胆石症患者血清,胆汁,胆石相关元素分析和胆石成因的研究

利用火焰原子吸收法，对２７例胆石症患者血清、胆汁和胆石的相关元素进行测定，结果表明，胆石症患者血清钙明显高于正常人，而血清铜则明显低于正常人（Ｐ＜０．０１）；胆汁中钙、铜、钠、镁等元素明显低于对照组（Ｐ＜０．０１）；胆色素结石组钙、钠、镁等元素亦明显高于胆固醇结石组，说明血清钙、铜代谢异常及胆汁中钙、铜、钠、镁等元素含量的改变与胆石形成有密切关系。     

胆囊术后胆漏致腹腔巨大积液介入治疗1例

患者，男，50岁，因右上腹疼痛20d，加重2d伴黄疸，2006—03在外院行胆囊切除术，术中见胆囊水肿张力大，部分坏疽，内见一枚结石。术后第6天出现腹痛、腹胀，第8天腹痛、腹胀加重并出现腹膜刺激症状，第10天行B超检查提示：腹腔有大量液性暗区。行左下腹穿刺抽出胆汁样液8ml,考虑有胆漏并胆汁性腹膜炎。行剖腹探查，腹腔内抽吸出胆汁样液量约2500ml，未发现明显胆漏部位。[第一段]     

高压氧对慢性肝炎患者体液免疫及肝组织中HBsAg、HBcAg的影响

目的 观察慢性肝炎（CH）高压氧（HBO）治疗前后患者的体液免疫功能和肝组织中HBsAg、HBcAg的变化。方法 用单人纯氧舱治疗（0.25MPa,1.5h/d,10d/couse,6courses)60例CH，用Array TM Protiein System Array160测定治疗前后静脉血α－白蛋白，γ－球蛋白，IgA,IgG,IgM，补体C1，C4；肝穿刺活检，SP法检测肝组织中HBsAg、HBcAg。结果 HBO治疗后CH患者静脉血γ球蛋白，IgA,IgG,IgM，补体C1，C4明显降低，α－白蛋白明显升高，治疗前后差异显著（P＜0．05），CH患者肝组织中HBsAg、HBcAg变化不明显，治疗前后差异不显著（P＞0．05）。结论 HBO治疗CH，可降低患者的体液免疫反应，对CH肝组织中HBsAg、HBcAg抑制作用不明显。     

口服绵羊血清IgG对小鼠免疫功能的影响

研究口服绵羊血清IgG对小鼠免疫功能的影响。采用环磷酰制造实验小鼠免疫功能抑制模型；选择口服扶正女贞素片的小鼠为阳性对照组、绵羊血清IgG为实验组，10d后测定小鼠免疫水平的变化。小鼠口服绵羊血清IgG后，对抗由环磷酰胺引起的小鼠免疫器官效果极显著（P＜0．01），并显著提高小鼠血清IgG水平（P＜0．01），对抗由环磷酰胺引起的小鼠血清IgG含量降低（P＜0．05）。小鼠急性经口服毒性实验属无毒经。口服绵羊血清IgG能显著提高小鼠的免疫功能。     

CT值联合纹理分析预测钬激光碎石术疗效的初步研究

【摘要】目的：探讨应用CT值联合纹理分析预测钬激光碎石术疗效的可行性。方法：回顾性纳入本院2012年-2015年经钬激光碎石术治疗的单发肾结石患者共128例，搜集患者影像学资料（包括术前平扫CT、术后4周泌尿系平片），根据泌尿系平片复查结果将患者分为结石排净组和结石残留组，按训练组：验证组=7：3将患者随机分配至训练组（共91例，排净57例，残留34例）及验证组（共37例，排净23例，残留14例）。测量患者结石的CT值后，通过MaZda软件于结石最大横截面处选取兴趣区（ROI），提取纹理特征。应用线性判别分析法（LDA）计算ROI最佳鉴别特征（MDF）值。联合CT值及MDF值，建立logistic回归模型，应用ROC曲线分析评估模型预测术后结石残留的诊断效能。最后，应用验证组数据对模型的诊断效能进行检验。 结果：单因素分析表明CT值与MDF值是结石残留的独立预测因素（P＜0.05），纳入二者进行多因素分析并建立的回归模型拟合较好（Hosmer-Lemeshow检验P=0.426）。模型预测术后结石残留的AUC为0.843（95%CI：0.751～0.911），进行验证时，模型的AUC为0.702（95%CI：0.529～0.841）。结论：CT值联合纹理分析对于预测钬激光碎石术后结石是否残留具有一定价值。     

