急性胰腺炎中放射性核素的胆道扫描

Glazer等的最近报道认为放射性核素的胆道扫描是目前最可信的、予测急性胰腺炎发作时存在胆石的方法。但Neoptolemos等报道在胆汁性胰腺炎患者中,此法的敏感性仅60%。为此促使作者报道在急性胰腺炎中HIDA扫描研究的初步结果。对因急性胰腺炎(血清淀粉酶>900IU/L)而在3天内住院的7例患者作了~(99m)Tc-HIDA扫描。扫描可     

淀粉酶,胰脂肪酶与肾功能衰竭

50多年来血清淀粉酶测定一直作为诊断急性胰腺炎的重要依据。经多年临床实践证明,其临床特异性较差 ,除急性胰腺炎外,很多疾病都可引起血清淀粉酶的水平升高。如:腮腺炎,穿孔性溃疡,肠梗阻,急性胆囊炎,巨淀粉酶血症,异位妊娠,糖尿病酸中毒,肾功能不全,急性阑尾炎,支气管肿瘤,卵巢恶性肿瘤,腹膜炎,腹部外伤及吗啡类药物等。同工酶技术的应用提高了其临床特异性和敏感性。胰脂肪酶的特异性和敏感性较淀粉酶好,但非胰腺疾病也可使其水平升高。 已知肾功能衰竭是高淀粉酶血症和高脂肪酶血症的原因之一。一些临床医学家研究了淀粉酶和胰脂肪酶的肾脏排泄及代谢机制。一些学者观测了肾功能衰竭病人血清淀粉酶和脂肪酶水平及淀粉酶的     

胆管囊肿全切除术患儿的护理体会

先天性胆管囊肿是小儿胆道疾病中最常见的病变,其胆道结石、复发性胆管炎、胆汁性肝硬变、囊肿癌变等并发证率高,长期保守治疗常因这些并发证导致死亡〔1〕。对胆管囊肿的治疗目前多采用囊肿内引流或囊肿十二指肠(空肠)吻合术,但其远期疗效较差〔2〕。我科于1998年1月～2 0 0 2     

急性坏死性胰腺炎的CT诊断价值(附38例报告)

急性坏死性胰腺炎是临床常见的急腹症 ,病情凶险 ,患者缺乏特异性症状和体征。CT早期诊断对治疗方案的确立以及预后估计有重要意义。本文收集我院自 1995～ 2 0 0 0年经B超 ,血清淀粉酶以及临床病理证实 ,资料完整的坏死性胰腺炎进行CT征象回顾性分析 ,探讨CT检查在急性坏死性胰腺炎的诊断价值。1　材料与方法3 8例 ,男 2 5例 ,女 13例 ,年龄 2 2～ 5 8岁 ,平均 47岁。临床症状剧烈腹痛、恶心呕吐。查体 :腹肌紧张、全腹压痛、反跳痛 ,肠鸣消失。 2 1例行诊断性腹穿为洗肉水样液体。实验室检查 :血清淀粉酶显著增高 ,16例在 10 0 0～ 15 …     

急性胰腺炎病理类型与CT分级及血和尿淀粉酶变化对照研究

目的：探讨CT与血尿淀粉酶改变对诊断急性胰腺炎病程变化的价值。方法：回顾性分析114例急性胰腺炎患者CT检查及血、尿淀粉酶等资料并进行对比研究。结果：急性水肿型胰腺炎，CT分级为A和B级时，血、尿淀粉酶轻度到显著升高，C级到E级时，胰腺坏死面积越大，血、尿淀粉酶越低。结论：胰腺组织有效面积的大小决定血、尿淀粉酶高或低的变化。     

来稿摘登

前列腺素E_1治疗急性胰腺炎10例报告本文报告用前列腺素E_1治疗急性胰腺炎10例,临床效果非常显著。本组病例中男7例、女3例;年龄19—60岁。其中并发胆囊结石、胆囊炎和胆道蛔虫病者各1例。病人均有不同程度的右上腹部疼痛,恶心呕吐等症;血、尿淀粉酶增高,     

ERCP在胆胰疾病中的应用现状

经内镜逆行胰胆管造影(ERCP),是在内镜下经十二指肠乳头插管注入造影剂,从而逆行显示胰胆管的造影技术,是目前公认的诊断胰胆管疾病的金标准。在ERCP的基础上,可以进行十二指肠乳头括约肌切开术(EST)、内镜下鼻胆汁引流术(ENBD)、内镜下胆汁内引流术(ERBD)等介入治疗。本文对ERCP在胆管结石、胆管癌、胆道蛔虫病、急性胆源性胰腺炎、慢性胰腺炎的诊断与治疗应用的现状进行了综述。     

