老年人肝外阻塞性黄疸外科治疗的变化特点

目的总结老年人阻塞性黄疸外科治疗30年来的变化特点。方法收集我院1971年1月至2000年12月经外科治疗的该方面的病历共181例进行总结分析,并将其分为1985年之前及1986年之后两个时期,从中了解其病因及治疗预后等变化,并与同期经手术治疗但无黄疸的胆道疾病的老年人225例作一临床比较,从中了解两者的治疗预后情况。结果(1)病因变化特点细菌感染下降((P<001),恶性肿瘤上升(P<001);结石及病死率均无下降(P>005)。(2)与无黄疸组的比较特点胆囊肿大、恶性肿瘤及病死率均明显比例高(P<001)。结论随着社会的发展,恶性肿瘤已成为老年人阻塞性黄疸的重要原因,其手术死亡率较高,故如何合理治疗及降低其死亡率,仍是当前不容忽视的问题。     

Treatment of 32 cases of bile reflux gastritis by embedding catgut in acupoints

在穴位胆俞、胃俞、梁门、中脘、上脘、足三里、内关、太冲和阳陵泉埋入羊肠线,1 d后取下.15-20 d埋线1次,治疗32例胆汁返流性胃炎患者,治疗4次后治愈20例,好转12例.     

医源性胆管损伤的预防及处理

目的 探讨胆囊切除、胆总管探查术并发症的防治。方法 回顾性分析我院1995年5月～2004年5月胆囊切除750例，同时行胆总管探查术127例的资料。结果 胆囊切除术中发生胆总管横断伤1例，肝总管部分损伤1例；胆总管探查术中发生胆总管远端损伤致十二指肠外瘘、十二指肠结肠肝曲内瘘1例，均经手术处理治愈，无死亡病例。结论 术中严格遵循三管一壶腹解剖关系，不过分强调小切口，总胆管探查强调koehe’s手法，保持手术人员良好心态，是避免胆管损伤的重要措施。     

A chronic toxicity study of diphenylarsinic acid in F344 rats in drinking water for 52 weeks

Diphenylarsinic acid (DPAA), a chemical warfare-related neurotoxic organic arsenical, is present in the groundwater and soil in some regions of Japan due to illegal dumping after World War II. The purpose of the present study was to evaluate the potential toxicity of DPAA when administered to rats in their drinking water for 52 weeks. DPAA was administered to groups 1–4 at concentrations of 0, 5, 10, and 20 ppm in their drinking water for 52 weeks. There were no significant differences in the final body weights between the control groups and the treatment groups in male or female rats. In serum biochemistry, in females 20 ppm DPAA significantly increased alkaline phosphatase and γ-glitamyl transferase compared to controls, and 10 and 20 ppm DPAA significantly increased total cholesterol compared to controls. Absolute and relative liver weights were significantly increased in females treated with 20 ppm DPAA compared to the control group. Dilation of the common bile duct outside the papilla of Vater and stenosis of the papilla of Vater was observed in all male and female rats administered 20 ppm DPAA. The incidence of intrahepatic bile duct hyperplasia was significantly increased in male and female rats treated with 20 ppm DPAA compared to the control groups. These results suggest that DPAA is toxic to the bile duct epithelium in rats. The no-observed adverse effect levels of DPAA were estimated to be 10 ppm (0.48 mg/kg b.w./day) for males and 5 ppm (0.35 mg/kg b.w./day) for females under the conditions of this study.     

A novel class of apical sodium--dependent bile salt transporter inhibitors: 1-(2,4-bifluorophenyl)-7-dialkylamino-1,8-naphthyridine-3-carboxamides

The apical sodium--dependent bile acid transporter (ASBT) is the main transporter to promote re-absorption of bile acids from the intestinal tract into the enterohepatic circulation. Inhibition of ASBT could increase the excretion of bile acids, thus increasing bile acid synthesis and consequently cholesterol consumption. Therefore, ASBT is an attractive target for developing new cholesterol-lowering drugs. In this report, a series of 1-(2,4-bifluorophenyl)-7-dialkylamino-1,8-naphthyridine-3-carboxamides were designed as inhibitors of ASBT. Most of them demonstrated potency against ASBT transport of bile acids. In particular, compound 4a₁ was found to have the best activity, resulting in 80.1% inhibition of ASBT at 10 μmol/L.     