ERCP、EST联合LC治疗肝外胆管结石

目的：探讨内窥镜逆行胆胰管造影术（ERCP）、内窥镜下括约肌切开术（EST）、联合腹腔镜胆囊切除术（LC）治疗胆石症的疗效。方法：回顾性分析2006-03～2008-03开展的ERCP＋EST＋LC治疗胆囊结石合并胆总管结石136例。其中LC术前发现的胆总管结石134例,LC术后确诊的胆总管残留结石2例。ERCP术后约7 d行LC。结果：LC术前取石成功128例,其中107例采用取石网篮/气囊取出,21例采用碎石器/碎石网篮先碎石后取出。LC术前EST取石失败6例,行LC＋术中胆道镜取石成功1例,5例行开腹手术。LC术后发现胆总管残留结石2例,经EST切开取石成功。LC术全部成功,无手术并发症。全部病例术后行B超或MRCP检查,显示胆道内无残留结石。结论：按不同的病情合理选择、分次施行ERCP加EST加LC,使治疗所致的创伤最小,是目前治疗肝外胆管结石较为理想的选择。     

肺癌术中放疗后病人血清中超氧化物歧化酶与丙二醛水平的观察

肺癌术中放疗后病人血清中超氧化物歧化酶与丙二醛水平的观察林善文孙玉鹗韩临春汪德清丁保国黄孝迈术中放疗（ＩＯＲＴ）是肺癌综合治疗方法之一，我们对ＩＯＲＴ后肺癌患者血清中超氧化物歧化酶（ＳＯＤ）活性与丙二醛（ＭＤＡ）含量进行动态观察。１材料和方法：住院拟...     

双腔尿管球囊压迫止血治疗顽固性胆道内大出血1例报告

病例资料 患者女60岁。因右上腹痛伴发热寒战2天入院。查体：全身皮肤粘膜轻度黄疸，腹平坦，右上腹腹肌紧，压痛反跳痛明显，Murphy氏征阳性，肠鸣音存在。B超示（1）胆囊结石并胆囊炎，（2）胆总管结石、左右肝管内结石。诊断为胆石症并感染，急症行胆囊切除、胆总管切开取石术。先行胆囊切除术，后探查胆总管及左右肝管，术中发现胆总管内大量脓性胆汁，部分胆管壁化脓，水肿严重，于胆总管及左右肝管内取出大小不等结石5枚，为胆红索结石。     

腹腔镜胆囊切除术后血清TBIL、ALT、AST水平变化的对比性临床研究

目的：探讨腹腔镜胆囊切除术（LC）术后血清TBIL、ALT、AST升高原因。方法：1999－09－10我院收治的95例胆囊结石患者,随机分为A、B组各32例,C组31例。A组患者LC术中CO2气腹压设置在1．3kPa,单极电刀切除胆囊,胆囊床普遍电凝处理,B组患者LC术中CO2气腹压同A组,弯剪刀切除胆囊,钛夹钳闭止血、常规置放腹腔引流,C组患者LC术中CO2气腹压设置在2kPa,切除胆囊方法同B组。术后1、3、5、7d抽外周静脉血送实验室测定TBIL、ALT、AST含量。结果：术后1d血清TBIL、ALT、AST含量A组患者明显升高,B、C组患者无升高,三组相比（F检验）,A组有显著性临床意义（P＜0．01）。结论：LC术中电刀对肝外胆管热效应和对局部肝组织热损伤是术后血清TBIL、ALT、AST升高的主要原因,近期可恢复正常,远期对肝功能无影响。     

胆囊颈部结石穿孔致胆囊与十二指肠通连畸形1例

1、病例介绍：患者女性57岁。反复右上腹痛3年入院，3年前无明届诱因出现右上腹痛。呈阵发性胀痛、向右肩背部放射，伴厌油腻食物，在当地医院行B超检查示胆囊颈部结石，予消炎利胆结石治疗后症状缓解，随后反复出现，多次复查B超示胆囊颈部结石，入院要求行经腹腔镜胆囊切除术。查体：神清，皮肤黏膜无黄染，浅表淋巴结无肿大，心肺检查正常，腹平坦，右上腹深压痛，无反跳痛，无肌紧张，Murphys征（-），移动性浊音阴性，肠鸣音正常。入院B超检查提示胆囊颈部结石，肝肾功能正常，上消化道钡透考虑十二指肠处少许钡剂存留。做好术前准备行经腹腔镜胆囊切除术，术中见胆囊颈部结石与十二指肠粘连，分离粘连，见有胆汁渗出，术中转开腹，证实为胆囊十二指肠瘘，行胆囊切除，十二指肠修瘘补术，术后10天痊愈出院。     

