磁共振胰胆管成像诊断胆系梗阻性疾病的临床评价

目的　探讨磁共振胰胆管成像 (MRCP)对胆道梗阻性疾病的临床诊断价值。方法　对 42例胆道梗阻患者进行MRCP检查 ,并经手术病理或 /和其它影像学和临床资料证实。结果　①本组MRCP定位诊断率为 10 0 % ,定性准确率为 83 % ;②扩张的胆道表现为枯枝状 2 3例、软藤状 15例、腊肠样 4例 ;③梗阻端呈倒杯口状 6例、截断状 5例、杵状 17例、鸟嘴状 9例、鼠尾状 5例。结论　MRCP对胆道梗阻性疾病定位诊断准确 ,结合MRI及源像对胆道梗阻性疾病的定性诊断也具有较高的特异性 ,是一种安全快捷、非创伤性的检查方法 ,能为胆道梗阻的诊治及术后评估提供可靠的依据。     

急性左半结肠癌梗阻一期切除吻合治疗39例

目的：探讨左半结肠癌致急性肠梗阻的手术处理方法。方法：回顾分析1995－2001年间39例左半结肠癌致肠梗阻一期切除吻合术的外科临床效果。结果：全组39例病人均采用梗阻近端肠管减压灌洗，并留置盲肠造瘘管术后接负压吸引，术后均一期愈合，未出现吻合口漏。随访2例中，1例存活率58％，3年存活率16％，5年存活率8％。结论：严格掌握手术适应症和基本操作，在病情允许时，对左半结肠癌急性肠梗阻行一期切除吻合手术是可行的。     

反相高效液相色谱法测定牛黄类中成药中胆汁酸的含量

反相高效液相色谱法测定牛黄类中成药中胆汁酸的含量倪坤仪，王建，陈健，郁建，屠树滋（中国药科大学２１０００９）含牛黄的中成药种类很多，在医疗中具有广泛的用途。中药牛黄中主要成分为胆汁酸和胆红素。本文主要研究用ＨＰＬＣ法测定牛黄以及含牛黄中成药中胆汁酸的...     

低场强MRCP结合轴面T2WI对胆系结石的诊断价值

目的探讨低场强MRCP结合轴面T2WI对胆系结石的诊断价值。方法回顾性分析38例胆系结石患者的低强场(0.2T)MRCP,MRCP结合T2WI及US所见并进行对比分析。结果MRCP,MRCP结合T2WI及US对胆系结石的检出率分别为75.0%,95.9%,79.5%,MRCP结合T2WI对胆系结石的检出率明显高于单一MRCP(χ2=7.31,P<0.01)和US(χ2=5.09,P<0.05)。结论在低场强MR扫描环境下,MRCP结合轴面T2WI可以提高胆系结石的检出率。     

失去肝动脉血液供应后大鼠肝门部胆管周围血管丛变化的三维构像研究

目的 探讨完全失去肝动脉血液供应后，大鼠肝门部胆管周围血管丛（PBP）的形态学变化。方法 将SD大鼠随机分为两组，对照组仅游离胆总管、门静脉、腔静脉和肝总动脉，不做切断；实验组结扎肝动脉，并切断肝十二指肠韧带除门静脉以外的其它组织，阻断其它侧支血管对肝门部胆管的血液供应。术后应用计算机对大鼠肝门部组织切片进行PBP三维可视化构建，并对PBP内层微血管进行定量分析，对胆管壁组织进行病理学检查。结果 实验组肝门部胆管分叉部位PBP平面结构显示胆管扩张，胆管壁明显增厚，壁内微血管尖细，排列紊乱，内层微血管密度减低；PBP立体构像显示空间结构紊乱，不规则，微血管细小，管壁不均匀增厚。与对照组相比，实验组肝门部PBP内层微血管总数明显减少（P〈0．01），肝门部PBP内层微动脉数也明显减少（P〈0．05）。实验组肝门部胆管壁呈慢性增生性炎症改变。结论 失去含氧量高的动脉血液供应时，PBP形态结构将会发生一系列改变，胆管壁组织也将发生相应的病理变化。     

胆道外引流感染的预防

目的 总结胆道外引流感染的预防，以利提高胆道外引流的护理质量。方法 通过经治的临床病例总结各胆道外引流的观察和处理要点。结果 通过向患者说明胆道外引流的重要性，帮助患者适应和解决各种生活问题，消除心理负担，观察引流伤口、胆汁引流情况，保持引流管的位置并保持通畅，使良性患者早日康复，晚期恶性肿瘤患者的生活质量得以提高。结论 胆道外引流是胆道良性或恶性疾病引发梗阻治疗的一个措施，有时是唯一的姑息性手段，做好引流术后的观察及护理，对改善患者的全身情况，恢复身体健康，提高生活质量非常重要。     

