【摘要】目的探讨外科手术治疗原发性肝癌致阻塞性黄疸的方法及疗效。方法自1991年1月至2001年12月期间我院对17例原发性肝癌致阻塞性黄疸的患者进行外科手术治疗，其中行肝叶切除及胆总管切开取癌栓者14例,行同种异体原位肝移植术3例。结果患者平均生存时间为8个月,最长24个月。结论外科治疗原发性肝癌致阻塞性黄疸明显改善了患者生活质量,延长了生存时间。
Objective To study the change of immunologic function of the patient with obstructive jaundice. Methods The level of the sIL-2R, TNF-α, IL-6 and IL-8 in 36 cases of obstructive jaundice before and after operation were measured. Results The level of the sIL-2R, TNF-α, IL-6 and IL-8 in 36 cases of obstructive jaundice before operation was higher than normal control group (Ｐ＜0.01). It decreased after the obstruction was removed, and it was close to normal control on 14th day after operation. Conclusion The result suggest that relief of jaundice could improve the immunologic function of the patient.
Objective To evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in obstructive jaundice. Methods Forty eight consecutive patients with obstructive jaundice were examined by MRCP, all results were testified during and /or after operation. Results Different causes of obstruction had their own characteristic manifestations. Level of obstruction was accurate in 100%, the accuracy in distinguishing obstructive causes was 93.8%. Conclusion MRCP is quite effective, safe and reliable in diagnosis of obstructive jaundice.
The morphologic changes of the liver,heart and kidney in relation to the serum choleic acids in obstructive jaundce of rats were investigated.One of the results showed that one to two weeks after the common bile duct was ligated and servered,the damages to the damages to the mitochondria were found in the organs,while the serum choleic acids markedly increased.The other result was that when the rats were fed with sodium cholate in the dosage that their peak blood concentrations were close to the average results concentration in obstrcutive jaundice,their mitochondrial damage were in the similar degree.These results suggest that choleic acids stasisi is one of the factors of multiple organ damage in obstructive jaundice.
ObjectiveTo investigate the change of renal endothelin (ET) excretion and its relation to renal dysfunctions in obstructive jaundice.MethodsSixty male Wistar rats were randomized into two groups, the common bile ducts were ligated to establish the model of obstructive jaundice in experimental group, and only sham operation was done in control group. Ten rats were taken from each group at 5, 10 and 15 days respectively after operation, renal functions were evaluated by paminohippuric acid clearance (CPAH), inulin clearance (CIN) and fractional sodium excretion (FENa+); furthermore, plasma endotoxin (EX) level was determined, and ET1 contents in renal arterial plasma, renal venous plasma and renal tissue were detected. ResultsOnly FENa+ was significantly increased at the 5th day in experimental group; since the 10th day, all the three renal functional parameters gradually decreased, and FENa+ was significantly lower than that in control group at 15th day (P＜0.01 vs control). ②The plasma EX sustained at significantly higher levels after operation in experimental group (P＜0.01 vs control). ③The renal arterial plasma ET1 was significantly decreased, while the contents in renal venous plasma and renal tissue were significantly increased after operation in experimental group (P＜0.01 vs control). ④There were positive correlation between plasma EX and renal ET1 content, negative correlation between renal ET1 content and CPAH/CIN, and positive correlation between renal ET1 content and FENa+ (P＜0.01).ConclusionThe increased excretion of renal ET stimulated by endotoxemia may play an important role in the renal dysfunctions in obstructive jaundice.
