中医外治技术联合快速康复外科理念对肝胆外科术后患者的临床疗效

目的:探讨中医外治技术联合快速康复外科(ERAS)理念促进肝胆外科患者康复的临床疗效。方法:选择于2018 年8 月—2020 年10 月在我科行腹腔镜手术的患者308 例,随机分为外治组156 例,对照组152 例。对照组行腹腔镜手术+ERAS 理念,外治组在前者基础上加用中医外治技术,比较两组患者在术后肠鸣音恢复、肛门首次排气及排便时间、疼痛评分、住院天数、相关并发症等方面的差异。结果:外治组术后肠鸣音恢复、肛门首次排气排便时间均短于对照组(P <0.05),术后疼痛评分低于对照组(P <0.05),行肝脏手术及胰腺手术患者的住院时间均短于对照组(P <0.05)。但两组相关并发症发生率差异无统计学意义(P <0.05)。结论:中医外治技术联合ERAS 理念在肝胆外科围手术期的应用能减轻术后患者的疼痛,促进胃肠道功能的恢复,缩短住院时间,值得临床推广应用。     

先天性胆总管囊肿术后十二指肠胃返流的动态观察

目的：利用不同的二种动态检测方法研究不同术式的先天性胆总管囊肿术后病儿十二指肠胃返流的特点。方法：采用２４ｈ胃食管双ｐＨ动态检测结合持续性核素静脉注射肝胆闪烁显像技术,检测２０例不同术式的先天性胆总管囊肿术后病儿及１７名正常儿十二指肠胃返流（ｄｕｏｄｅｎｏｇａｓｔｒｉｃ ｒｅｆｌｕｘ,ＤＧＲ）出现情况。结果：二种术式中囊肿切除,肝总管十二指肠吻合组（Ｈ－Ｄ吻合组）ＤＧＲ发生率高于囊肿切除,肝总管空     

New hepatocellular diffusion model for analysis of hepatobiliary transport processes of drugs

A new hepatocellular diffusion model was developed to kinetically evaluate the hepatobiliary transport processes of drugs in the perfusion system, based on the physiological structure of the liver. Since the equations describing the hepatocellular diffusion phenomena were derived as image forms in the Laplace domain, the fast inverse Laplace transform (FILT) was adopted to manipulate the image equations. Cefixime and cefpiramide were selected as model drugs. The concentrations in the perfusate and the excreted amounts into the bile were simultaneously measured at appropriate intervals after the rapid administration of each drug into the portal vein. The hepatocellular diffusion model was fitted to the biliary excretion profiles from rat livers, by means of a nonlinear least squares program, MULTI(FILT). According to this model, the hepatobiliary transport process of drug is kinetically separated into three steps, that is, the diffusion into and through the hepatocytes, the transfer from the hepatocytes into the bile canaliculi, and the movement through the bile canaliculi to the outlet of bile duct. These steps are characterized by the diffusion rate constant through hepatocytes (k_dif), the permeability rate constant into the bile canaliculi (k_bmc) and the transit time through the bile canaliculi to the outlet of bile duct ( ), respectively. It was demonstrated that k_dif of cefixime (0.023min¹) was significantly smaller than that of cefpiramide (0.044 min¹), while the differences in k_bmc and were not obvious between cefixime and cefpiramide. k_bmc and of both drugs were about 1.2 min¹ and about 1.0 min, respectively. These parameters were correlated to the excretion ratio into the bile (F_bile) and the mean transit time from the sinusoid through the hepatocytes to the outlet of bile duct ( ).     

Evaluation of esophageal bile reflux after total gastrectomy by gastrointestinal and hepatobiliary dual scintigraphy

Conducting the qualitative evaluation of reconstruction methods is difficult because of their complexity. The aim of the present study was to compare esophageal bile and food reflux by performing gastrointestinal and hepatobiliary dual scintigraphy (GHDS) after various methods of reconstruction following total gastrectomy. Of 17 patients studied, 4 had undergone Roux-en-Y anastomoses (R-Y); 6, jejunal pouch-Y anastomoses (P-Y); and 7, jejunal pouch interposition (P-I). GHDS was performed 1 year after surgery using¹¹¹In-diethylene triamine pentaacetic acid administered orally, and^99mTc-pyridoxyl-5-methyl tryptophan administered intravenously. Imaging data from a gamma camera were stored in and processed by a data analyzer. Three patients who had undergone R-Y and one who had undergone P-I complained of heartburn, while one who had undergone R-Y, two who had undergone P-Y, and three who had undergone P-I complained of a feeling of fullness. Esophageal bile reflux was confirmed by GHDS in four of the patients who had undergone R-Y, one who had undergone P-Y, and four who had undergone P-I. Moreover, GHDS demonstrated food retention in two patients who had undergone R-Y, five who had undergone P-Y, and four who had undergone P-I. Weight loss was closely related to the esophageal reflux of bile or food which can be accurately detected by GHDS. Despite the absence of heartburn, patients diagnosed as having bile reflux by GHDS showed poor recovery of body weight.     

