【Abstract】Objective To explore the relation between the expression of telomerase and DNA ploidy with biliarypancreatic system cancer, so as to find a better way to diagnose and distinguish jaundice between malignance and benign disease.Methods Endoscopic retrograde cholangiopancreatography (ERCP) were performed before operation in patients with obstructive jaundice. The bile and pancreatice juice were collected before ERCP. Biopsy specimens from part of patients were obtained during ERCP. All cancer specimens were possessed once again during operation and were assessed by the activity of telomerase and DNA ploidy. Results ① Telomerase positive rate 〔87.50%(56/64)〕 of tissue specimens in malignant obstructive jaundice were higher than that in benign obstructive jaundice 〔3.33%(2/60)〕，P=0.000. ② Telomerase positive rate〔71.88%(46/64)〕of Bile and pancreatice juice in malignant obstructive jaundice were higher than that in benign obstructive jaundice 〔3.33%(2/60)〕， P=0.000, tissue specimens obtained by endoscopy with malignant obstructive jaundice had detectable telomerase activity, positive rate was 83.33%（20/24）. ③ The rate of DNA heteroploid with malignant obstructive jaundice was 62.50%（40/64）, that of diploid can be seen in all patients with benign obstructive jaundice, the difference was statistically significant (P=0.000). ④ The rate of telomerase positive and DNA heteroploid in high differentiation tumor were significantly lower than in middlelow differentiation tumor （P=0.028，P=0.001）.Conclusion Applying the duodenoscope we collected the bile and pancreatic fluid before operation and obtain biopsy specimens whose telomerase activity and DNA ploid were detected. This is simple, safe, quick method which can identify the malignant and benign obstructive jaundice.
【Abstract】Objective To study the expression of serum soluble interleukin-2 receptor (sIL-2R) level in perioperative period of patients with obstructive jaundice and its clinical significance. Methods Serum sIL-2R was measured during perioperative period in 30 patients with obstructive jaundice by using a sandwich enzyme linked immunosorbent assay (ELISA). Results The preoperative serum sIL-2R level in patients with obstructive jaundice was increased obviously. The expression of serum sIL-2R level in them was correlated with the degree and duration of obstructive jaundice and nutritional status respectively (r=0.734, P＜0.01; r=0.646, P＜0.01; r=0.594, P＜0.05). The serum sIL-2R in the patients with malignant obstructive jaundice was significantly higher than that with benign obstructive jaundice (P＜0.05). Among the patients with malignant obstructive jaundice, the serum sIL-2R level in the patients with metastasis was higher than in those without metastasis (P＜0.05). The immunologic function underwent a process from temporary suppression to gradual recovery during perioperative period. On the 21th day after operation the sIL-2R was recovered to normal level in patients with benign obstructive jaundice while it only recovered to preoperative level in patients with malignant obstructive. Conclusion Depressed immunity is observed in patients with obstructive jaundice. The abnormal expression of sIL-2R is related to the type, degree and duration of obstructive jaundice and the nutritional status and metastasis. The result that preoperative sIL-2R might be used to evaluate the state of immunity, clinical condition, and treatment and prognosis of patients with obstructive jaundice.
Objective To compare the therapeutic effect of percutaneous transhepatic cholangial drainage (PTCD) and operation drainage for the patients with inoperable malignant obstructive jaundice. Methods A total of 131 patients with inoperable malignant obstructive jaundice were treated in this hospital, in which 102 patients had PTCD by placement of metallic stent and (or) plastic tubes to remove obstruction of bile duct (interventional treatment group). Simultaneously 29 patients were selected for operation by intraexternal drainage (operation drainage group). The patients were followed up for comparison of the serum level of total bilirubin, postoperative complications, average length of hospitalization and average cost between the two groups. Results PTCD was successfully performed in all the patients of the interventional treatment group. There were no significant differences of 50% decrease period of average total bilirubin level or postoperative complications between the two groups (Pgt;0.05). The average length of hospitalization and average cost of interventional treatment group were less than those of operation drainage group (Plt;0.05). Conclusions Compare with operation drainage, interventional treatment can reduce average length of hospitalization and average cost, without increase of postoperative complications, which is a main chance of treatment for malignant obstructive jaundice.
