The value of radionuclide hepatobiliary scintigraphy in combination with determination of bilirubin from duodenal drainage in differential diagnosis of infantile persistent jaundice

The aim of this study was to investigate the value of technetium etifenin injection (^99mTc-EHIDA) hepatobiliary scintigraphy in combination with determination of bilirubin from duodenal drainage in differential diagnosis between infantile hepatitis syndrome and biliary atresia. ^99mTc-EHIDA hepatobiliary scintigraphy in combination with duodenal fluid examination was used for evaluation in 84 infants with persistent infantile jaundice. For diagnosing biliary atresia, the sensitivity and specificity of scintigraphy were 100% and 74.5%, respectively; the sensitivity and specificity of scintigraphy in combination with duodenal fluid examination were 100% and 100%, respectively. In conclusion, hepatobiliary scintigraphy, which is a noninvasive, safe, valuable examination method, in combination with examination of duodenal fluid, is of value for the differential diagnosis between infantile hepatitis syndrome and biliary atresia.     

从“三人小组”到“三甲医院”

医院始终坚持以提高肝胆疾病的诊治疗效为目标,依靠科技创新,培养优秀拔尖人才,坚持临床与基础相结合,不断拓展＂哑铃式＂国际交流模式,实现了医院跨越式发展。     

Utility of hepatobiliary scintigraphy in diagnosing or excluding biliary atresia in premature neonates and full-term infants with conjugated hyperbilirubinemia who received parenteral nutrition

Purpose: Hepatobiliary scintigraphy (HBS) is used to aid in the diagnosis of Biliary Atresia in full-term infants with conjugated hyperbilirubinemia. There is little information on the utility of the HBS in premature infants with conjugated hyperbilirubinemia and infants with parenteral nutrition associated cholestasis (PNAC). The purpose of this study is to assess the utility of HBS in differentiating Biliary Atresia and PNAC in premature neonates and full-term infants who received parenteral nutrition (PN).

Materials and methods: Retrospective data collection and analysis on infants who developed conjugated hyperbilirubinemia and had HBS performed during their stay at level IV neonatal intensive care unit between 2005 and 2015.

Results: A total of 20 patients with exposure to PN had HBS; two patients were confirmed to have Biliary Atresia. There were no statistically significant differences between patients with Biliary Atresia versus PNAC in demographics, days on PN, or gamma glutamyl-transferase levels. Stool color was statistically significantly different between the two groups; patients with Biliary Atresia had acholic stools more consistently than patients without Biliary Atresia. HBS had 100% sensitivity, 17% specificity, positive-predictive value of 12%, and a negative-predictive value (NPV) of 100%.

Conclusions: These data indicate that the ability of HBS to aid in diagnosing Biliary Atresia is poor in a population of preterm neonates and full-term infants with PNAC. Although there is 100% sensitivity, the poor specificity (17%) should be acknowledged when utilizing HBS to diagnose Biliary Atresia in this vulnerable patient population. NPV of 100% is helpful in ruling out Biliary Atresia in this population.     

雷公藤甲素致小鼠肝损伤对转运体Mrp2和Oatp2的影响

目的：通过多药耐药相关蛋白2（multidrug resistance protein 2,Mrp2）和有机阴离子转运多肽2（organic anion transporting polypeptides 2,Oatp2）初步探究雷公藤甲素诱导小鼠肝损伤的机制。方法：雄性ICR小鼠单次灌胃给予雷公藤甲素（1.0 mg·kg^-1）24 h后称重,摘眼球采血后分离血清,测定血清生化指标;取肝组织做病理切片;采用免疫印迹法检测肝脏组织中Mrp2和Oatp2的蛋白表达量。结果：与对照组相比,雷公藤甲素组肝重指数显著增加（P<0.05）,部分血清生化指标显著上升（P<0.05）,且肝细胞发生核碎裂和脂肪变性。雷公藤甲素组Oatp2的表达较对照组显著升高了32.79%（P<0.05）,而Mrp2的表达较对照组显著下降了45.47%（P<0.01）。结论：雷公藤甲素可能通过上调肝细胞膜转运体Oatp2和下调Mrp2,扰乱肝内胆红素和胆汁酸代谢排泄平衡,可能是雷公藤甲素诱导肝损伤的机制之一。     

3D腹腔镜在复杂性胆囊切除术中的临床应用

目的探讨3D腹腔镜在复杂性胆囊切除术中的临床应用价值。方法收集我院2014年3月~2015年3月间复杂性胆囊结
石资料,按照所使用的腹腔镜分为2D组和3D组,比较2组患者手术时间、术中出血量、术后并发症、中转开腹机率、术后排气时
间及术后住院天数。结果共计纳入89例,其中3D组46例,2D组43例;3D组43例成功完成LC,中转开腹3例,2D组39例成功
完成LC,中转开腹4例;3D组和2D组手术时间分别为50.5±15.2 mL和65.4±18.1 min,两组比较差异有统计学意义（P<0.05）;
3D组和常规组术中失血量分别为34.1±13.6 mL和44.5±22.3 mL;两组比较差异有统计学意义（P<0.05）;两组在中转开腹率、术
后排气时间、术后住院天数差异无统计学意义（P>0.05）。结论3D腹腔镜能提供清晰的三维立体视觉,良好的深度感,可实现
精确操作,在复杂性胆囊切除术中有助于缩短手术时间,减少术中出血量,值得在临床手术中推广。
     

综合护理对肝胆外科术后患者感染的影响

目的：研究综合护理对肝胆外科术后患者感染的影响。方法：选取该院2012年1月至2015年1月收治的480例肝胆外科手术患者作为研究对象,采取等距随机抽样法分为观察组和对照组,对照组患者采用常规护理,观察组患者在对照组的基础上采用综合护理。结果：两组患者术后感染率组间比较差异有统计学意义（P ＜0.05）。结论：采用综合护理的方式能够降低肝胆手术患者术后感染率,护理效果显著,具有临床应用及推广价值。     

TBL联合CBL和PBL三轨教学模式在肝胆外科教学中的实践及效果

北京大学以社会需求为导向,借助深化专业学位研究生教育综合改革契机,充分发挥北大医学特色,对医学专业学位研究生教育结构进行顶层设计,探索与国际接轨的公共卫生、药学、医学技术领域高级应用型人才培养模式;深入贯彻落实医教协同精神,推进临床医学专业学位博士培养与专科医师规范化培训有机衔接。     

肝胆外科患者出院准备度与出院指导质量的相关性研究

目的了解肝胆外科患者出院准备度及出院指导质量现状及相关性,为针对性干预提供参考。方法选取肝胆外科患者170例,采用出院准备度量表、出院指导质量量表调查,并分析其相关性。结果肝胆外科患者出院准备度得分为7.28±1.64,出院指导质量得分为7.93±1.93。出院准备度和出院指导质量呈正相关(r=0.572,P0.01)。结论肝胆外科患者出院准备度及出院指导质量处于中等水平,出院指导质量正向影响出院准备度。医护人员需加强肝胆外科患者的出院指导,以更好地提高其出院准备度。