目的 总结超声引导下经皮经肝穿刺胆管引流术(PTCD)的优、缺点,为临床治疗重症急性胆管炎（SAC）提供参考。方法 回顾性分析我院1994年8月至2008年7月期间对156例老年SAC患者行在超声引导下的PTCD治疗的临床资料。结果 156例行PTCD均获成功,1次穿刺成功140例，其成功率达89.7%（140/156）; 16例首次穿刺失败后再次穿刺均成功。无一例发生腹腔出血、胆汁性腹膜炎等并发症。本组引流效果较好,中毒危象缓解，黄疸减退，肝功能改善。结论 PTCD较外科手术创伤小、操作简单、快速,具有微创的特点,对老年、有严重合并症及复杂疾病不能耐受手术及麻醉的SAC患者，其作为紧急抢救措施切实可行,并为后期施行根治性手术争取了时间。
To study the lipid peroxidation injury and the protecting effect of vitamin E emulsion on liver function following acute cholangitis. During the operation and 24 hours after operation, vitamin E emulsion or placebo emulsion was infused via mesenteric vein in rats suffering acute cholangitis. The contents of malondialdehyde (MDA), superoxide dismutase (SOD) and adenosine triphosphate (ATP) in the liver tissue and serum were measured at 48hrs after operation. Results: As compared with the placebo emulsion group, MDA and mGOT contents in the liver tissue and serum decreased significantly, but SOD activity increased dramatically in the VE emulsion group. ATP content in the infected lobe was much higher than those in the placebo emulsion group. Conclusion: Intravenous infusion of large dose of vitamin E emulsion may reduce the lipid peroxidation reaction in acute cholangitis, and have protecting effect.
【摘要】目的 探讨急性重症胆管炎(ASC)患者的手术时机、治疗方式的选择以及患者围手术期的治疗。方法 回顾性分析156例ASC患者的临床资料。结果 治愈131例，死亡25例，总死亡率为16.0%。入院后行急诊手术者32例，术后死亡9例，死亡率28.1%； 入院后经支持治疗、纠正休克和酸碱失衡及抗感染治疗后再行手术者53例，死亡9例，死亡率为17.0%。行ERCP+乳头括约肌切开术治疗17例,行PTCD 治疗12例,行保守治疗42例。结论 对ASC患者掌握好手术时机，根据病情选择治疗方式，重视围手术期支持治疗以及适时手术治疗，是降低死亡率，提高疗效的重要措施。
ObjectiveTo investigate activation of phosphatidylinositol 3 hydroxykinase (PI3K)/AKT pathway and sphingosine 1-phosphate receptor 2 (S1PR2) in peripheral blood mononuclear cells (PBMCs) of acute obstructive cholangitis (AOC) rats and their effects on systemic inflammation in rats.Methods① In vitro experiment: The isolated PBMCs from the rats were divided into 4 groups: a control group, LY294002 treatment group, lipopolysaccharide (LPS) treatment group, and LPS+LY294002 treatment group. The levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the supernatant were detected and the phosphorylation levels of PI3K and AKT and protein level of S1PR2 in the PBMCs were detected. ② In vivo experiment: The rats were randomly divided into four groups: a control group, LY294002 treatment group, AOC model group, and AOC+LY294002 treatment group. The survival rate of rats was recorded, the liver function (ALT, AST, and TBIL), TNF-α, and IL-6 levels in the serum were detected. The phosphorylation levels of PI3K and AKT and protein level of S1PR2 in the PBMCs of the rats were detected. Results① The results of in vitro experiment: The levels of TNF-α and IL-6 in the LPS+LY294002 treatment group were significantly lower than those in the LPS treatment group (P<0.050). The phosphorylation levels of PI3K and AKT and protein level of S1PR2 in the LPS+LY294002 treatment group were significantly lower than those in the LPS treatment group (P<0.050). ② The results of in vivo experiment: The survival rate of rats in the AOC+LY294002 treatment group was higher than those in the AOC group. The serum levels of ALT, AST, TBIL, TNF-α, and IL-6 in the AOC+LY294002 treatment group were significantly lower than those in the AOC model group (P<0.050). The phosphorylation levels of PI3K and AKT and protein level of S1PR2 in the AOC+LY294002 treatment group were significantly lower than those in the AOC model group (P<0.050).ConclusionInhibition of activation of PI3K/AKT pathway in PBMCs can inhibit expression of S1PR2, then alleviate systemic inflammatory response induced by AOC in rats.