Ｈｅｍｏｄｙｎａｍｉｃ ｃｈａｎｇｅｓ ｏｆ ｓｙｓｔｅｍｉｃ ａｎｄ ｐｏｒｔａｌ ｖｅｉｎ ｆｌｏｗ ａｎｄ ｒｅｇｕｌａｔｉｏｎ ｏｆ ｉｎｄｏｍｅｔｈａｃｉｎ ｈａｖｅ ｂｅｅｎ ｓｔｕｄｉｅｄ ｉｎ ７３ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ（ｇｒｏｕｐ Ａ）ａｎｄ ３９ ｃａｓｅｓ ｗｉｔｈ ｓｉｍｐｌｅ ｇａｌｌｂｌａｄｄｅｒ ｓｔｏｎｅｓ（ｇｕｏｕｐ Ｂ）．Ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ ｗａｓ ｓｕｂｇｒｏｕｐｅｄ ｉｎｔｏ ｇｒｏｕｐ Ａ１（ｎｏｉｎｄｏｍｅｔｈａｃｉｎ ａｄｍｉｎｉｓｔｒａｔｉｏｎ），ｇｒｏｕｐ Ａ２（ｐｒｅｏｐｅｒａｔｉｖｅ ａｄｍｉｎｉｓｔｒａｔｉｏｎ ｏｆ ｉｎｄｏｍｅｔｈａｃｉｎ），ｇｒｏｕｐ Ａ３（ｐｏｓｔｏｐｅｒａｔｉｖｅ ａｄｍｉｎｉｓｔｒａｔｉｏｎ ｏｆ ｉｎｄｏｍｅｔｈａｃｉｎ），ａｎｄ ｇｒｏｕｐ Ａ６（ｓｅｎｉｌｅ ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ）．Ｏｆ ｔｈｅｍ ｇｒｏｕｐ Ａ１ ｗａｓ ｓｕｂｇｒｏｕｐｅｄ ｉｎｔｏ ｇｒｏｕｐ Ａ４（ｍａｌｉｇｎａｎｔ ｏｂｓｔｒｕｃｔｉｏｎ）ａｎｄ ｇｒｏｕｐ Ａ５（ｂｅｎｉｇｎ ｏｂｓｔｒｕｃｔｉｏｎ）ａｇａｉｎ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｔｈｅ ｓｔｒｏｋｅ ｖｏｌｕｍ（ＳＶ），ｃａｒｄｉａｃ ｏｕｔｐｕｔ（ＣＯ）ａｎｄ ｃａｒｄｉａｃ ｉｎｄｅｘ （ＣＩ）ｗｅｒｅ ｈｉｇｈｅｒ ｉｎ ｅａｃｈ ｇｒｏｕｐ ｏｆ ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ ｔｈａｎ ｔｈｏｓｅ ｉｎ ｇｒｏｕｐ Ｂ（Ｐ＜０．０１），ａｎｄ ｔｈｅ ｍｅａｎ ａｒｔｅｒｙ ｐｒｅｓｓｕｒｅ （ＭＡＰ），ｓｔｒｏｋｅ ｖｅｓｓｅｌ ｒｅｓｉｓｔａｎｃｅ （ＳＶＲ）ａｎｄ ｐｏｒｔａｌ ｖｅｉｎ ｂｌｏｏｄ ｆｌｏｗ（ＰＶＦ）ｗｅｒｅ ｌｏｗｅｒ ｉｎ ｅａｃｈ ｇｒｏｕｐ ｏｆ ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ ｔｈａｎ ｔｈｏｓｅ ｉｎ ｇｒｏｕｐ Ｂ（Ｐ＜０．０１）．Ｔｈｅ ＭＡＰ，ＳＶＲ ａｎｄ ＰＶＦ ｉｎ ｇｒｏｕｐ Ａ２ ａｎｄ ｇｒｏｕｐ Ａ３ ｓｈｏｗｅｄ ｂｅｔｔｅｒ ｉｍｐｒｏｖｅｍｅｎｔ ｔｈａｎ ｔｈｏｓｅ ｉｎ ｏｔｈｅｒ ｓｕｂｇｒｏｕｐｓ，ｂｕｔ ａｓ ｃｏｍｐａｒｅｄ ｗｉｔｈ ｇｒｏｕｐ Ｂ ｔｈｅｒｅ ｗｅｒｅ ｓｉｇｎｉｆｉｃａｎｔ ｄｉｆｆｅｒｅｎｃｅｓ （Ｐ＜０．０１）．Ｔｈｅ ａｕｔｈｏｒｓ ｃｏｎｓｉｄｅｒ ｔｈａｔ ｉｎｄｏｍｅｔｈａｃｉｎ ｃａｎ ｉｍｐｒｏｖｅ ｔｈｅ ｃｉｒｃｕｌａｔｉｏｎ ｆｕｎｃｔｉｏｎ，ＰＶＦ ａｎｄ ｌｉｖｅｒ ｆｕｎｃｔｉｏｎ ｉｎ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ．
ObjectiveTo study the changes of lipopolysaccharide binding protein (LBP) in the serum of Wistar rats with obstructive jaundice and to investigate its potential mechanism.MethodsEighty male Wistar rats were randomly divided into obstructive jaundice group (OJ group, n=40） and sham operation group (SO group, n=40）. Before operation and the 5th, 10th, 15th, 20th day after common bile duct ligation, the levels of LBP, endotoxin, tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in plasma were detected in all the rats. ResultsLBP levels in serum increased significantly in OJ group on the 10th day after operation compared with those of SO group. Moreover, LBP levels gradually increased in OJ group with the prolongation of obstructive time. A positive correlation existed between serum LBP and plasma endotoxin, TNF-α and IL-6.ConclusionThe study demonstrates that LBP in serum is high and plays an important role in the pathogenesis of multiple organ injury secondary to obstructive jaundice. It may be an appropriate way to treat patients with obstructive jaundice by decreasing LBP levels in serum.