丹参抗LDL的脂质过氧化和脑缺血损伤的研究

给新西兰大白兔分别喂１％胆固醇食和标准食共５周，测定了血脂和低密度脂蛋白（ＬＤＬ）中的脂质过氧化物（ＬＰＯ）含量，并制成氧化型ＬＤＬ，提取ｏｘＬＤＬ中的脂质进行薄层层析，并制成脑缺血模型，观察丹参抗脑缺血损伤的作用。结果：胆固醇食组兔血清胆固醇（ＣＨ）、磷脂（ＰＬ）、游离脂肪酸（ＦＦＡ）以及血浆和ＬＤＬ中ＬＰＯ含量均高于标准食组；胆固醇食兔ＬＤＬ和Ｃｕ＾２＋透析后的ｏｘＬＤＬ中的脂质成分发生变化，     

志贺氏菌激发的粘膜免疫与粘膜保护

将家兔分为三组,分别经口服、滴眼或皮下接种活福氏2a 志贺氏菌。用 BA-ELISA 技术测定血、唾液、泪和粪中 IgG、IgM 和 IgA 类特异抗体。结果表明:滴眼组兔血 IgG 抗体迅速上升,口服组兔血以 IgM 抗体增加幅度较大,并出现较早。两组动物的唾液、泪和粪中 IgG 和 IgA 抗体上升幅度大。粪抗体以口服组出现最早。皮下组血 IgM 增加明显,下降迅速。其他体液中,三类抗体都未见增加。各组动物于免疫后约90天,经眼攻击。局部免疫的两组动物呈现有保护作用,皮下组则无。以上结果证实了机体内共同粘膜免疫系统的存在,并提示唾液、泪和粪产生的对志贺氏菌的免疫应答可能反映动物肠道的免疫状态,评价口服疫苗和研究免疫机理。     

反流性食管炎食管内pH值与胆汁反流的关系

研究反流性食管炎（ＲＥ）患者食管内ｐＨ值与胆汁反流的关系。ＲＥ患者８５例，应用便携式ｐＨ及胆汁监测仪同步监测食管下端２４ｈ ｐＨ值及胆红素吸收值。结果发现，胃酸反流时，胆红素吸收值与ｐＨ值无相关性（ｒ＝－０．０６７，Ｐ〉０．０５）；胆汁反流时，食管内ｐＨ值与胆红素吸收值呈负相关性（ｒ＝－０．２７６，Ｐ〈０．０１）。可见，单纯监测食管下端ｐＨ值能反映是否有胃酸反流，但不能判断是否合并有十二指肠胃食管     

急进高原新兵淋巴细胞HSP70的表达与血清CRP的检测分析

目的:探讨急进高原时外周血淋巴细胞热休克蛋白70(HSP70)表达和血清C-反应蛋白(CHP)、心肌酶谱的变化规律与意义。方法:采用流式细胞术和火箭电泳法检测22例新兵急进高原(海拔3658m)1d、3d时外周血淋巴细胞HSP70的表达强度和血清CRP水平,以及心肌酶活性水平,并与在平原时比较。结果:淋巴细胞HSP70和血清CRP、LD、HBD在急进高原1d与3d时显著高于平原时水平,P<0.01;3d时HSP70、LD、HBD、AST比1d时显著降低,P<0.01;CRP降低不明确,但仍明显高于平原水平,P<0.05。结论:急进高原时低氧、低压等因素使心肌细胞膜通透性升高,刺激淋巴细胞HSP70的表达和CRP的增加。     

Regional perfusion, oxygen metabolism, blood volume and immunoglobulin G accumulation at focal sites of infection in rabbits.

Infection causes remarkable changes in extracellular fluid volume, blood flow and oxygen consumption in the region of the lesion. To determine the sequence and magnitude of these changes, we performed serial scintigraphic measurements in 10 rabbits with experimental Escherichia coli abscesses. Positron emission tomography with C15O2, 15O2 and 11CO was used to measure regional blood flow, oxygen extraction (OEF) and blood volume; extracellular fluid volume was evaluated by single photon scintigraphy with indium-111 immunoglobulin G (IgG). Images were recorded following tracer administration at 1 and 7-10 days after infection. At the first imaging time, blood flow to infected muscle had increased by 40% compared with control sites (7.4 +/- 0.6 to 10.8 +/- 3.8 ml/min.100 g), OEF had decreased from 55% +/- 34% to 45% +/- 14%, and the infected-to-contralateral (I/C) ratio of IgG had increased to 3.34 +/- 1.85. At the later imaging time, flow had increased by almost threefold compared with day 1 (29.4 +/- 9.8 ml/min.100 g), OEF had decreased to 29% +/- 14%, and the I/C ratio for IgG had remained constant. Although OEF fell, oxygen delivery (OEF x flow) increased from 4.07 ml/min (control value) to 4.86 ml/min on day 1 and 8.64 ml/min on days 7-9. The infected-to-contralateral (IC) ratio of 15O2/C15O2 was 0.74 +/- 0.15 on day 1 and 0.77 +/- 0.10 at 7-9 days. These studies indicate that expansion of the extracellular fluid volume increases early in the evolution of the infection and exceeds changes in regional perfusion and oxygen delivery.     

