飞行人员年龄、飞行时间、高脂血症与肝胆病症检出率关系分析

目的调查分析飞行人员常见肝胆病症捡出率情况及与年龄、飞行时间、高脂血症的关系，为有效防治肝胆病症提供依据。方法以2006—10—2010—10在我院疗养和健康体检的3810例飞行人员为研究对象，分析不同年龄段、飞行时间段及合并高脂血症与常见肝胆病症检出率的关系。结果飞行人员肝胆病症检出率为17．1％。①不同年龄段两两比较。脂肪肝检出率差异有高度统计学意义（P〈0．01）；相邻年龄段胆囊息肉、肝胆结石、肝囊肿、ALT升高检出率差异有统计学意义（P〈005）；〉40岁组与≤30岁组比较差异有高度统计学意义（P〈0．01）。②不同飞行时间段两两比较。脂肪肝检出率差异有高度统计学意义（P〈0.01）；〉2000h组与≤1000h组比较，胆囊息内、肝胆结石、ALT升高检出率差异有高度统计学意义（P〈0．01），〉2000h组与1001～2000h组比较，胆囊息肉、肝胆结石检出率差异有统计学意义（P〈0．05）。⑧合并高脂血症组与未合并高脂血症组的脂肪肝、胆囊息肉、肝胆结石、ALT升高检出率比较差异有高度统计学意义（P〈001）。飞行员与其他飞行员肝胆结石、ALT升高检出率比较差异有统计举意艾fP〈0051。结论飞行人玩常见肝胆痛症检出率较高．年龄、飞行时间、高脂血症主要与脂肪肝、肝胆结石、胆囊息肉、肝囊肿（年龄）、ALT升高检出率密切相关，应加大对飞行人员肝胆病症防治力度，以控制肝胆病症的发生率。

腹部超声诊断肝胆病症的影像学特征分析

探讨腹部超声诊断肝胆病症的效果及观察影像学特征。方法 将2021年3月-2022年3月期间经病理诊断确诊的60例肝胆病症患者纳入研究,并均给予腹部超声检查,同时分析诊断结果。结果 经病理诊断共确诊脂肪肝18例,肝硬化5例,肝肿瘤5例,胆结石15例,病毒性肝炎9例,急性胆囊炎8例。腹部超声诊断脂肪肝94.44%、肝硬化80.00%、肝肿瘤100.00%、胆结石100.00%、病毒性肝炎55.56%、急性胆囊炎100.00%。结论 诊断肝胆病症时联合展开腹部超声检查可提升诊断准确性,有助于肝胆病症的早发现、早诊断、早干预,可在临床中进行推广运用。

基于数据挖掘分析新安王氏内科治疗肝胆系病症用药规律

目的基于数据挖掘分析新安王氏内科治疗肝胆系病症的中药配伍及组方用药规律。方法筛选并整理新安王氏内科代表医家临床治疗肝胆系病症效案,使用Microsoft Excel 2010软件构建临床方药数据库,通过SPSS 22.0和IBM SPSS Modeler 14.1统计软件对所有中药进行性味归经频次分析、关联规则分析及聚类分析。结果用药频次≥40次的中药有33味,按照用药频次从高到低排序,前5位依次为丹参、郁金、枸杞子、五灵脂、茯苓;功效以活血化瘀、滋阴、清热、利水渗湿等为主。药性以寒性中药频次最高,苦、甘、辛3种药味的中药所占比例较大,药物归经以肝、肺、脾、胃、肾为主。按照药物组合频次从高到低排序,前3位依次为丹参、五灵脂,丹参、郁金,五灵脂、郁金。青黛、明矾、枸杞子药物组合的置信度为1.0。王氏内科治疗肝胆系病症常用的药物组合有丹参、郁金、五灵脂,枸杞子、女贞子,茯苓、半夏等。结论新安王氏辨治肝胆系病症时首辨疾病虚实,实者以湿热蕴结、络脉瘀阻、肝脾失调为主,虚者多见肝肾阴虚、肝脾失养、阳气不足,辨证论治时注重结合肝病发展的不同阶段性特征,顺肝性、适肝用、调肝体。

