精氨酸对阻塞性黄疸大鼠的免疫调节作用

阻塞性黄疸患者围手术其易感性明显高于非黄疸者，其发病原因尚不完全清楚。本文研究了阻塞性黄疸大鼠脾脏淋巴细胞白细胞介素２生成能力及抑制性Ｔ淋巴细胞功能的变化；同时观察了精氨酸对阻塞性黄疸大鼠免疫功能的影响。结果显示：胆管结扎大鼠脾脏淋巴细胞白细胞介素２生成能力明显下降，抑制性Ｔ淋白细胞活性明显增强；应用精氨酸治疗的阻塞性黄疸大鼠脾脏淋巴细胞白细胞介素２生成能力较单纯胆管结扎大鼠明显增强；抑制性Ｔ淋巴     

消炎痛对阻塞性黄疸大鼠的免疫调节作用

本文研究了阻塞性黄疸大鼠脾脏淋巴细胞白细胞介素２生成能力的变化，同时观察了消炎痛对其的影响。结果表示：胆管结扎大鼠脾脏淋巴细胞白细胞介素２生成能力明显下降，细胞内ｃＡＭＰ浓度下降，ｃＧＭＰ水平升高；应用消炎痛治疗的胆管结扎大鼠脾脏淋巴细胞白细胞介素２生成能力增强，淋巴细胞内ｃＡＭＰ水平上升ｃＧＭＰ浓度下降。消炎痛能够明显改善大鼠的免疫功能，提高阻塞性黄疸机体的抗感染力，有可能成为临床上调节阻塞性黄     

大鼠肝再生过程中毛细胆管增生的形态计量研究

Morphometric analysis of the liver during regeneration after partial hepatectomy showed that the mean area and number of bile canaliculi increased, while the volume density of microvilli related to the lumina of the canaliculi decreased. These changes were observed 12 hours after the operation, which gradually returned to normal on the third day after operation. It indicated that the decrease of volume density of microvilli was the result of enlargement of bile canaliculi, which was different from the decrease of microvilli due to passive widening of the canaliculi such as in cholestasis from loss of microvilli. All these phenomena suggest that enlargement of the area of bile canaliculi during liver regeneration may be due to the increase of membranous protein synthesis. Moreover, the increase of the number of bile canaliculi suggests that the proliferation of hepatocytes is associated with formation of new branches of bile canaliculi.     

恶性梗阻性黄疸的介入治疗

目的探讨恶性梗阻性黄疸的介入治疗方法及其疗效。方法对256例恶性梗阻性黄疸患者,施用经皮经肝穿刺胆道引流术(PTCD)加金属内支架置入术或结合局部动脉化疗术,共使用256条外引流管和256枚金属内支架。结果 256例患者采用经皮经肝穿刺置入外引流管及支架置入术,均一次置入成功。术后总胆红素、直接胆红素、碱性磷酸酶均明显下降。术后256例患者黄疸消退满意;112例黄疸消退,并于术后4周行局部灌注化疗术。结论经皮经肝穿刺胆道外引流加内支架置入术是姑息性治疗恶性梗阻性黄疸的安全、有效方法,结合局部动脉灌注化疗,能提高患者的生命质量及延长生存期。     

梗阻性黄疸大鼠血清胃泌素水平的变化

梗阻性黄疸易并发消化性溃疡,其中机制尚未明了,但认为与多种因素有关,我们通过测定梗阻性黄疸的大鼠血清胃泌素水平,从一个侧面阐述其中的机制。 材料和方法 一、动物与分组:选用本院动物房提供的60只年龄相近、体重200～300g、饲养条件一致的SD大鼠,雌雄不拘,随机分为二组:手术组,假手术组。每组各30只。所有大鼠在清晨空腹时从尾部取血1～2ml,待试管中血凝固后,离心分离血清,置-4℃保存待测。 二、梗阻性黄疸大鼠模型的制作:将手术组动物30只在1％硫喷妥钠腹腔麻醉下(剂量按3.5mg/100g)消毒腹部,取下中切口,依层切开腹腔,在肝十二指肠韧带内找到胆总管,双重结扎,关腹。假手术组只分离胆总管而不结扎。所有动物     

正常人胆管壁组织构筑的研究

对5例正常人胆道系统的组织构筑及平滑肌、弹性纤维、胶原纤维的分布进行了面积计量研究.从胆总管胰后段至左右肝管汇合部,平滑肌的面积分数从13.56±0.65%降至3.34±0.32%,弹性纤维的含量以肝总管和左右肝管汇合部为高,与胆总管胰后段和十二指肠上段比较,差别有显著性.胶原纤维的含量在肝外胆管各段之间和肝内胆管各段之间无显著差异,但肝内胆管与肝外胆管之间的差异显著.肝内与肝外胆管壁的组织构筑存在一定的差异,说明它们的生理功能有所不同.     