Cast syndrome

The term cast syndrome is used to denote duodenal obstruction occurring after application of a corrective plaster cast to patients with scoliosis. We report a classical case in a 14-year-old female who required surgical intervention after conservative treatment failed. Six months later the patient had no further gastrointestinal symptoms. Clinical, radiological, and pathological details as well as the surgical treatment are described and discussed. Offprint requests to: M. E. Martín Hortigüela     

动脉自旋标记法磁共振成像在颈动脉狭窄性脑缺血疾病中的初步应用

目的:对比研究颈动脉严重狭窄患者动脉自旋标记法(ASL)和动态磁化率效应对比剂增强(DSC)磁共振脑灌注成像表现,探讨ASL的临床运用价值。材料和方法:健康自愿者12例,行DSC和ASL,计算左侧大脑中动脉供血区与右侧相应区域相对脑血流量(rCBF)比值并进行比较。病例组为单侧颈内动脉狭窄程度≥70％患者32例,计算DSC和ASL所得的患侧与健侧大脑中动脉供血区rCBF比值并进行比较。结果:12例健康自愿者所测的DSC和ASL的rCBF比值分别为1．0012±0．1030和1．0015±0．1611,无统计学差异。32例患者中,15例患者灌注异常,DSC与ASL的rCBF比值相比无显著性差异(P=0．072)。结论:ASL序列能快速无创的提供脑灌注情况,可作为初步了解颈动脉狭窄性脑缺血疾病脑灌注情况的常规检查方法。     

The influence of liver dysfunction on cyclosporine pharmacokinetics —A comparison between 70 per cent hepatectomy and complete bile duct ligation in dogs—

The influence of experimentally induced hepatic dysfunction on the pharmacokinetics of Cyclosporine A (CsA) was determined in dogs. The pharmacokinetics of oral (PO) and intravenous (IV) CsA were studied before and after 70 per cent hepatectomy or complete bile duct ligation (CBDL). Changes in liver function were monitored by serial measurements of serum bilirubin, and by the maximum removal rate (Rmax) and plasma disappearance rate (ICG-K) of indocyanine green (ICG). Concentrations of CsA in whole blood were measured by HPLC. Seventy per cent hepatectomy caused significant liver dysfunction: the ICG-Rmax decreased by 47.7±7.1 per cent (mean±SD) and the ICG-K decreased by 61.3±9.7 per cent during the first week after hepatectomy. At the same time, the systemic clearance (CLs) of IV-CsA decreased by 43.9±8.2 per cent, the area under the concentration curve (AUC) of IV-CsA increased by 35.4±20.8 per cent and the bioavailability of CsA decreased by 26.4±14.8 per cent. CBDL also induced significant liver dysfunction: the ICG-Rmax decreased by 39.1±12.8 per cent and the ICG-K decreased by 65.6±3.6 per cent in the second week after the operation. During the same period, the AUC of PO-CsA decreased by 69.9±10.7 per cent and the bioavailability of CsA also decreased markedly by 73.9±15.6 per cent. These data indicate that hepatic impairment significantly influences the pharmacokinetics of CsA, not only by the changes in intestinal absorption, but also by those in hepatic, metabolism. Dose adjustment is therefore necessary in the presence of hepatic dysfunction in order to maintain an adequate blood concentration of CsA without causing side effects. This research was performed in the Department of Surgery, University of Pittsburgh Health Center, University of Pittsburgh, USA     

Effects of adrenergic and cholinergic antagonists on diameter of nasolacrimal drainage system

Background To determine the effect of an adrenergic and a cholinergic antagonist on the diameter of the lumen of the nasolacrimal drainage system. Methods The asymptomatic side of 38 patients (29 women, nine men) with unilateral stenosis/obstruction of the nasolacrimal drainage system was studied. The tear meniscus height (TMH) of the asymptomatic side was normal, and the lacrimal drainage system was patent as revealed by dacryocystography. The nasolacrimal drainage system of the asymptomatic side was infused with 100 μl of 0.01% bunazosin hydrochloride, a selective α-1 adrenergic antagonist, or 100 μl of 0.4% tropicamide, a muscarinic and cholinergic antagonist. Dacryocystography was performed to determine the diameter of the lumen of the nasolacrimal drainage system before and after the antagonists. Results Bunazosin reduced the diameter of the lumen significantly, and the changes were more marked in the nasolacrimal duct (NLD), especially the middle and the lower regions. The diameter of the lumen of the lacrimal sac was not changed significantly. In contrast, tropicamide did not cause any significant change in the diameter of the lumen of the nasolacrimal drainage system. Conclusions The alterations of the size of the lumen of the nasolacrimal drainage system, especially the NLD, by an adrenergic antagonist suggest that the lumen diameter is under continuous sympathetic tone, and the parasympathetic tone is weak. This study has not received any financial support.