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Primary sclerosing cholangitis （PSC） is a chronic progressive disorder of unknown aetiology characterised by chronic inflammation and stricture formation of the biliary tree. Symptoms include itch and lethargy and in advanced cases cholangitis and end-stage liver disease, however increasing numbers of asymptomatic individuals are being identified. The disease is rare in the general population but is strongly associated with inflammatory bowel disease （IBD） affecting up to 5% of patients with Ulcerative Colitis, with a slightly lower prevalence （up to 3.6%） in Crohns disease. The strength of this association means that the vast majority （ 〉 90%） of patients with PSC also have IBD, although many may have only mild gastro-intestinal symptoms. Usually IBD presents before PSC, although vice-versa can occur and the onset of both conditions can be separated in some cases by many years. Mean age of diagnosis of PSC is in the fitch decade of life with a strong male predominance. Risk is increased in those with a family history of PSC, suggesting a genetic predisposition and the disease is almost exclusive to non-smokers. The ulcerative colitis associated with PSC is characteristically mild, runs a quiescent course, is associated with rectal sparing, more severe right sided disease, backwash ilieitis and has a high risk of pouchitis post-colectomy. Most worrisome is the high risk of colorectal malignancy which necessitates routine colonoscopic surveillance. Cholangiocarcinoma is also a frequent complication of PSC with a 10%-15% lifetime risk of developing this condition. Treatment with high dose ursodeoxycholic acid offers some chemoprotective effects against colorectal malignancy and may decrease symptoms, biochemical and histological progression of liver disease. Small duct PSC patients characteristically have normal cholangiography, and liver biopsy is required for diagnosis, it appears to have a more favourable prognosis. Autoimmune Hepatitis （AIH） is also more prevalent in patients with IBD, with up to 16% of patients with Autoimmune Hepatitis also having ulcerative colitis. A small subgroup of patients have a AIH-PSC overlap syndrome and the management of these patients depends on liver histology, serum IgM levels, autoantibodies, degree of biochemical cholestasis and cholangiography as some of these patients may respond to immunosupression.

Hemobilia secondary to hepatic artery pseudoaneurysm: An unusual complication of bile leakage in a patient with a history of a resected Ⅲb Klatskin tumor

We report a case of a 74-year-old woman with a 16-year history of a double bilo-enteric anastomosis due to resected hilar cholangiocarcinoma [Type IIIb Klatskin tumor]. The patient presented with cholangitis secondary to benign anastomotic stenosis which resulted in a large intrahepatic biloma. In order to restore the patency of the anastomosis and overcome cholangitis, several attempts took place, including endobiliary stenting, balloon-assisted biloplasty and transhepatic billiary drainage. Anastomotic patency was achieved, complicated, however, by persistent upper gastro-intestinal bleeding, presented as hemobilia. A biloma-induced pseudoaneurysm of the left hepatic artery was diagnosed. This had ruptured into the biliary tract, and presented the actual cause of the hemobilia. Selective embolism of the pseudoaneurysm resulted in control of the hemorrhage, and was successfully combined with transhepatic dilatation of the anastomosis and percutaneous drainage of the biloma. The patient was ultimately cured and seems to be in excellent condition, 5 mo after treatment.

Hemobilia as the initial manifestation of cholangiocarcinoma in a hemophilia B patient

Hemobilia is a rare manifestation of hemophilia and is usually iatrogenic following liver biopsy. There are only few reports of spontaneous hemobilia in hemophilia patients. Cholangiocarcinoma is a well-established cause of hemobilia. We describe a case of a 70-year-old male, with known haemophilia B and a past history of papillotomy, who presented with classical symptoms of hemobilia. The initial diagnostic work-up failed to demonstrate a potential cause of bleeding other than the coagulopathy. Three months later, he was readmitted to our hospital with a second episode of hemobilia. During the second work-up, a cholangiocarcinoma was diagnosed both by imaging studies and by a significant elevation of cancer antigen 19-9. Although hemobilia could be attributed to hemophilia, especially in a patient with previous papillotomy, an underlying malignancy of the biliary tree should be suspected.

Intrabiliary rupture: An algorithm in the treatment of controversial complication of hepatic hydatidosis

AIM: Intrabiliary rupture (IBR) is a common and serious compli-cation of hepatic hydatid cyst. The incidence varies from 1% to 25%. The treatment of IBR is still controversial. We aimed to design an algorithm for the treatment of hepatic hydatidosis with IBR by reviewing our cases.METHODS: Eight cases of IBR were analyzed retrospectively.Patients were evaluated according to age, sex, clinical findings, cyst number and stage, abdominal ultrasonography and CT-scan, surgical methods, complica-tions, results and coincidental diseases.RESULTS: Female/male ratio was 1/7. Mean age was 52.12±18.26 years (range 24-69 years). Right upper quadrant pain, flatulence, palpable hepatic mass were symptoms common in all patients. Cholestatic jaundice was found in four cases. In all patients, cyst evacuation and omento-plasty were performed, followed by either choledochod-uodenostomy, T-tube drainage, intracavitary suturing of the orifice, two cases in each. Whereas in two patients diagnosed post-operatively percutaneous drainage of biliary collection or ERCP and sphincteroplasty were added. Morbidity and hospital stay were higher in these cases.CONCLUSION: When the diagnosis of IBR can be done pre-or intra-operatively, morbidity decreases. If a biliary fistula is seen post-operatively, endoscopic procedures such as ERCP, sphincteroplasty or nasobiliary drainage can be applied.