【Abstract】ObjectiveTo study the effects of endothelin (ET) and Xuesaitong injection on hepatic, renal and myocardial tissues after bile duct ligation (BDL) in rabbits. MethodsSeventytwo rabbits were randomly divided into three groups: BDL group (24 rabbits), BDL+Xuesaitong injection group (24 rabbits), and sham operation group (24 rabbits). Each group was subdivided into four subgroups of postoperative 3, 6, 9 and 12 d (6 rabbits in each subgroup). Automatic biochemical analysis equipment was used to detect the levels of serum TBIL, ALT, BUN and Crea. The levels of ET in plasma, hepatic, renal and myocardial tissues were measured with radioimmunological method. ResultsThe levels of ET in plasma, hepatic, renal and myocardial tissues in both BDL group and BDL+Xuesaitong injection group were higher than those of sham operation group (P＜0.01). The levels of ET in plasma and tissues of BDL+Xuesaitong group were lower than those in BDL group (P＜0.05). ConclusionObstructive jaundice can lead to an increase of ET in plasma, hepatic, renal and myocardial tissues, the level of ET increases with the time of obstruction. Xuesaitong injection may play a protective role in the injury of hepatic, renal and myocardial tissues after obstruction by decreasing the level of ET in plasma and tissues.
ObjectiveTo investigate the effects of MK-801 on antioxidant system activity in the central nervous system of rats with obstructive jaundice. MethodsTwenty rats were divided into four groups: sham operation group, control group, MK-801 low dose group, and MK-801 high dose group. The control group, MK-801 low dose group, and MK-801 high dose group were the obstructive jaundice model groups (OJ groups). From the first day after operation, MK-801 low dose group were processed intraperitoneal injection of MK-801 0.025 mg/(kg·d) and MK-801 high dose group were processed intraperitoneal injection of MK-801 0.25 mg/(kg·d). Meanwhile, sham operation group and control group were injected the same volume of normal saline everyday for 10 days. Three days after operation, rats' tail vein blood were collected for examining the direct bilirubin DBIL) and total bile acids (TBA) in order to determine whether the model were successfully established. And malondialdehyde (MDA), catalase (CAT), total superoxide dismutase (T-SOD), and total antioxidant capacity (T-AOC) were determined on the 10th day to evaluate the oxdative status of the rats. Results①Obstructive jaundice model was established successfully.②The content of MDA in control group, MK-801 low dose group and MK-801 high dose group were significantly increased than the sham operation group, and there was statistical difference (P < 0.05). The content of MDA decreased in MK-801groups compared with the control group (P < 0.05).③Compared with the sham operation group, the activity of CAT in control group decreased significantly (P < 0.05). The activity of CAT in the MK-801 groups increased compared with the control group with significant difference (P < 0.05). There was no statistical difference on the activity of CAT between MK-801 low dose group and high dose group (P > 0.05).④Compared with sham operation group, the activity of T-SOD was decreased significantly in control group with statistical significance (P < 0.05). The activity of T-SOD were increased in the MK-801 groups compared with control group with significant difference (P < 0.05), but the activity of T-SOD was decreased significantly in the high dose group than the low dose group (P < 0.05).⑤In the Oj groups, the T-AOC were significantly increased compared with the sham operation group, and there was statistical significance (P < 0.05). The T-AOC in MK-801 groups were increased compared with the control group with statistical significance (P < 0.05), but there was no statistical difference between the MK-801 groups. Conciusions Oxidative stress exists when obstructive jaundice occurs, and obstructive jaundice can aggravate the oxidative stress damage in the rats' central nervous system and cause increasing expression of enzymes such as CAT which enhance antioxidant capacity of the whole body. MK-801 can decrease lipid peroxidation, and increase activity of CAT and SOD as well as T-AOC in CNS of jaundice rats. But High dose of MK-801 has no better effect than low dose of MK-801. On the contrary, activity of T-SOD decrease in the high dose group than in the low dose group. Further research is needed on the specific mechanism.
Twenty-eight cases of hepatocellular carcinoma(HCC)involving bile duct and causing obstructive jaudice in this hospital between 1987-1994 were studied.In this series cancerous cast formation in bile duct was found in 13 cases and cancerous thrombus in 15 cases which accounts for 5.7% of 487 HCC patients admitted to this hospital in the same period.According to the operative and pathological findings,characteristics of cancerous cast type are:①direct connection of cancerous cast with the primary tumor as a dumb bell-shped,②no adhesion between the cast and the thin wall of bile duct,③central location of the primary tumor in liver near the larger bile duct and ④HCC tissues seen in pathologic section of the cast.Characteristics of cancerous thrombus type are:①no connection between intraductal thrombus and the primary tumor,②segmental stenosis or obstruction of the bile duct,③adherence of cancerous thrombus to the thick ductal wall,④peripheral location of the primary tumor and⑤HCC cells scattered in the thrombus.