肝叶肝段切除治疗肝内胆管结石

本文报告肝叶、肝段切除治疗肝内胆管结石并狭窄７８例，其中２２例切除肝叶或肝段后剖开狭窄胆管与空肠扩大吻合。经１－１３年随访优良效果９３．５％。作者认为局限于部份肝叶、肝段为主的肝内胆管结石并狭窄行肝叶、肝段切除，必要时配合胆道镜取石和肝胆管空肠扩大合联合手术是合理的。     

Post mortem CT of intrahepatic gas distribution in twenty-seven victims of a flood: Patterns and timing

We reported the results of post mortem computed tomography of the liver in 27 subjects dead simultaneously during a flood. The aim of our work was to identify the different patterns of post mortem intrahepatic gas distribution and the timing of its appearance. Although post mortem CT is the method of choice for the evaluation of gas distribution, controversies exist about the first site of appearance of intrahepatic gas (portal veins versus hepatic veins) as well as the timing and steps of intrahepatic gas spreading. In each subject we performed thin slice CT scanner (Somatom Definition, Siemens) and post processing of native CT images with Minimum Intensity Projection technique.Our results show that the first site of appearance of intrahepatic gas is portal veins. Gas in hepatic veins was never seen without the presence of the gas in portal vein. Gaseous cysts in hepatic parenchyma represent a further and usually more tardive pattern of intrahepatic gas distribution.In addition, we demonstrated that differences in timing of gas spreading was statistically significative for exclusive presence of portal veins gas before 48 h as well as for complete substitution of hepatic parenchyma by cysts 64 h after death.In conclusion, our work shows that the CT study of postmortem intrahepatic gas distribution could be a useful complementary tool both in demonstrating the mechanism of intrahepatic gas spreading and in estimating post mortem interval.     

血红素加氧酶1在妊娠期肝内胆汁淤积症孕鼠肝脏组织和胎鼠脑组织中的表达及其意义

目的：建立肝内妊娠期胆汁淤积症（ICP）大鼠模型,检测血红素加氧酶1（HO-1）在ICP孕鼠肝脏组织及胎鼠脑组织中的表达,探讨ICP的发病机制。方法：40只孕鼠随机分为实验组和对照组,每组20只。从孕15 d起,实验组孕鼠每天后肢内侧皮下注射孕酮和雌二醇,对照组孕鼠注射精制植物油。至孕21 d断头取血检测生化指标;取出母鼠肝脏及胎鼠脑组织,HE染色观察其病理组织学变化;免疫组织化学和图像分析法检测脑海马CA1区HO-1表达水平。结果：与对照组比较,实验组孕鼠血清天冬氨酸氨基转移酶(AST)、丙氮酸氨基转移酶（ALT）和总胆汁酸（TBA）水平均明显升高(P<0.01)。病理组织学表现,实验组孕鼠部分肝细胞有颗粒变性和空泡变性,肝小叶结构正常;胎鼠脑组织疏松,空泡样变性明显,部分细胞溶解,甚至消失。对照组孕鼠肝脏和胎鼠脑组织无明显病理改变。免疫组织化学及图像分析结果,与对照组比较,实验组胎鼠脑组织HO-1免疫着色强度减弱,HO-1表达水平明显下降 (P<0.05)。结论: ICP胎鼠脑组织中HO-1表达下降,可能与ICP胎儿窘迫的不良结局有关。     

中西医结合治疗妊娠期肝内胆汁淤积症临床疗效观察

目的：探讨中药联合西药治疗妊娠期肝内胆汁淤积症（ICP）的临床指标及围产结局。方法：对2011年10月—2013年2月在本院诊断为妊娠期肝内胆汁淤积症的168例孕妇收住院,进行前瞻双盲的临床研究。随机分为2组。研究组：选择88例以中药汤剂联合西药（熊去氧胆酸）治疗;对照组：选择80例,单以熊去氧胆酸治疗。比较两组治疗前后的生化指标,甘胆酸（CG）、总胆汁酸（TBA）、丙氨酸转氨酶（ALT）、天冬氨酸转移酶（AST）、总胆红素（T-BIL）等水平变化及围产结局。结果：①治疗后生化指标,研究组比对照组明显改善,CG（4.7±3.6）v（s35.1±27.5）μmol/L、ALT（23.5±14.5）vs（96.1±20.7）U/L、AST（24.7±14.3）vs（90.5±19.8）U/L、TBA（4.6±3.5）vs（7.8±4.9）μmol/L、T-BIL（7.7±4.6）vs（15.7±10.6）μmol/L、D-BIL（4.4±2.3）vs（12.5±7.8）μmol/L,P〈0.05;终止妊娠平均孕周：研究组比对照组明显延长（38.1±1.5）vs（35.6±1.7）周,早产率分别为7.9%vs23.8%,P〈0.05;②研究组与对照组胎儿窘迫（9.1%vs26.3%）、羊水粪染（18.8%vs41.3%）、新生儿窒息（0%vs5%）、剖宫产率（29.5%vs53.8%）、产后出血（2.3%vs7.5%）比较,研究组均明显低于对照组,P〈0.05,差异显著。结论：中药汤剂联合西药治疗妊娠期肝内胆汁淤积症较单西药治疗能明显改善临床经过,延长孕周,降低剖宫产率和改善围产结局。     