急性胰腺炎诊断指标Logistic回归分析

目的探讨包括血脂肪酶（serum lipase，LPS）、血淀粉酶（serum amylase，SAMY）、尿淀粉酶（urine amylase，UA—MY）、性别、年龄、胆道疾病、酗酒等相关因素与急性胰腺炎（acute pancreatitis，AP）的关系，建立相应的Logistic多元回归模型，为今后的急诊室AP的早期诊断提供科学依据。方法对304例本院门诊或住院患者的LPS、SAMY、UAMY进行测定，并询问其胆道疾病史与发病前的饮食状况，利用SAS8．0统计软件对所得数据进行整理统计，建立Logistic方程。结果对AP的影响因素进行Logistic回归分析，发现除年龄、性别因素外，其余5项均进入回归模型（P〈0．05）。结论AP与患者LPS、SAMY、UAMY、胆道疾病、酗酒等因素呈正相关，但各因素对AP诊断的诊断价值不同。     

PTGCD治疗急性重症胆源性胰腺炎的观察和护理

近年来,急性重症胰腺炎（severe acute pancreatitis,SAP）发病率逐渐增高,约占急性胰腺炎的20%,是常见的消化系统急腹症之一。其临床表现多样性,病情复杂,有并发症者可高达50%,病死率达30%～50%。在我国,最常见的就是胆道结石、胆道感染等引起的胆管下端明显梗阻,胆道内压力升高,高压的胆汁逆流胰管,造成胰腺腺泡破裂,胰酶进入胰腺间质而发生急性重症胆源性胰腺炎。     

急性胰腺炎的影像表现与淀粉酶改变的对比分析

目的：探讨急性胰腺是的CT、B超表现与血清、尿淀粉酶变化的相关性以指导临床治疗。方法：回顾性分析已确诊的急性胰腺炎63例．将其CT改变分为5个级别．分别与B超表现及相应的血清、尿淀粉酶数值对比。结果：CT改变为A级时血尿淀粉酶轻中度升高．B级时中度升高．C级时显著升高．D级时趋向下降．E级时显著下降。结论：CT检查可以准确地反映急性胰腺炎A、B、C、D、E级的病理变化；CT诊断优于B超、B超对胆源性胰腺炎的诊断有明确帮助，明显优于淀粉酶值的改变。对于早期仅限于间质水肿的炎症．CT、B超诊断困难．主要依靠临床症状、体征，血、尿淀粉酶的变化来做出诊断。     

Routine liver function tests and serum amylase determinations after biliary lithotripsy: are they necessary?

Shock-wave-induced soft-tissue damage after biliary extracorporeal shock-wave lithotripsy (BESWL) has been reported. Every patient treated in Vancouver has, therefore, had liver function tests and serum amylase levels measured before and within 6 days after BESWL. All patients had symptomatic cholecystolithiasis with normal pre-BESWL biochemistry. Analysis of 311 patients after treatment with the Siemens Lithostar unit showed elevation of one or more laboratory value in 19% (60/311). Serum aspartate transaminase level was most frequently abnormal (38 cases). The majority of abnormalities were mild, less than two times normal levels. Clinically significant complications occurred in five patients (three pancreatitis, one cholecystitis, one common bile duct obstruction); four of these occurred 1 week or more after treatment. The results of routine laboratory tests could not be used to predict complications. No correlation was seen between abnormal values and number of shock waves administered or peak shock-wave pressure. Of 112 patients surveyed at the time of post-BESWL enzyme measurement, 49 (44%) reported a degree of pain, which was severe in eight cases. Presence of severe pain correlated strongly (p less than .001) with abnormal laboratory findings, however not with the degree of abnormality. As results of these laboratory tests are nonspecific, have not been shown to correlate with the degree of severity of BESWL-induced tissue damage, and do not predict complications, the tests are of little value in the absence of clinical signs and symptoms. These conclusions, however, apply only to the Siemens Lithostar Plus with patients treated in the steep left posterior oblique position. Cost savings can be expected if routine post-BESWL biochemical tests are abandoned.     

Silicone biliary stents for percutaneous management of biliary obstruction

Silicone tubes in 2-F increments from 12 to 20 F were developed for long term external-internal drainage of benign and malignant biliary obstructions. Passed coaxially over Teflon catheters and a guidewire, the silicone stents were softer and had larger sideholes than conventional drainage tubes. Once the acute track had matured (two weeks or longer), a silicone stent, 2 F larger than the preceding one, could be placed at each succeeding tube change. We have placed these tubes in 50 patients, 24 of whom had initially placed percutaneous catheters and 26 of whom had surgically placed stents. These tubes remain patent at least as long as conventional catheters and all patients have reported increased comfort using these catheters compared with standard ones.     