A case of recurrent cholangitis after bile duct injury during laparoscopic cholecystectomy: Value of scintigraphy with Tc-99m GSA and hepatobiliary scintigraphy for indication of lobectomy

A 39-year-old woman with acute cholecystitis and gallstones underwent laparoscopic cholecystectomy. She suffered from recurrent episodes of cholangitis due to injury of the major bile ducts during laparoscopic cholecystectomy. Hepatobiliary scintigraphy with Tc-99m Sn-N-pyridoxyl-5-methyltryptophan was performed. Although normal bile excretion was found from the left hepatic duct to the percutaneous transhepatic biliary drainage (PTBD) tube, excretion from the right hepatic lobe was prolonged. Scintigraphy with Tc-99m diethylenetriaminepentaacetic acid-galactosyl human serum albumin demonstrated atrophy of the right hepatic lobe and enlargement of the left hepatic lobe. Cholangiography via the PTBD tube revealed complete obstruction of the left hepatico-jejunal anastomosis and could not enhance the right intrahepatic bile duct. A right hepatic lobectomy was performed because of the atrophy, glissonitis and the absence of an appropriate bile duct for reconstruction. Postoperatively she was active and exhibited no evidence of recurrent cholangitis.     

肝胆胰腺外科手术部位感染相关危险因素研究

目的了解肝胆胰腺手术患者发生手术部位感染（SSI）的相关危险因素。 方法选取2006年1月-2010年1月某三级甲等医院普通外科接受肝胆胰腺手术并发生SSI的60例患者作为病例组,同时期普通外科接受肝胆胰腺手术但未发生SSI的119例患者作为对照组,对其病历资料进行回顾性调查研究。结果单因素分析结果显示：年龄、心脑血管疾病史、腹部手术史、吸烟史、术前贫血、术前凝血功能和血糖异常、术前存在感染、是否使用腹腔镜、切口类型、手术持续时间、ASA评分、术后是否引流和术后24 h内换药与肝胆胰腺手术患者发生SSI相关（均P＜0.05）。多因素分析结果显示：有腹部手术史［OR95%CI：3.09(1.21～7.91) ］、NISS评分高风险型［OR95%CI：6.18(2.41～15.85)］是肝胆胰腺手术患者发生SSI的危险因素,术后48 h内换药［OR95%CI: 3.81(1.56～9.34)］是其保护因素。结论腹部手术史及NISS评分高是肝胆胰腺手术患者发生SSI的主要危险因素,为降低患者SSI风险,术前应积极调整患者血糖、纠正贫血和凝血功能异常;应尽量缩短手术持续时间,术后注意无菌操作,保持切口清洁、及时换药。     

Diagnostic Accuracy of Split-Bolus Single-Phase Contrast-Enhanced Cone-Beam CT for the Detection of Liver Tumors before Transarterial Chemoembolization

Purpose

To evaluate detectability of hepatocellular carcinoma (HCC) using split-bolus cone-beam CT in intraindividual comparison between cone-beam CT and contrast-enhanced MR imaging.

Current trends in imaging evaluation of acute cholecystitis

This study was designed to retrospectively determine recent clinical trends of initial radiological evaluation in patients pathologically proven to have acute cholecystitis (AC) and to assess the methodology that led to its diagnosis. Over a 28-month period, the medical records and imaging studies of 117 consecutive patients who had pathologically confirmed AC were retrospectively analyzed. The sensitivities of ultrasound (US) and hepatobiliary ^99mTc-iminodiacetic acid (HIDA) were computed. The false-negative scans were retrospectively reviewed by a blinded radiologist to determine the limitations and advantages of each modality. The 117 patients were grouped into six categories based on the type of imaging examination they underwent prior to cholecystectomy: initial US evaluation only (n=80, 68.4%), initial US followed by HIDA (n=17, 14.5%), initial HIDA only (n=2, 1.7%), initial HIDA followed by US (n=3, 2.6%), initial CT (n=5, 4.3%), and no imaging evaluation (n=10, 8.6%). HIDA scan had a calculated sensitivity of 90.9% (20 true-positive, 2 false-negative) while US had a sensitivity of 62% (62 true-positive, 38 false-negative). Current practice in the initial radiological evaluation of acute cholecystitis remains outdated. The vast majority of patients in our study group were initially worked up using US, although HIDA scan has been shown to have greater sensitivity for the diagnosis of acute cholecystitis.     

肝病患者合并希瓦菌感染的临床分析

目的 总结肝病患者希瓦菌感染的临床因素及耐药情况.方法 回顾性分析2009年1月至2015年12月无菌部位希瓦菌培养阳性的肝病患者的临床资料,并采用表型实验和质谱仪对希瓦菌进行再鉴定.结果 共收集7例非重复希瓦菌感染者的资料,其中希瓦菌所致血流感染2例,腹膜炎4例,胆道感染1例.经鉴定,4株为海藻希瓦菌,3株为腐败希瓦菌.在临床治疗过程中,希瓦菌易对碳青霉烯类药物不敏感,而对左氧氟沙星和阿米卡星敏感.结论 希瓦菌可引起重症肝病患者多个无菌部位的感染,左氧氟沙星或阿米卡星可取得较好的抗菌效果.