【Abstract】ObjectiveTo explore the effect of glutamine on immune function of rat with obstructive jaundice and its possible mechanism. MethodsFifty male Wistar rats were randomly divided into three groups: Control group (n=10)， obstructive jaundice group (n=20) and glutamine treatment group (n=20). The serum concentration of TNF-α, IL-10 was detected by using radioimmune method. Liver function was measured through automated biochemistry analyzer. The animal model of obstructive jaundice was established by ligating the rat’s common bile duct. Bacteria cultures were performed with the rat’s tissues of lung, spleen, liver and kidney respectively. ResultsCompared with control group, obstructive jaundice group showed statistically lower serum level of TNF-α, and statistically higher serum level of IL-10, TBIL, ALT and AST during the first and the second week after ligation of common bile duct. During the first and second week after administration of glutamine, the serum TNF-α of glutamine treatment group was statistically higher than that in control group and obstructive jaundice group. Meanwhile, glutamine treatment group showed statistically lower serum level of IL-10, TBIL, ALT and AST than obstructive jaundice group. There were statistically less bacteria translocations in glutamine treatment group than those in obstructive jaundice group. Conclusion Glutamine can increase the immune function by changing serum concentration of TNF-α, IL-10 and decrease the bacteria translocation.
Objective To explore the regulating mechanism of hepatic injury in obstructive jaundice (OJ). Methods①Rat hepatocytes were isolated by in situ collagenase perfusion and primary culture. Hepatocytes were pretreated with various concentrations of protein kinase C (PKC) agonist parsmeae (PMA) and inhibitor chelerythrine for 20 min. After pretreatment, 50 μmol/L glycochenodeoxycholate (GCDC) was added. Cells were next detected by FCM and TUNEL.②Experimental obstructive jaundice was induced by double ligation of the bile duct (BDL), BDL for 3, 7, 14, 21days.We detected apoptotic status in liver with TUNEL and PKC protein in liver with immunohistochemistry method. Results①PMA increased GCDCinduced apoptosis and chelerythrine decreased GCDCinduced apoptosis in a concentrationdependent manner. ②The apoptotic rate of liver was related to time of OJ. Apoptosis index (AI) was the highest in 14day bile duct ligation. The ber PKC expression, the more number of apoptotic cells in OJ.Conclusion PKC takes part in the regulation and the occurrence and progression of hepatic injury in OJ.
Objective To study the regulative effect of angelica sinensis on cellular immune function in perioperative patients with obstructive jaundice. Methods Fourteen patients with obstructive jaundice were injected with angelica before and after operation for 14 days. The activity of IL-2 and the expression of IL-2R in lymphocytes in peripheral blood were measured, respectively. Results The activity of IL-2 and the expression of IL-2R decreased significantly in patients with obstructive jaundice (P＜0.01). The activity of IL-2 and the expression of IL-2R in peripheral blood lymphocyte increased significantly before and after operations (after treatment using angelica) (P＜0.01), though there was a little decrease after operation but they were still higher than that befor using angelica.Conclusion It maybe useful to use angelica to improve the cellular immune function in patients with obstructive jaundice.
ObjectiveTo study the change and significance of the serum nitric oxide (NO) level in patient with obstructive jaundice complicated with renal dysfunction. MethodsThe level of NO, BUN, Cr in serum and the activity of NOS in 25 patients with obstructive jaundice and renal dysfunction and 26 healthy adults was studied.ResultsThe patients’ serum NO level and the activity of NOS were significantly lower than those in the control group(P＜0.01)，whereas the serum BUN and Cr levels were significantly higher than those in control group(P＜0.01). The linear correlation analysis showed that the serum NO had a negative correlation between serum BUN and Cr level (P＜0.01). ConclusionThe patients with obstructive jaundice and renal dysfunction may lead to the decrease of serum NO level. NO may have some protective effects to the renal function during obstructive jaundice.
Kupffer cell phagocytic function and plasma endotoxin level in 36 patients with obstructive jaundice were observed. The results indicated that kupffer cell phagocytic function was inhibited and the plasma endotoxemia level was markedly increased as compared with those in the control group Ｐ＜0.05 and Ｐ＜0.01 respectively. Kupffer cell phagocytic function were recoverd and plasma endotoxemia alleviated while the biliary obstruction was released by surgery.