Clinical outcome of Fitz-Hugh-Curtis syndrome mimicking acute biliary disease

AIM: To analyze the clinical characteristics of patients diagnosed with Fitz-Hugh-Curtis syndrome.METHODS: The clinical courses of patients that visited St. Mary's Hospital with abdominal pain from January 2005 to December 2006 and were diagnosed with Fitz-Hugh-Curtis syndrome were examined.RESULTS: Fitz-Hugh-Curtis syndrome was identified in 22 female patients of childbearing age; their mean age was 31.0 ± 8.1 years. Fourteen of these cases presented with pain in the upper right abdomen alone or together with pain in the lower abdomen, and six patients presented with pain only in the lower abdomen. The first impression at the time of visit was acute cholecystitis or cholangitis in 10 patients and acute appendicitis or pelvic inflammatory disease in eight patients. Twenty-one patients were diagnosed by abdominal computer tomograghy (CT), and the results of abdominal sonography were normal for 10 of these patients. Chlamydia trichomatis was isolated from 18 patients. Two patients underwent laparoscopic adhesiotomy and 20 patients were completely cured by antibiotic treatment.CONCLUSION: For women of childbearing age with acute pain in the upper right abdomen alone or together with pain in the lower abdomen, Fitz-Hugh-Curtis syndrome should be considered during differential diagnosis. Moreover, in cases suspected to be Fitz-Hugh-Curtis syndrome, abdominal CT, rather than abdominal sonography, assists in the diagnosis.

Ectopic fascioliasis mimicking a colon tumor

Fasciola hepatica, a leaf shaped trematode that is common in cattle, sheep and goats, is acquired by eating raw water plants like watercress or drinking water infected with the encysted form of the parasite. The varied clinical presentations of fascioliasis still make a high index of suspicion mandatory. Besides having a wide spectrum of hepatobiliary symptoms like obstructive jaundice, cholangitis and liver cirrhosis, the parasitic infection also has extrabiliary manifestations. Until recently, extrahepatic fascioliasis has been reported in the subcutaneous tissue, brain, lungs, epididymis, inguinal lymph nodes, stomach and the cecum. In this report, a strange manifestation of the fasciola infection in a site other than the liver, a colonic fascioliasis, is presented.

The right hepatic artery syndrome

Various benign and malignant conditions could cause biliary obstruction. Compression of extrahepatic bile duct (EBD) by right hepatic artery was reported as a right hepatic artery syndrome but all cases were compressed EBD from stomach side. Our case compressed from dorsum was not yet reported, so it was thought to be a very rare case. We present here the first case of bile duct obstruction due to the compression of EBD from dorsum by right hepatic artery.

Churg-Strauss syndrome complicated by colon erosion, acalculous cholecystitis and liver abscesses

We report on a case of Churg-Strauss syndrome (CSS)with colon erosion, cholecystitis and liver abscesses. A 21-year-old woman with a history of bronchial asthma for 3 years was admitted with a complaint of abdominal pain. Laboratory findings included remarkable leukocytosis and eosinophilia, and a colonoscopy revealed erosion from the rectum to the ileocecal region. In addition, a colonic biopsy specimen showed necrotizing vasculitis and marked eosinophilic infiltration. On the basis of the clinical features and histopathological findings, she was diagnosed with CSS and subsequently treated with oral prednisolone,after which the eosinophilia and abdominal pain disappeared. However, on the 15th d in hospital she developed cholecystitis and liver abscesses. She was therefore treated with antibiotics and as a result went into clinical remission.

Liver disease in pregnancy

Liver diseases in pregnancy may be categorized into liver disorders that occur only in the setting of pregnancy and liver diseases that occur coincidentally with pregnancy. Hyperemesis gravidarum, preeclampsia/eclampsia, syndrome of hemolysis, elevated liver tests and low platelets (HELLP), acute fatty liver of pregnancy, and intrahepatic cholestasis of pregnancy are pregnancy-specific disorders that may cause elevations in liver tests and hepatic dysfunction. Chronic liver diseases, including cholestatic liver disease, autoimmune hepatitis, Wilson disease, and viral hepatitis may also be seen in pregnancy. Management of liver disease in pregnancy requires collaboration between obstetricians and gastroenterologists/hepatologists. Treatment of pregnancy-specific liver disorders usually involves delivery of the fetus and supportive care, whereas management of chronic liver disease in pregnancy is directed toward optimizing control of the liver disorder. Cirrhosis in the setting of pregnancy is less commonly observed but offers unique challenges for patients and practitioners. This article reviews the epidemiology, pathophysiology, diagnosis, and management of liver diseases seen in pregnancy.

浅谈个性化护理在肝胆胰外科疾病护理中的应用效果

本文主要针对肝胆外科病症病患在医治的过程当中,使用个性化护理的方式对其疾病治疗效果所产生的成效进行探讨。方法:在2018年1月-2019年12月这两年间,选取我院120例患者来作为研究对象,实验组实行常规护理,观察组实行个性化护理,对比两组护理效果。结果:通过研究表明,可以发现参与本次探究的病患在护理满意度,手术治疗效果这两项指标方面存在比较大的差异。结论:在使用对肝胆外科手术医治的病患,进行护理的过程当中,使用个性化护理的方式,通过实行个性化护理能够使得效果更佳,改善患者的生活质量。