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61.
小儿胆汁性腹膜炎27例诊断与治疗 总被引:1,自引:0,他引:1
目的 探讨小儿胆汁性腹膜炎的病因 ,提高小儿胆汁性腹膜炎的诊治水平。方法 对 2 7例小儿胆汁性腹膜炎的病因与诊治进行回顾分析。结果 2 7例中 17例手术中发现穿孔灶 ,行胆总管引流和腹腔引流 ,合并胆道扩张症作二期根治术 ;未明确穿孔灶 10例 ,作腹腔引流 ,合并胆道扩张症作一期根治术。无手术死亡及严重并发症 ,疗效满意。其中婴幼儿 6例 (2 2 .2 % ) ,儿童 2 1例 (77.8% )。病因多与胆总管囊肿 (6 2 .9% )、胆道结石与蛔虫 (7.4% )、经皮肝穿刺胆道造影 (PTC)损伤 (3 .7% )等有关 ,部分原因不明 (2 2 .2 % )。结论 小儿胆汁性腹膜炎容易误诊 ,掌握其临床特点、提高诊断意识及选择合适的手术方法 ,是提高早期诊断率和减少并发症的关键。 相似文献
62.
63.
目的:分析重型胆源性胰腺炎的死亡原因,方法:对我院自1988年4月至1998年12月间行早期手术的重型胆源性胰腺炎63例,术后死亡26例作回顾性分析,结果:术后3d内死亡12例,其余术后24d死亡,死亡主要原因为休克、ARDS等。结论早期手术仍有较高的病死亡率。 相似文献
64.
《Immunobiology》2023,228(4):152398
BackgroundPrimary biliary cholangitis (PBC) is an autoimmune disease of the liver characterized by destructive lymphocytic cholangitis and anti-mitochondrial antibodies (AMA). Anti-gp210 and anti-Sp100, are used for the diagnosis of PBC in AMA-negative PBC patients. Patients with PBC have a propensity to have an extrahepatic manifestation which is especially autoimmune.ObjectiveWe aimed to determine the frequency of serological markers of rheumatoid arthritis (RA) (CCP-Ab or RF) in PBC patients and to do the vice versa.MethodsOur PBC study included 70 patients with PBC and 80 healthy blood donors (HBD) and our RA study included 75 patients with RA and 75 HBD. Anti-cyclic citrullinated peptide antibodies (CCP-Ab) and rheumatoid factor (RF) were performed by indirect ELISA. AMA, anti-Sp100 and anti-gp210 were determined by indirect immunofluorescence.ResultsRA autoantibodies (CCP-Ab or RF) were more frequent in PBC patients than in HBD (65.7% vs. 8.7% p 〈1 0 −6). CCP-Ab were significantly more frequent in patients than in controls (15.7% vs. 2.5%; p = 0.004). Nine patients had both CCP-Ab and RF vs. none of controls (12.8% vs. 0%; p = 0.001). RF were detected in 45 patients with PBC and in 5 HBD (64.3% vs. 6.2%; p 〈1 0 −6). In PBC patients, RF were more frequent than CCP-Ab (64.3% vs. 15.7%; p 〈1 0 −6). RF-IgG were present in 18.5% of patients; RF-immunoglobulin (Ig) A in 34.3% and RF-IgM in 54.3%. These frequencies were significantly higher than those found in control group (1.2% for RF-IgG (p 〈1 0 −3); 0% for RF-IgA (p 〈1 0 −6); and 6.2% for RF-IgM (p 〈1 0 −6)). In our PBC patients, RF-IgA were more frequent than RF-IgG (34.3% vs. 18.5%; p = 0.03) and than CCP-Ab (34.3% vs. 15.7%; p = 0.01). Six patients had only RF-IgA versus none of the control group (8.6% vs. 0%; p = 0.01). AMA, anti-Sp100 and anti-gp 210 were absent in all RA patients.ConclusionsSerological markers of RA were more frequent in PBC patients than in HBD and the vice versa was not true. 相似文献
65.
Purpose. This study was designed to test the hypothesis that the enzymatically stable opioid peptide, [D-pen2,5] enkephalin (DPDPE), is excreted extensively into bile.
Methods. Following an i.v. bolus dose of DPDPE (10 mg/kg) to rats, concentrations of DPDPE in serum, bile, liver homogenate and urine were measured by a novel capillary zone electrophoresis method. Data were analyzed to recover the fundamental pharmacokinetic parameters (volumes of distribution; distribution and elimination rate constants governing DPDPE systemic and biliary disposition). Parallel in vitro experiments were performed to evaluate the partitioning of DPDPE between erythrocytes and plasma, as well as to assess the degree of binding of DPDPE to serum proteins.
Results. The majority of the administered dose (~80%) was recovered from bile as intact peptide. DPDPE disposition was best described by a two-compartment model with Michaelis-Menten elimination (Km: 37.5 ± 11 g/ml; Vmax: 1143 ± 368 g/min/kg) from the central compartment into bile, suggestive of an active hepatic transport system. DPDPE was associated with a distributional space of 486 ± 62 ml/kg. In vitro incubation of DPDPE with whole blood showed that ~65% of the peptide was associated with erythrocytes. The difference between concentrations of DPDPE in erythrocytes and plasma was statistically significant (29.2 ± 4.9 vs. 18.1 ± 3.1 g/ml, p < 0.05), but not between whole blood and plasma (21.3 ± 2.8 vs. 18.1 ± 3.1 g/ml, p > 0.05). Concentration-independent binding of DPDPE to serum proteins was evidenced between 10 and 100 (g/ml, with an unbound fraction of 0.517 ± 0.182.
