【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.
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.
Objective To investigate the changes and significance of intercellular adhesion molecule-1 (ICAM-1) and tumor necrosis factor-α (TNF-α) in intestinal mucosa in rats with obstructive jaundice. MethodsTwenty-four SD rats were randomly divided into sham operation (SO) group and bile duct ligation (BDL) group, and each group were randomly divided into the day 7 and day 14 subgroup. The expression of ICAM-1 was assayed by immunohistochemistry. The level of TNF-α was determined by ELISA. The activity of myeloperoxidase (MPO) and diamine oxidase (DAO) was determined as well.ResultsOn the day 7 and 14, in the bile duct ligation group, the ICAM-1 protein was mainly expressed in the intestinal epithelia and increased with the time on (P＜0.05); the level of TNFα increased from （14.25±1.01） ng/g to （23.83±1.43） ng/g （P＜0.01）； the intestinal DAO activity decreased from （1.70±0.36） U/mg to （1.22±0.41） U/mg （P＜0.01），and plasma DAO activity increased from （6.44±1.74）U/ml to （8.93±1.29） U/ml （P＜0.01）; the MPO activity increased from （2.85±1.22 ） U/mg to （4.93±1.37） U/mg （P＜0.01）. ConclusionThe ICAM-1 expression is significantly upregulated and the level of TNFα significantly increases after bile duct ligation, which may be involved in the PMNmediated injury to intestinal mucosa.
We have measured the serum levels of total cholic acid (TCA) in 103 samples of obstructive jaundiced patients (OB group) and 83 samples of gallbladder stone patients without jaundice (control group) by enzymeconjugated colorimetric analysis method. The results revealed that TCA level was higher in OB group than in control group (Plt;0. 001) and had postive correlation with total bilirubin, direct bilirubin and alanine aminotransferase in OB group (Plt;0.01 in all). The clinical value of TCA in obstructive jaundice in comparison with alkaline phosphatase is discussed.
Objective To investigate the pathological characteristics of hepatic energy metabolism changes following hepatic inflow occlusion and the tolerant limit to ischemia in cholestatic rats.Methods On the day 7 after rats biliary obstruction, the survival rate, hepatic mitochondrial respiratory function, content of ATP, and the ketone body ratio in arterial blood were investigated following the different duration of hepatic ischemia and reperfusion with portal blood bypass.Results The survival rate on postoperative day 10 was 100%, 100% and 40% subjected to 30, 60 and 90min of hepatic vascular occlusion. The hepatic energy metabolic function was decreased markedly following ischemia, and was increased markedly on 24 hours following reperfusion subjected to 30, 60min of hepatic vascular occlusion, but it had less increase with 90min of hepatic vascular occlusion.Conclusion The hepatic energy metabolic function injury is reversible in cholestatic rats, and the rats can tolerate hepatic inflow occlusion within 60min, but the hepatic energy metabolic function injury is irreversible after 90min of hepatic occlusion.
Aippuric acid test(HAT) and hepatic energy metabolism and mitochondrial oxidative phosphorylation activity in rabbit with acute obstractive jaunidce was studied.The result showed that the HAT values were decreased from 98.4±32.0mg/h to 32.7±17.6mg/h(Plt;0.001),energy charge(EC) decreased from 0.81±0.01 to 0.72±0.02(Plt;0.001),and phosphorylation rate(PR)decreased from 62.1V5.1 to 38.3V2.4(Plt;0.001).Correlation coefficients between HAT and EC was 0.786,(Plt;0.001).This result suggests that HAT can be used as an indicator of hepatic energy metabolism status in acute 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.
ObjectiveTo explore the variation of the structure of the intestinal flora between healthy people and patients with obstructive jaundice perioperatively. MethodsFrom February 2013 to August 2014, 20 patients with obstructive jaundice and 10 healthy persons (normal control group) in our hospitol were selected as the research object. The first stool specimens of the research object after admission were obtained and the total fecal bacteria DNA were extracted. After polymerase chain reaction amplification, the changes in the structure of bacterial flora were dynamic observed by using denaturing gradient gel electrophoresis (DGGE), and the gel bands were analyzed by using Quantity One software. The similarity and diversity of flora structure, and principal component analysis (PCA) were analyzed. ResultsSignificant differences of colonic microflora were found between patients with obstructive jaundice and healthy people; advantage intestinal flora in obstructive jaundice patients was significant lower than the normal control group. With the extension of time and degree of obstruction aggravated, a descending trend was found in number, abundance, and diversity of the intestinal microflora (P < 0.05). ConclusionThere is significant differences in the structure of colon bacteria in patients with obstructive jaundice and healthy persons.