胆道闭锁术后肝内胆管囊性扩张的诊治

目的总结胆道闭锁术后肝内胆管扩张的诊治经验,探讨葛西手术后肝内胆管扩张对患儿远期预后的影响,以及如何早期诊断和治疗。方法2003年4月至2008年3月,对3例因胆道闭锁行葛西手术的患儿进行追踪随访,3例术后均有不同程度胆管炎症状,其中1例合并门脉高压。3例行超声、CT或经皮肝穿刺置管引流(PTCD),结果显示肝内胆管囊性扩张。2例行胆管扩张与空肠胆支再吻合术,1例仅行PTCD置管引流。结果2例经手术治疗的患儿,术后黄疸消退或减轻。1例仅行PTCD的患儿肝内胆管扩张长期存在。结论肝内胆管扩张使胆管炎反复发作,特别是扩张的囊状胆管压迫门静脉,可使门静脉变窄,血流减少,致受累肝叶萎缩。胆道闭锁患儿葛西手术后应定期行超声检查,及时发现肝内胆管囊性扩张。葛西手术后肝内胆管扩张应早期诊断,早期手术治疗,术前应常规行PTCD,暂时解除胆汁淤积,并为术中定位做好准备。

胆管损伤的诊治研究进展

胆结石是常见病、多发病，通过非手术手段治愈胆结石目前难以成为现实，手术仍是治愈的唯一方法。胆囊切除术发展至今已有100多年历史了，经历了开腹胆囊切除术（OC）及腹腔镜下胆囊切除（LC）两种术式。随着腹腔镜技术的发展，

疏肝实脾法治疗慢性胆囊炎、胆石症56例

目的:观察疏肝实脾类中药配伍治疗慢性胆囊炎胆石症的临床疗效。方法:采用自拟方疏肝实脾汤(柴胡、郁金、白芍、炒白术、党参等)治疗慢性胆囊炎胆石症56例。结果:总有效率92.9%。提示:疏肝实脾法治疗慢性胆囊炎胆石症疗效显著。

肝外胆管手术后并发胆漏19例原因及防治分析

目的:探讨肝外胆管手术后并发胆漏的原因及其防治方法。方法:对肝外胆管手术后并发胆漏19例患者的临床资料进行回顾性分析。结果:LC术后胆囊床迷走胆管漏7例,胆总管探查后放置T管胆漏3例,拔T管后胆漏4例,胆管损伤后胆漏3例,胆肠吻合口漏1例,胆总管癌切开探查后胆漏1例。保守及内镜治疗14例,再手术4例,除1例胆管癌自动出院外其余均痊愈出院。结论:胆漏多发生于胆囊切除术、胆管手术及拔T管后,主要原因与胆管解剖变异及胆管损伤和操作不当等有关,应根据有无胆管损伤或梗阻以及腹腔引流是否通畅等选择保守治疗或内镜及再手术治疗。

治疗性内镜下逆行胰胆管术诊治肝移植术后胆管并发症的临床效果

目的探究治疗性内镜下逆行胰胆管术诊治肝移植术后胆管并发症的临床效果。方法 筛选在清华大学北京市垂杨柳医院完成的32例原位肝移植术后发生胆管并发症并接受内镜治疗的患者，将32例患者根据不同的并发症分为8组：胆道炎组、吻合口胆道狭窄组、非吻合口胆道狭窄组、吻合口漏组、胆道过长扭曲/成角组、乳头狭窄组、单纯胆道结石组、胆道肿瘤组，每组4例，接受治疗性内镜下逆行性胰胆管造影（ERCP）。实施ERCP前一个月和实施ERCP一个月检测受试者的肝功能：谷丙转氨酶（ALT）、天门冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转移酶（γ-GT）。ERCP治疗完成后1个月对疗效进行全面评估。结果 各组受试者实施ERCP后，其ALT、AST、ALP以及γ-GT均较治疗前改善（P〉0.05）。ERCP治疗后，各组的症状均有明显缓解，其中以胆道炎组和单纯胆道结石组为最佳（全部治愈），而胆道过长扭曲/成角组和胆道肿瘤组只能达到好转的效果。结论 治疗性ERCP可显著改善患者的肝功能；但对于非吻合口狭窄、胆道过长扭曲/成角以及胆道肿瘤者，需要在进行ERCP治疗的同时实施联合治疗方式。

Ursodeoxycholic acid treatment of vanishing bile duct syndromes

Vanishing bile duct syndromes （VBDS） are characterized by progressive loss of small intrahepatic ducts caused by a variety of different diseases leading to chronic cholestasis, cirrhosis, and premature death from liver failure. The majority of adult patients with VBDS suffer from primary biliary cirrhosis （PBC） and primary sclerosing cholangitis （PSC）. Ursodeoxycholic acid （UDCA）, a hydrophilic dihydroxy bile acid, is the only drug currently approved for the treatment of patients with PBC, and anticholestatic effects have been reported for several other cholestatic syndromes. Several potential mechanisms of action of UDCA have been proposed including stimulation of hepatobiliary secretion, inhibition of apoptosis and protection of cholangiocytes against toxic effects of hydrophobic bile acids.