Conclusions. DPDPE undergoes extensive biliary excretion after i.v administration in rats. The apparent nonlinearity in the biliary excretion of DPDPE revealed by the pharmacokinetic modeling strongly suggests the existence of an active transport system(s) in hepatocytes which may mediate the rapid disappearance of DPDPE from the systemic circulation. 相似文献
66.
Hiroyuki Yasui Kiyoshi Yamaoka Terumichi Nakagawa 《Journal of pharmacokinetics and pharmacodynamics》1995,23(2):183-203
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 (kdif), the permeability rate constant into the bile canaliculi (kbmc) and the transit time through the bile canaliculi to the outlet of bile duct (
), respectively. It was demonstrated that kdif of cefixime (0.023min1) was significantly smaller than that of cefpiramide (0.044 min1), while the differences in kbmc and
were not obvious between cefixime and cefpiramide. kbmc 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 (Fbile) and the mean transit time from the sinusoid through the hepatocytes to the outlet of bile duct (
). 相似文献
67.
自1987年迄今,用金石散(4-6胶囊/次,2-3次/天)治疗胆结石患者177例,3月为一疗程,共2-4疗程。治疗前后均经B超检查以判断疗效。结果显示:1.服药一月,90%病人的发热、腹胀、疼痛等临床症状消失。2、62例胆囊结石经服药平均8.18+7.14月后,3例结石完全消失(4.84%),37例结石减少变小,总有效率64.52%;而临床类型型相似的另外23例,用UDCA治疗作为对照组,总有效率 相似文献
68.
Inagaki M Yabuki H Hashimoto M Maguchi M Kino S Sawa M Ojima H Tokusashi Y Miyokawa N Kusano M Kasai S 《Surgery today》1999,29(12):1260-1263
We describe herein the case of a 51-year-old woman in whom metastatic tumor seeding of the percutaneous transhepatic biliary
drainage tract occurred following a pancreatoduodenectomy for carcinoma of the distal common bile, duct. An abdominal computed
tomography scan done 6 months after the initial operation detected a hepatic lesion located at the site of the previous percutaneous
transhepatic biliary drainage tract. Implantation of bile duct carcinoma in the drainage tract was diagnosed, and the recurrent
tumor was successfully resected by performing a subsegmentectomy of segment 3 and removal of the adjacent abdominal wall.
At present, 5 years and 4 months after the second resection, the patient is in good health without any signs of recurrence.
This case report demonstrates that an aggressive surgical approach should be performed for tumor seeding of a transhepatic
biliary catheter tract. 相似文献
69.
Definition and pathology of primary sclerosing cholangitis 总被引:4,自引:1,他引:3
Nakanuma Y Harada K Katayanagi K Tsuneyama K Sasaki M 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(4):333-342
Although primary sclerosing cholangitis (PSC) is not a common disease, it is important in the differential diagnosis of hepatobiliary
tract diseases in clinical practice. A diagnosis of PSC should be made only after the exclusion of similar diseases with well
known etiologies or pathogeneses. In this review, the pathology of classical PSC and its variants or related diseases is highlighted.
PSC is histologically characterized by progressive periductal fibrosis with luminal stenosis or obliteration, along with the
formation of a fibrous core, as well as dilatation (cholangiectasis). Its etiology is unknown. Bacterial ascending cholangitis
is superimposed on its long clinical course. Such a heterogeneous distribution of biliary lesions with biliary obliteration
and cholangiectasis is responsible for the radiological demonstration of biliary abnormalities, particularly the beaded appearance.
Sampling variability is common in needle or wedge biopsied specimens. As a result of biliary damage, the liver shows progressive
cholestatic change followed by biliary fibrosis and cirrhosis, and this hepatic progression is divisible into four stages.
There are several variants of PSC or related diseases, such as localized biliary sclerosis and stenosis, sclerosing cholangitis
associated with inflammatory pseudotumor, and PSC-autoimmune hepatitis overlapping syndrome. Cholelithiasis, including secondary
hepatolithiasis and, to a lesser degree, biliary carcinoma and dysplasia, are also known to develop at the perihilar bile
ducts as a late complication of PSC.
Received for publication on March 8, 1999; accepted on April 30, 1999 相似文献
70.
Kubota T Thomson A Clouston AD Nakazawa Y Steadman C Kerlin P Shimada H Balderson GA Lynch SV Strong RW 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(4):377-381
Whether primary sclerosing cholangitis (PSC) occurs after orthotopic liver transplantation is controversial, largely because
the pre-transplant diagnosis of PSC is based on nonspecific radiological and histological findings. We reviewed clinical,
radiological, and histological records of 53 patients who underwent liver transplantation for PSC between 1985 and 1998. Three
patients with patent hepatic arteries and no evidence of chronic rejection had radiological and histological findings that
may have been due to recurrent PSC. Bile duct stricturing in these patients proved permanent and progressive and affected
both the quality of life and graft survival. The first patient, who is 110 months after transplantation, has had repeated
episodes of cholangitis for the last year. The second patient underwent excision of a strictured hepatic duct 45 months after
transplantation and was ultimately retransplanted 95 months after initial transplantation. The third patient underwent left
hemihepatectomy of an atrophied lobe 50 months after transplantation. Although the patient population assessed in this study
is limited, putative recurrent PSC in the allografts has led either to graft loss or to clinically significant hepatobiliary
complications of the graft.
Received for publication on March 8, 1999; accepted on April 30, 1999 相似文献