic hypersecretion in obstructive jaundice is not due to excessive serum levels of secretin and pancreozymin or impaired metabolism of these hormones.     

Clinical characteristics of initial recurrence in lung after surgical resection for pancreatic ductal adenocarcinoma

BackgroundThe clinical characteristic differences at the initial recurrence site after resection for pancreatic ductal adenocarcinoma (PDAC) remain unknown. We investigated the clinical characteristics in patients with lung recurrence after surgical resection and evaluated the outcome of resection for isolated lung recurrence.MethodsOf 442 consecutive PDAC patients who underwent surgical resection between 2002 and 2018, 229 had recurrence on imaging. Initial recurrence sites were the liver, lung, local, peritoneal, multiple organs, and others. We analyzed the clinicopathologic factors and outcomes, comparing by initial recurrence site, and investigated the outcomes of resection for isolated lung recurrence.ResultsLiver recurrences were the most frequent (n = 60, 26%), followed by lung recurrence (n = 48, 21%). The interval from surgery to recurrence was significantly longer in lung recurrence (P = 0.0001). Patients with lung recurrence had significantly longer overall survival after diagnosis (P < 0.0001). Patients who underwent surgical resection of lung recurrence had a significantly prolonged overall survival rate after recurrence diagnosis (P = 0.004).ConclusionsPatients with lung recurrence had significantly prolonged survival than those with other recurrence patterns. Resection for isolated lung recurrence represented relatively good prognosis, and possibly may be beneficial in highly-selected patients.     

Endoscopic biliary drainage for patients with unresectable pancreatic cancer with obstructive jaundice who are to undergo gemcitabine chemotherapy

INTRODUCTION Pancreatic cancer is one of the most intractable mali- gnancies of the digestive tract and has a dismal prognosis. Such cancer in most patients is in an advanced stage when they first visit medical facilities, and management of obstructive ja…     

胰十二指肠切除术后胆瘘及胰瘘的防治53例

目的:探讨胰十二指肠切除术后胆瘘及胰瘘的防治经验.方法:回顾分析1999-03/2005-11胰十二指肠切除术53例,均作Child术式重建消化道,彭氏捆绑式胰肠吻合术.结果:发生并发症5例,其中发生胰瘘1例,占1.9%,腹腔出血3例,占5.7%,无胆瘘发生,全组无手术死亡,有并发症的5例,均治愈.结论:胰十二指肠切除术后胆瘘及胰瘘的防治在于手术技术的提高及胰肠吻合、胆肠吻合的处理.     

Evaluation of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma

AIM:To review the usefulness of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma and identify problems that may need to be addressed.METHODS:The study population consisted of 36 patients with obstructive jaundice caused by hepatocellular carcinoma(HCC)who underwent endoscopic biliary stenting(EBS)as the initial drainage procedure at our hospital.The EBS technical success rate and drainage success rate were assessed.Drainage was considered effective when the serum total bilirubin level decreased by 50%or more following the procedure compared to the pre-drainage value.Survival time after the procedure and patient background characteristics were assessed comparatively between the successful drainage group(group A)and the non-successful drainage group(group B).The EBS stent patency duration in the successful drainage group(group A)was also assessed.RESULTS:The technical success rate was 100%for both the initial endoscopic nasobiliary drainage and EBS in all patients.Single stenting was placed in 21 patients and multiple stenting in the remaining 15 patients.The drainage successful rate was 75%and the median interval to successful drainage was 40 d(2-295 d).The median survival time was 150 d in group A and 22 d in group B,with the difference between the two groups being statistically significant(P<0.0001).There were no statistically significant differences between the two groups with respect to patient background characteristics,background liver condition,or tumor factors;on the other hand,the two groups showed statistically significant differences in patients without a history of hepatectomy(P=0.009)and those that received multiple stenting(P=0.036).The median duration of stent patency was 43 d in group A(2-757 d).No early complications related to the EBS technique were encountered.Late complications occurred in 13 patients(36.1%),including stent occlusion in 7,infection in 3,and distal migration in 3.CONCLUSION:EBS is recommended as the initial drainage procedure for obstructive jaundice caused by HCC,as it appears to contribute to prolongation of survival time.     