PTC诊断梗阻性黄疸的价值（附126例报告）

经皮经肝内胆管穿刺造影（ＰＴＣ）操作简单，穿刺成功率及诊断准确率高，并发症少，ＰＴＣ能提供准确的定位性诊断，胆道全部图像对手术有指导作用。我院从一九八三年至一九九九年对１２６例梗阻性黄疸病人术前采用ＰＴＣ诊断，效果满意，报告如下。１　临床资料１１　一般资料本组１２６例，男性５８例，女性６８例，年龄８～７７岁，平均４５７岁，有黄疸或黄疸史１１８例，全组病例均行Ｂ超检查１～３次，ＣＴ检查７１例，肝内胆管扩张１１２例，肝内胆管不扩张１４例。Ｂ超或ＣＴ检查提示肝门部梗阻１６例，胆总管中、下段梗阻９５…     

阻塞性黄疸降低靛氰绿的大鼠肝胆转运过程

采用结扎胆总管的方法复制阻塞性黄疸(OJ)大鼠模型,研究靛氰绿在OJ大鼠的肝胆内转运过程。实验观察了OJ大鼠模型下列变化：各器官病理学的变化;肝血流量和靛氰绿肝清除率的改变;靛氰绿的药代动力学参数。结果表明,靛氰绿在OJ大鼠体内的消除减慢,肝清除率下降,肝血流量也明显减少。靛氰绿在OJ大鼠的清除率下降。药代动力学分析结果提示靛氰绿通过肝细胞膜转运至肝细胞内、在肝细胞内的滞留以及自肝细胞向胆管的转运等过程均出现损害。     

阻塞性黄疸患者血清EGF测定的临床意义

目的：探讨阻塞性黄疸病人手术前后血清表皮生长因子（ＥＧＦ）水平的变化及其在胃粘膜病变中的作用。方法：采用放射免疫分析法检测３１例阻塞性黄疸病人手术前后血清ＥＧＦ水平。结果：与正常对照组相比,阻塞性黄疸病人血清ＥＧＦ术前即降低,术后降低更明显。结论：阻塞性黄疸患者手术前后血清ＥＧＦ均减少,ＥＧＦ不能发挥对胃粘膜的保护作用,致使胃粘膜保护性因素减弱,可能是阻塞性黄疸时胃粘膜病变及术后应激性溃疡的发病机     

Traumatic neuroma of the bile ducts with intrahepatic extension causing obstructive jaundice

Most traumatic neuromas of the biliary tract occur in the cystic duct stump after cholecystectomy and produce no symptoms. The authors report the rare occurrence of traumatic neuroma of the bile ducts that arose from injury to the duct occurring during cholecystectomy. The neuroma blocked the common hepatic duct and extended into the left hepatic duct, causing obstructive jaundice. The pseudotumor was removed from the common hepatic duct, but intrahepatic extension prevented complete removal. The patient remains well ten years after the surgical procedure.     

Phalloidin-induced alterations of bile canaliculi

Phalloidin, a toxin from the plant Amanita phalloides, irreversibly polymerizes actin filaments and causes cholestasis. Three-dimensional structural changes induced by phalloidin in the bile canaliculi and the intra-acinar localization of these changes were studied in the rat liver by scanning and transmission electron microscopy. After 3 days of treatment, canalicular changes appeared mainly in zones 2 and 3 of Rappaport's acinus, but after 7 days of treatment changes occurred in bile canaliculi of the whole acinus. The changes in the bile canaliculi included tortuosity, saccular dilatation, loss of microvilli, bleb formation and elongation of canalicular side branches. Some side branches extended near to Disse's space, leaving only a thin cytoplasmic rim between the canalicular lumen and Disse's space. Kupffer cells were occasionally situated near such extended bile canaliculi and protruded their processes into the hepatic cord. These results suggest that bile canaliculi in zone 3 are more susceptible to phalloidin toxicity than those in zone 1 and that biliary constituents may leak from such altered bile canaliculi.     