经皮胆道引流术治疗恶性梗阻性黄疸

目的　回顾性分析恶性梗阻性黄疸的介入性经皮胆道引流治疗方法及其疗效。方法　对4 7例患者采用经皮肝穿刺胆道引流术治疗恶性梗阻性黄疸。先行PTC后探查通过阻塞段 ,如不能越过阻塞段 ,则直接进行外引流 ;如能越过阻塞段 ,则置入内外引流管作内外引流或置入金属支架或塑料内涵管作内引流。结果　内引流组 18例 ,15例置入金属支架 ,共 18枚 ,3例置入塑料内涵管 ,共 4根 ;内外引流组 15例 ,置入 18根内外引流管 ;外引流组 14例 ,置入 17根外引流管。术后 1周总胆红素从术前的 (5 14 .1± 2 0 4 .3) μmol/L降至 (2 38.4± 14 2 .8) μmol/L(P <0 .0 0 1) ,碱性磷酸酶与丙氨酸转氨酶均下降明显 (P均 <0 .0 0 1)。 4例于术后 1个月内死亡。跟踪随访 37例 ,平均随访 5 .3个月 ,8例仍存活。随访期内 18例 (48.6 % )总胆红素降至正常范围。结论　经皮肝穿刺胆道引流术是对恶性梗阻性黄疸的一种安全、有效的姑息性治疗方法 ,可明显缓解黄疸、减轻痛苦、提高生存质量 ,并可改善肝脏功能 ,有限地延长生存时间。     

Malignant biliary obstruction: complications of percutaneous biliary drainage

The medical records of 161 patients who underwent percutaneous biliary drainage (PBD) for malignant biliary obstruction were reviewed with attention to the complications resulting from this mode of drainage. Observed was a higher incidence of complications--particularly of cholangitis--than that generally reported in the literature. Although PBD is an effective method of biliary drainage, it carries a high risk of cholangitis in patients with cancer, who frequently receive myelosuppressive agents that predispose them to infections.     

Percutaneous management of biliary leaks: biliary embosclerosis and ablation

Biliary leaks after hepatobiliary surgery are not uncommon. In certain situations minimal invasive percutaneous techniques may result in avoidance or reduction of the extent of surgery. Minimal invasive percutaneous techniques include (1) percutaneous bile collection (biloma) drainage, (2) percutaneous transhepatic biliary drainage, (3) biliary leak site embolization/sclerosis, and (4) leaking biliary segment ablation. There are two clinical applications for biliary ablation. The first is actual bile leak site ablation or embosclerosis to reduce an aperture or ablate a fistula (block a hole). The second is ablating an entire biliary segment to cease bile production and induce hepatic segmental atrophy (cease bile production). This article discusses the techniques used for biliary leak site embosclerosis/ablation (including biliary-cutaneous tract ablation) and biliary segmental ablation.     

经皮肝穿刺胆道引流术及胆管内支架植入术在恶性梗阻性黄疸治疗中的应用

目的 评价经皮肝穿刺胆道引流(FTBD)及胆管内支架植入术(PTIBS)治疗恶性梗阻性黄疸的疗效.方法 对56例恶性梗阻性黄疸患者采取PTBD或PTIBS,所有患者均经B超、CT或MRI明确诊断,并确定梗阻部位,其中高位梗阻19例,低位梗阻37例.梗阻原因包括肝癌14例,胆管癌11例,胆囊癌5例,胃癌伴淋巴结转移14例,壶腹部占位1例,胰头癌11例.术中根据造影结果选择合适方案.结果 所有56例均成功完成手术.其中行PTBD 11例,PTIBS 40例,PTBD并PTIBS 5例.TBIL由术前(295.65 ±152.86)μmol/L降至术后(151.05 ± 107.36)μmol/L(P<0.01).术后感染对黄疸消退有影响(P<0.01).梗阻部位与黄疸消退情况比较差异无统计学意义(P=0.063).结论 经皮肝穿刺胆道引流及支架植入术治疗恶性梗阻性黄疸安全有效,可明显减轻黄疸,改善患者生活质量,延长生存期.     

Acute cholecystitis, biliary obstruction, and biliary leakage

The use of cholescintigraphy to diagnose acute cholecystitis, biliary obstruction, and biliary leakage dates back to the late 1970s. Today, despite the many advances in imaging instrumentation, radiopharmaceuticals, and methodology over these years, cholescintigraphy still plays an important role in confirming or excluding these diagnoses in acutely ill patients. Acute calculous and acalculous cholecystitis, gallbladder perforation, biliary obstruction, and biliary leakage often present as acute abdominal pain, and must be differentiated from other surgical and nonsurgical etiologies with similar symptoms and presentation. Understanding the pathophysiology of acute hepatobiliary diseases is vital for deciding on the most advantageous imaging work-up and for interpretation of the studies. To optimize the value of cholescintigraphy, up-to-date methology, proper use of appropriate pharmacologic interventions, and recognition of characteristic image findings are critical.     

Strategy for the use of biliary scintigraphy in non-iatrogenic biliary trauma

Biliary scintigraphy was used to examine 21 patients who had suspected non-iatrogenic biliary trauma. Seven patients (33%) had scintigraphic evidence of biliary leakage. Ultimately, surgical biliary repair was required for only three of these patients. Visualization of the gallbladder did not occur in eight trauma patients, but only one patient was shown to have cholecystitis. In this series, 16 patients had Tc-99m sulfur colloid scans that offered no significant advantage over cholescintigraphy in the detection of hepatic parenchymal defects. Biliary scintigraphy provides clinically useful information in cases both of blunt and penetrating trauma.