Diagnosis and initial management of cholangiocarcinoma with obstructive jaundice

Cholangiocarcinoma is the second most common primary hepatic cancer. Despite advances in diagnostic techniques during the past decade, cholangiocarcinoma is usually encountered at an advanced stage. In this review, we describe the classification, diagnosis, and initial management of cholangiocarcinoma with obstructive jaundice.     

术前胆道引流对低位恶性胆道梗阻患者行胰十二指肠切除术后的影响

目的 评价术前胆道引流(PBD)对低位恶性胆道梗阻性黄接受胰十二指肠切除术(PD)后的并发症、死亡率及住院时间的影响.方法 回顾性总结分析2001年1月至2010年12月期间接受PD术的71例低位恶性胆道梗阻患者的临床资料.术前胆道引流方法包括经皮肝穿刺胆道引流(PTCD)、逆行胰胆管造影术(ERCP)及胆囊造瘘术,71例中行PBD患者19例(26.8%),未行PBD患者52例(73.2%).结果 PBD组总胆红素(TBIL)在引流前为(424.9±129.9)μmol/L,引流后下降为(77.7±48.6)μmol/L,差异具有统计学意义(t=11.1,P＜0.001).PBD组直接胆红素(DBIL)在引流前为(300.7±98.1)μmol/L,引流后下降为(60.0±34.5)μmol/L,差异具有统计学意义(t=10.7,P＜0.001).PBD组谷丙转氨酶(ALT)在引流前为(227.9±275.8)U/L,引流后下降为(90.3±66.5)U/L,差异具有统计学意义(t=2.5,P=0.023).PBD组术中输血量为(589±93)ml,非PBD组为(603±71)ml,差异无统计学意义(t=-110,P=0.913).PBD组术后并发症发生率为52.6%(10/19),非PBD组为55.8%(29/52),差异无统计学意义(P＞0.05).PBD组术后住院时间为(33±3)d,非PBD组为(25±2)d,差异无统计学意义(P＞0.05).结论 对黄疸较重、肝功能严重受损的患者,行PBD可有效改善患者的一般状况,但并未降低PD术后并发症发生率及死亡率,也未减少术后的住院时间.     

CT引导下一步法经皮肝穿刺胆管引流术治疗梗阻性黄疸患者疗效观察*

目的 观察在CT引导下采用一步法经皮肝穿刺胆管引流术(PTCD)治疗梗阻性黄疸患者的疗效。方法 2017年1月～2019年12月我院收治的恶性梗阻性黄疸患者60例,随机分为对照组和观察组,每组30例,分别采用在X线透视引导下或在CT引导下一步法行PTCD穿刺置管引流治疗。结果 术中,观察组穿刺一次性成功率为96.7%,显著高于对照组的43.3%(P<0.05),穿刺透视时间为(13.6±2.1)s,显著短于对照组【(32.6±4.1)s,P<0.05】,总穿刺时间为(48.9±10.3)s,显著短于对照组【(92.3±13.6)s,P<0.05】,辐射暴露剂量为(2.5±0.3)mGy,显著小于对照组【(5.8±1.1)mGy,P<0.05】;在术后2 w时,观察组血清总胆红素水平由(241.8±83.6)μmol/L降至(109.8±45.6)μmol/L,对照组由(242.4±91.2)μmol/L降至(108.4±61.9)μmol/L,两组肝功能指标变化无显著性差异(P>0.05);在术后3月末,观察组胆道感染、出血、肝脓肿和腹膜炎发生率为3.3%,显著低于对照组的26.6%(P<0.05)。 结论 在CT引导下采取一步法PTCD术治疗恶性梗阻性黄疸患者可提高穿刺效率,减少术后并发症发生率,具有较好的临床应用价值。