Myeloid sarcoma of the extrahepatic bile ducts presenting as obstructive jaundice

We report a rare case of myeloid sarcoma (MS) of the extrahepatic bile ducts presenting as obstructive jaundice in a patient without leukemia at time of diagnosis. A 75-year-old female presented with a one-month history of abdominal pain and jaundice. Computerized tomography scan of the abdomen showed stenosis of the extrahepatic bile ducts. Endoscopic retrograde cholangiography disclosed an irregular narrowing of the common biliary duct, suggestive of a cholangiocarcinoma, and resection was performed. Histologic examination showed diffuse transmural infiltration of malignant cells. These cells exhibited medium-sized round nuclei with central nucleoli and eosinophilic cytoplasm, and were strongly positive for myeloperoxidase, CD68, lysozyme, CD45, CD117 (c-kit protein) and CD43. Eight months following surgery the patient presented with multiple cutaneous nodules and bone marrow trephine biopsy showed acute myelomonocytic leukemia. A literature search identified two previously reported cases of MS of the extrahepatic biliary duct. MS should be taken into consideration in the differential diagnosis of a patient with obstructive jaundice. Immunohistochemistry is essential for a correct diagnosis.     

Studies on pruritus in obstructive jaundice cases with special references to serum bile acid fractions

About, 22 cases with pruritus and 18 cases without pruritus of obstructive jaundice, serum bile acids were analysed quantitatively by high performance liquid chromatography (HPLC) before and after biliary decompression for the study on the relationship between pruritus and non-pruritus group. Analysis was also carried out on 11 cases with normal liver function as the control group. And 15 kinds of bile acids were as followed: unconjugates (ursodeoxycholic: UDCA, cholic: CA, chenodeoxycholic: CDCA, deoxycholic: DCA, lithocholic acid: LCA), glycine conjugates (Gly-UDCA, Gly-CA, Gly-CDCA, Gly-DCA, Gly-LCA) and taurine conjugates (Tau-UDCA, Tau-CA, Tau-CDCA, Tau-DCA, Tau-LCA). Data was analysed by t-test statistically. [I] Before biliary decompression (1) No significant difference was observed between the pruritus group and non-pruritus group about total bile acid level, total unconjugates level and CA/CDCA ratio. (2) On total glycine-conjugates level the pruritus group was significantly lower than the non-pruritus group, that level was about 3/5. Similarly on Gly-CA level was about 2/3, on Gly-CDCA level was about 1/2. (3) By contraries on total taurine-conjugates level the pruritus group was significantly high as compared with the non-pruritus group, that level was about two times. Similarly on Tau-CA and Tau-CDCA levels were about two times. (4) From there results on glycine/taurine ratio (G/T) of total bile acids pruritus group was significantly low as compared with the non-pruritus group, that level was about 1/3. Similarly on G/T ratio of CA level was about 2/5 and on G/T ratio of CDCA was about 1/3. (5) As for various unconjugates, UDCA level was significantly high in pruritus group as compared with non-pruritus group. [II] After biliary decompression No significant difference was shown in the composition of serum bile acids between the pruritus group and the non-pruritus group. These studies showed that the pruritus in the obstructive jaundice cases stood in a certain relation to the increase of taurine-conjugates, especially taurine-conjugated CA and taurine-conjugated CDCA, moreover increase of unconjugated UDCA.     

Kupffer cell phagocytosis blockade decreases morbidity in endotoxemic rats with obstructive jaundice

OBJECTIVE AND DESIGN: The consequences of Kupffer cell phagocytosis blockade were studied in endotoxemic rats with obstructive jaundice. MATERIAL OR SUBJECTS: 159 male Wistar rats. TREATMENT: Obstructive jaundice was induced by bile duct ligation (BDL). Gadolinium chloride (1 mg/100 g iv) was given 6 days after BDL to inhibit Kupffer cell activity and the animals were challenged with 1 microg/g endotoxin 24 h later. METHODS: Endotoxin sensitivity, tumor necrosis factor-alpha and interleukin-6 production were studied, liver and lung injury were assessed by neutrophil infiltration assay, tissue adenosine triphosphate, aspartate aminotransferase, alanine aminotransferase level determinations and histology, respectively. For statistics non-parametric methods were used. RESULTS: BDL sensitized the animals to endotoxin, increased endotoxin-induced tumor necrosis factor-alpha and interleukin-6 production and reduced ATP contents of the liver and the lung. Kupffer cell blockade significantly increased the resistance against endotoxin, diminished the inflammatory cytokine release and reduced endotoxin-induced tissue injury in BDL animals. CONCLUSION: Attenuation of Kupffer cell function decreases endotoxin-induced lethality and morbidity in obstructive jaundice.