胆管空肠Roux-en-y吻合术后逆行性胆管感染的相关临床因素分析

目的：探讨胆管空肠Roux-en-y吻合术后逆行性胆管感染的相关临床因素。方法选择本院收治并实施胆管空肠Roux-en-y吻合术患者134例，分析糖尿病病史（有或无）、吻合口直径（≤2 cm或＞2 cm）、吻合方式（侧侧吻合、端侧吻合）、术前黄疸持续时间（≤7 d或＞7 d）、术前胆红素水平（≤171μmol/L或＞171μmol/L）、术中抗菌药物（有或无）对术后逆行性胆管感染的影响。结果合并糖尿病患者发生逆行性胆管感染发生率高于无糖尿病患者，差异有统计学意义（P＜0.05）；吻合口直径≤2 cm患者发生逆行性胆管感染发生率高于吻合口直径＞2 cm患者，差异有统计学意义（P＜0.05）；侧侧吻合患者的逆行性胆管感染发生率高于端侧吻合患者，差异有统计学意义（P＜0.05）。结论胆管空肠Roux-en-y吻合术后逆行性胆管感染与患者是否合并糖尿病、吻合口大小及吻合方式有关，值得临床借鉴。     

Bile acid indices as biomarkers for liver diseases I: Diagnostic markers

BACKGROUNDHepatobiliary diseases result in the accumulation of toxic bile acids (BA) in the liver, blood, and other tissues which may contribute to an unfavorable prognosis.AIMTo discover and validate diagnostic biomarkers of cholestatic liver diseases based on the urinary BA profile.METHODSWe analyzed urine samples by liquid chromatography-tandem mass spectrometry and compared the urinary BA profile between 300 patients with hepatobiliary diseases vs 103 healthy controls by statistical analysis. The BA profile was characterized using BA indices, which quantifies the composition, metabolism, hydrophilicity, and toxicity of the BA profile. BA indices have much lower inter- and intra-individual variability compared to absolute concentrations of BA. In addition, BA indices demonstrate high area under the receiver operating characteristic curves, and changes of BA indices are associated with the risk of having a liver disease, which demonstrates their use as diagnostic biomarkers for cholestatic liver diseases.RESULTSTotal and individual BA concentrations were higher in all patients. The percentage of secondary BA (lithocholic acid and deoxycholic acid) was significantly lower, while the percentage of primary BA (chenodeoxycholic acid, cholic acid, and hyocholic acid) was markedly higher in patients compared to controls. In addition, the percentage of taurine-amidation was higher in patients than controls. The increase in the non-12α-OH BA was more profound than 12α-OH BA (cholic acid and deoxycholic acid) causing a decrease in the 12α-OH/ non-12α-OH ratio in patients. This trend was stronger in patients with more advanced liver diseases as reflected by the model for end-stage liver disease score and the presence of hepatic decompensation. The percentage of sulfation was also higher in patients with more severe forms of liver diseases.CONCLUSIONBA indices have much lower inter- and intra-individual variability compared to absolute BA concentrations and changes of BA indices are associated with the risk of developing liver diseases.     

胃大部切除术后合并胆汁瘘7例教训分析

目的通过回顾性分析胃大部切除术后并发胆汁瘘的患者资料，总结临床经验。方法本院7例行毕罗I式胃大部分切除术的患者术后第1—5天并发胆汁瘘，根据患者临床体征及腹部超声检查诊断为胆汁瘘，行胆囊切除胆肠Roux—en—Y吻合术。结果所有患者平均住院（19．2±3．7）d后痊愈出院，无一例患者死亡。结论胃大部切除术操作较为复杂，因此掌握手术适应证、优化手术技术、术后定期胃镜检查，早期发现并治疗并发症可避免发生严重不良后果。