Objective To investigate the alternatives of different endoscopic drainages for acute cholangitis of severe type (ACST) in elderly patients with chronic respiratory disease. Methods The clinical data of 74 cases of ACST in elderly patients with chronic respiratory disease undergoing 3 kinds of drainages, endoscopic retrograde double biliary stent drainage (D-ERBD), endoscopic retrograde single biliary stent drainage (S-ERBD), or endoscopic nasobiliary drainage (ENBD) in the First Hospital of Lanzhou University from October 2005 to October 2015 were collected to analyze prospectively. Results Compared with preoperative, the white blood cell (WBC), direct bilirubin (DBIL), temperature, and abdominal pain NRS evaluation in 48 h after operation in 3 groups all decreased, the difference was statistically significant (P＜0.05). Compared among 3 groups, there were no significant difference among the incidences of postoperative hyperamylasemia, pancreatitis and gastrointestinal hemorrhage (P＞0.05). The group of ENBD was more likely to develop pulmonary infection and achieve a secondary treatment than other 2 groups (P＜0.05). Totally 5 patients died in 3 groups, with a mortality of 6.76%, but the mortality rates were similar among the 3 groups (P＞0.05). The deaths were predominantly caused by multiple organ failure (MOF), 4 cases of which were caused by respiratory failure related to respiratory infection. Conclusion The alternative of endoscopic retrograde double biliary stent drainage (D-ERBD) can not only alleviate cholangitis rapidly, but it can reduce the incidence of aspiration pneumonia.
Objective To investigate the phenotypic change and proliferation of fibroblasts in human inflammatory strictured bile duct wall. Methods We observed the density and ultrastructure of fibroblasts, and the histologic structure in human normal bile duct wall and inflammatory strictured bile duct wall by light and electron microscope.Results The results showed that fibroblasts were the main source of extracellular matrix production in bile duct wall. The phenotype of fibroblasts in inflammatory strictured bile duct wall changed obviously, quiescent fibroblasts were activated and transformed to myofibroblasts, with massive proliferation. Conclusion These data suggest that massive proliferation of activated fibroblasts and myofibroblasts is the main source of extracellular matrix overproduction which results in inflammatory bile duct stricture.
Objective To evaluate the relationship between endothelin (ET) in bile and peripheral blood with systemic and hepatobiliary injury in patients with acute cholangitis of severe type (ACST). Methods ET, ALT and total bilirubin in bile and peripheral veinous blood of 25 patients with acute cholangitis of severe type (ACST) were detected during operation, one week and two weeks after operation. Results The contents of ET, ALT and total bilirubin were significantly lower on 7-day and 14-day after operations as compared with that during operations (Ｐ＜0.05 and Ｐ＜0.01). The concentration of ET in peripheral veinous blood paralleled with that in bile. Conclusion This suggests that ET is tightly related with the pathologic process of ACST. So, in patients with ACST, the dynamic measurement of ET in peripheral veinous blood can be an index for judging the degree of pathological damage either to the hepatobiliary or systemic systems.
Objective To investigate the recurrence of hepatolithiasis and reoperation and their relation to the location of intrahepatic stone. MethodsTwo hundred and twentysix patients of hepatolithiasis operated upon in the period of 1990-1995 were retrospectively analysed.ResultsAmong those patients, there were 101 patients (44.7%) had previous operation for the gallstones diseases including cholecystectomy for gallbladder stones (n=21, 20.8%), choledocholithotomy (n=72, 71.3%),liver segmentectomy (n=6， 5.9%), and choledochojejunostomy (n=2, 2.0%). The operative mortality was 5.0% for the reoperation group and none for the first time operation for hepatolithiasis.Conclusion Although the liver resection is an ideal surgical method to eradicate the diseased lesion and to minimize the malignant changes especially in primary hepatolithiasis (type I, or IE)， choledochojejunostomy is only recommended for the secondary type (type IE or IE) where possible. In the management of hepatolithiasis, the complete information of biliary tract is needed for the choice of surgical methods.