Laparoscopic hepatic left lateral lobectomy combined with fiber choledochoscopic exploration of the common bile duct and traditional open operation

AIM: To investigate the possibilities and advantages of laparoscopic hepatic left lateral lobectomy combined with fiber choledochoscopic exploration of the common bile duct compaired with traditional open operation.METHODS: Laparoscopic hepatic left lateral lobectomy combined with fiber choledochoscopic exploration of the common bile duct and traditional open operation were performed in two groups of patients who had gallstones in the left lobe of liver and in the common bile duct. The hospitalization time, hospitalization costs, operation time, operative complications and post-operative liver functions of the two groups of patients were studied.RESULTS: The operation time and post-operative liver functions of the two groups of patients had no significant differences, while the hospitalization time, hospitalization costs and operative complications of the laparoscopic hepatic left lateral lobectomy combined with fiber choledochoscopic exploration in the common bile duct group were significantly lower than those in the traditional open operation group.CONCLUSION: For patients with gallstones in the left lobe of liver and in the common bile duct, laparoscopic hepatic left lateral lobectomy combined with fiber choledochoscopic exploration of the common bile duct can significantly shorten the hospitalization time, reduce the hospitalization costs and the post-operative complications,without prolonging the operation time and bringing about more liver function damages compared with traditional open operation. This kind of operation has more advantages than traditional open operation.

Composition of common bile duct stones in Chinese patients during and after endoscopic sphincterotomy

AIM： Endoscopic sphincterotomy （ES） is a well-established therapeutic modality for the removal of common bile duct （CBD） stones. Alter ES there are still around 10% of patients that experience recurrent CBD stones. The aim of this study is to investigate the composition of CBD stones before and alter ES and its clinical significance in Chinese patients.METHODS： From January 1996 to December 2003, 735 patients with CBD stones received ES at Kaohsiung Veterans General Hospital and stone specimens from 266 patients were sent for analysis. Seventy-five patients had recurrent CBD stones and stone specimens from 44 patients were sent for analysis. The composition of the stones was analyzed by infrared （IR） spectrometry and they were classified as cholesterol or bilirubinate stones according to the predominant composition. Clinical data were analyzed.RESULTS： In the initial 266 stone samples, 217 （82%） were bilirubinate stones, 42 （16%） were cholesterol stones,3 were calcium carbonate stones, 4 were mixed cholesterol and bilirubinate stones. Patients with bilirubinate stones were significantly older than patients with cholesterol stones （66＋13 years vs 56＋17 years, P = 0.001）. In the 44 recurrent stone samples, 38 （86%） were bilirubinate stones, 3 （7%） were cholesterol stones, and 3 were mixed cholesterol and bilirubinate stones. In 27 patients, both initial and recurrent stone specimens can be obtained,23 patients had bilirubinate stones initially and 2 became cholesterol stones in the recurrent attack. In the four patients with initial cholesterol stones, three patients had bilirubinate stones and one patient had a cholesterol stone in the recurrent attack.CONCLUSION： Bilirubinate stone is the predominant composition of initial or recurrent CBD stone in Chinese patients, The composition of CBD stones may be different from initial stones afl：er ES,

Bioinformatic approach for understanding the heterogeneity of cholangiocytes

It is remarkable that microarray technologies have nearly reached a pinnacle. Establishment of further analysis and management of enormous data derived from microarray technology is currently the highest priority. The heterogeneous functions of cholangiocytes regulate the pathophysiology of the biliary epithelium in relation to secretory, proliferative and apoptotic activities. Distinct expression profiles of two murine cholangiocyte lines, termed small and large have been revealed by microarray analysis. The features of the two cholangiocyte cell lines, categorized partly according to gene ontology, indicate the specific physiological role of each cell line. The large cholangiocytes are characterized as “transport” and “immune/ inflammatory responses” In contrast, small cholangiocytes are associated with properties of limited physiological functional ability and proliferating/migrating potential with specific molecules like Eph receptors, comparable to mesenchymal cells. ＇Omic study will be of great help in understanding the heterogeniety of cholangiocytes.

先天性胆管扩张症18例诊治分析

目的:总结先天性胆管扩张症的诊断和治疗体会。方法:回顾性分析18例胆管扩张症的诊治经过。结果:术后胆汁瘘1例,经腹腔引流2周后,瘘口愈合,拔管后出院;2例出院后反复发生胆道感染,分别于术后8个月、1a时行二次手术(Roux-Y吻合术);余效果良好,无一例术后感染,结石形成发生。结论:本病的诊断依据临床"三联症",腹痛、黄疸及腹部包块,和B超、CT、MRCP(磁共振胰、胆管造影)等确定。治疗以囊肿切除、肝总管-空肠Roux-Y吻合术为主要手术方式,疗效满意。