Intrauterine fetal death

Sadly, intrauterine fetal death is a common occurrence and one that all labour ward personnel should be trained to manage. Recent advances have improved the likelihood of identifying a cause. The key to this is a logical and methodical approach to investigation. Postmortem examination remains a critical aspect of investigation and labour ward teams require a clear understanding of the legal aspects of this. Sympathetic and supportive care of parents should respect parental wishes and allow choice wherever possible. However, maternal safety should also be a central aspect of this care.     

冷保存对肝移植术后肝内胆管微循环的影响

目的探讨供肝冷保存对肝移植术后肝内胆管微循环的影响。方法实验大鼠随机分为假手术组（SO组）、供肝冷保存1h组（CP1h组）、供肝冷保存24h组（CP24h组）。采用重建肝动脉的大鼠肝移植模型。在肝移植术后的不同时间点,观察肝内胆管组织损伤程度;经肝动脉注入微球,光镜下行肝组织汇管区内微球计数;采用间接免疫荧光双染技术检测肝组织汇管区微小血管内皮细胞eNOS、El＂-1和ICAM-1的表达,并采用原位杂交技术检测其mRNA的表达。结果冷保存再灌注可引起肝内胆管结构改变,冷保存时间越长损害程度越重。冷保存再灌注可引起肝组织汇管区内微球数量增加,且时间越长微球数量增加越明显。冷保存再灌注可引起汇管区微小血管内皮细胞eNOS蛋白及mRNA表达水平降低,而ET-1和ICAM-1的蛋白及mRNA表达水平升高。结论冷保存可引起大鼠移植肝脏肝内胆管微循环及其内皮细胞功能明显改变,微循环障碍可能在肝内胆管冷保存再灌注损伤中起重要作用。     

滤纸尿半乳糖醇气相色谱/质谱分析在筛查希特林蛋白缺陷致新生儿肝内胆汁淤积症中的应用

目的观察不同大小及不同放置时间的滤纸洗脱尿半乳糖醇气相色谱/质谱(GC/MS)检测结果与原尿液半乳糖醇GC/MS检测结果之间差异,探讨滤纸尿送检筛查希特林蛋白缺陷所致新生儿肝内胆汁淤积症(NICCD)的可行性。方法选择既往GC/MS分析提示含有半乳糖醇的原尿液10份,每份制成3种大小不同的滤纸吸附,晾干,在室温下放置1～7 d,然后洗脱。取原尿液和洗脱尿100μL,用生化分析仪测定尿肌酐水平。取原尿液和洗脱尿100μL,原尿液先采用尿素酶处理后进行尿液代谢产物GC/MS检测。用质谱仪检索NIST图谱库定性检测到的尿液代谢产物。用正十七烷酸作为内标物质,应用内标法以内生肌酐定量代谢产物。结果同一份含有半乳糖醇的尿液,制成3种大小不同的滤纸尿,放置第1、3、5、7天的大小不同滤纸洗脱尿与其原尿液均经GC/MS检测,并进行比较,发现不同时间/不同大小的滤纸洗脱尿与其原尿液半乳糖醇的出峰时间及水平,均无统计学差异,不同时间/不同大小的滤纸洗脱尿半乳糖醇的出峰时间及水平均无统计学差异。结论在常温下,7 d内当洗涤滤纸的液体与滤纸吸收的尿液量一致时,滤纸尿可代替-80℃储存的原尿。建议使用的滤纸片规格是5 cm×8 cm,可吸收1.0 mL尿液。     

Improvement of refractory pruritus after lipoprotein‐apheresis in arthrogryposis‐renal failure‐cholestasis syndrome

Accumulation of bile acids can lead to invalidating pruritus in cholestatic patients. Few reports exist on the influence of lipoprotein‐apheresis (LA) on plasma level of total bile acids (tBA). We report of significant decrease in tBA levels and drastic improvement of pruritus in a 5‐year‐old girl with arthrogryposis‐renal failure‐cholestasis syndrome. We present LA as a suitable rescue treatment option in therapy‐refractory cholestasis‐associated pruritus, at least as bridge until a long‐term solution such as entero‐biliary anastomosis or transplantation is possible.