Treatment of malignant biliary obstruction with a PTFE-covered self-expandable nitinol stent.

OBJECTIVE: We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. MATERIALS AND METHODS: Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50-80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2-81 weeks). RESULTS: Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively. CONCLUSION: The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.     

The influence of hypercholesterolaemia on the adrenal uptake and metabolic handling of 131I-6 beta-iodomethyl-19-norcholesterol (NP-59)

The biodistribution of 131I-6 beta-iodomethyl-19-norcholesterol (NP-59) was assessed in hypercholesterolaemic patients and in a rabbit model of HC to examine the alterations in the relative distribution of NP-59 and its metabolites and to explain the changes in the patterns of adrenal cortical imaging in patients with expanded cholesterol pools. Rabbits were rendered hypercholesterolaemic with a diet supplemented with 2% cholesterol for 2 weeks prior to the intravenous administration of 240 to 570 microCi of NP-59. Adrenal, bile and serum samples were obtained from four hypercholesterolaemic rabbits at 48 h following NP-59 administration, and the distribution of 131I radioactivity was compared to that of seven rabbits maintained on a standard laboratory diet. Serum cholesterol levels were 1940 +/- 248 mg dl-1 in the hypercholesterolaemic rabbits as compared to 268 +/- 62 mg dl-1 in the controls. Adrenal cortical uptake of NP-59 was decreased in HC rabbits but no significant differences were observed in the relative proportions of NP-59 or its metabolites in the bile and adrenal tissues of hypercholesterolaemic versus control animals. Hypercholesterolaemic animals did exhibit an increase in NP-59 esters in serum as compared to controls. In three of five patients with hypercholesterolaemia, adrenal uptake of NP-59 was enhanced after successful lowering of serum cholesterol levels, while the remaining two patients who responded inadequately to cholesterol-lowering therapy showed a slight drop in NP-59 uptake.     

胰十二指肠切除术后联合营养支持临床分析

目的：探讨肠内营养＋肠外营养（EN＋PN）支持对维持和改善手术创伤术后患者营养状态的效果。方法：选择胰十二指肠切除术后需行营养支持的16例患者，随机分PN组及EN＋PN组。两组营养支持均等热量、等氮量。营养支持前、手术后12d测血清白蛋白、胆固醇和胆红素含量。结果：①EN＋PN组白蛋白、血清胆固醇含量高于PN组，但无显著差异（P〉0．05）。@EN＋PN组血胆红素、胆汁酸比PN组明显改善（P〈0．05）。结论：与PN支持相比，EN＋PN可较早期有效地改善术后患者的营养状态。应根据术后患者的具体情况，合理早期应用EN。     

去白细胞输血在大剂量输血患者中的临床应用疗效分析

回顾性调查分析大剂量输血患者，比较了去白细胞输血和常规输血患者输血前、输血后1、3、7天丙氨酸氨基转移酶（GPT）、天门冬氨酸氨基转移酶（GOT）、乳酸脱氢酶（LDH）、总胆红素（TB）、直接胆红素（DB）、碱性磷酸酶（ALP）、总蛋白（TP）、白蛋白（ALB）、血糖（GLU）、Ca^2 、总CO2、pH的变化 以及非溶血性发热反应（FNHTR）等多项指标的变化。结果显示,与常规输血组比较，去白细胞输血组输血后3天GPT降低（P＜0．05）；输血后1、3、7天GOT、LDH均降低，差异有显著性意义（P＜0．01）；输血后3天TB较低（P＜0．05），而输血后1、3、7天DB均低（P＜0．01）。常规输血组在大剂量输血后总CO2有 一定程度的升高，而去白细胞输血组基本保持稳定。两组输血后pH均略有升高 ，无高血K^ 发生， 输血后1天血Ca^2 明显降低，输血后GLU明显增高。输血前后两组GLU、ALP、TP、ALB、K^ 、pH比较差异均无显著性意义（P＞0．05）。常规使用激素或其他抗过敏药物后，大剂量常规输血FNHTR发生率27％，而去白细胞输血组仅为1．9％，提示去白细胞输血在大剂量输血患者中的应用，可有效地防止FNHTR的发生，改善脏器功能，可减少组织受损程度。