目的探讨血清谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、腺苷脱氨酶(ADA)、糖类抗原CA19-9升高程度在黄疸类型鉴别中的价值。方法选取本院2011年1月—2013年10月收治的黄疸患者614例,根据黄疸类型将614位患者分为肝细胞性黄疸组和梗阻性黄疸组,后者又分为良性梗阻性黄疸和恶性梗阻性黄疸两组,分析GGT、ALP、ADA、CA19-9水平在各组间分布差异。结果 GGT、ALP值在梗阻性黄疸组中较肝细胞性黄疸组高,差异有统计学意义(P0.05);ADA值在肝细胞性黄疸组较对照组与梗阻性黄疸组增高,差异有统计学意义(P0.05);GGT、ALP、CA19-9值在恶性梗阻性黄疸组中较良性梗阻性黄疸组高,差异有统计学意义(P0.05)。结论 GGT、ALP显著升高,而ADA无明显升高的黄疸考虑梗阻性黄疸;GGT、ALP轻中度升高,而ADA显著升高的黄疸考虑肝细胞性性黄疸;GGT、ALP、CA19-9均显著升高者考虑恶性梗阻性黄疸。

Objective To investigate the value of serum GGT,ALP,ADA and CA19 - 9 in the diagnosis of jaun-dice. Methods 614 cases with jaundice were admitted to our hospital from January 2011 to October 2013,were divided into hepatocellular and obstructive jaundice group according to the type,and the patients in obstructive jaundice group were divided into benign obstructive jaundice group and malignant obstructive jaundice group. The distribution of serum GGT,ALP,ADA and CA19 - 9 in each group were analyzed. Results Compared with hepatocellular jaundice group,the serum level of GGT and ALP were higher in obstructive jaundice group,the differences were statistically significant(P < 0. 05);Compared with obstruc-tive jaundice group,the serum level of ADA was higher in hepatocellular Jaundice group,the difference was statistically signifi-cant(P < 0. 05);Compared with benign obstructive jaundice group,the serum levels of GGT,ALP and CA19 - 9 were higher in malignant obstructive jaundice group,the dif

探讨超声、核磁共振胰胆管成像(MRCP)检查方法对梗阻性黄疸的诊断价值。方法:选择2008年1月~2013年5月确诊为梗阻性黄疸的患者,比较分析各种检查方法对梗阻部位及梗阻病因的准确率。结果:确诊为梗阻性黄疸的患者为73例,彩超梗阻部位的显示率为79%,MRCP梗阻部位的显示率为91%。而梗阻原因有:胆总管结石、胰头癌、壶腹周围癌、、胆囊癌、胆管癌等。结论:各种诊断方法各有其优缺点,MRCP在梗阻性黄疸的诊断上具有较大的价值。

Objective To study diagnostic value of ultrasound and magnetic resonance Cjolangiopancreatograpjy( MRCP)in tje diag-nosis of obstructive jaundice. Method To Select tje patients diagnosed witj obstructive jaundice from January 2008 to May 2013,tje accu-racy of position and obstructive causes witj various metjods of cjecking was compared and analyzed. Results Obstructive jaundice patients wjo were Diagnosed were 73 cases,tje rate for distinction of color Doppler ultrasound for obstructive parts was 79%,tje Rate for distinction of MRCP for obstructive parts was 91%. Obstruction causes were cjoledocjolitjiasis,cancer of tje jead of tje pancreas,periampullary ade-nocarcinoma,carcinoma of bile duct,carcinoma of gallbladder. Conclusion Various diagnostic metjods jas tjeir advantages and disadvanta-ges,Tjere is a great value for diagnosing obstructive jaundice witj MRCP.

目的 通过检测良恶性梗阻性黄疸患者术前及术后血清B7-H3水平,了解其在梗阻性黄疸良恶性鉴别诊断方面的临床应用价值.方法 采集良性梗阻性黄疸32例及恶性梗阻性黄疸患者28例手术治疗前后的血清,通过酶联免疫吸附试验检测血清B7-H3浓度.结果 恶性梗阻性黄疸组血清B7-H3水平明显高于良性组(9334.57±1009.57) pg/mL vs(4450.81±406.92) pg/mL,差异具有显著的统计学意义(P＜0.01);良恶性梗阻性黄疸组术后血清B7-H3水平较术前降低(2531.03 ±415.64) pg/mL vs(4450.81±406.92)pg/mL,(5833.00 ±2190.87) pg/mL vs(9334.57±1009.57) pg/mL,差异具有显著的统计学意义(P＜0.01).结论 血清B7-H3参与机体炎症及肿瘤免疫应答,可用于梗阻性黄疸良恶性病因鉴别诊断.

Objective To investigated the significance of serum B7-H3 in differential diagnosis of patients with benign and malignant obstructive jaundice.Methods The B7-H3 levels in 60 patients with obstructive jaundice who were divided into benign (32 patients) and malignant (28 patients) obstructive jaundice group were tested by enzyme-linked immunosorbent assay before and after operation.Results The serum B7-H3 levels of malignant obstructive jaundice group were significantly higher than that of benign group (9334.57 ± 1009.57) pg/mL vs (4450.81 ± 406.92) pg/mL,(P ＜ 0.01).The B7-H3 levels of benign and malignant obstructive jaundice group after operation were significantly lower than those before operation (2531.03 ± 415.64) pg/mL vs (4450.81 ±406.92) pg/mL,(5833.00 ± 2190.87) pg/mL vs (9334.57±1009.57) pg/mL,(P＜0.01).Conclusion B7-H3 participate in the inflammatory immune and tumor immune response,The serum B7-H3 can be used as differential diagnosis index of benign and mali

目的动态观察梗阻性黄疸小鼠血浆MFG-E8水平,以及肝脏、脾脏、淋巴结、胸腺的MFG-E8mRNA和蛋白的表达情况,探讨其在梗阻性黄疸中的意义。方法建立梗阻性黄疸小鼠模型,分为假手术组、胆总管结扎组,采用蛋白免疫印迹法检测梗阻性黄疸小鼠第3、7、14天血浆中MFG-E8蛋白水平;RT-PCR检测肝脏、脾脏、淋巴结、胸腺中MFG-E8mRNA的表达变化;采用蛋白免疫印迹法检测上述组织中MFG-E8的蛋白表达水平。结果梗阻性黄疸小鼠血浆中MFG-E8蛋白水平在每个时相点均较假手术组明显降低(P0.05);肝脏、脾脏、淋巴结、胸腺组织中MFG-E8mRNA表达明显降低(P0.05),同时,肝脏、脾脏、淋巴结、胸腺组织中MFG-E8蛋白表达水平亦明显下降(P0.05)。结论 MFG-E8在梗阻性黄疸免疫组织中的表达明显减少,可能对梗阻性黄疸后组织凋亡细胞的清除产生重要的影响。

Objective To dynamically observe the plasma levels of MFG-E8 in mice with obstructive jaundice and the expression of MFG-E8 mRNA and protein in liver,spleen,lymph nodes and thymus,and to investigate their significance in obstructive jaun-dice.Methods The mice models of obstructive jaundice were established and divided into the sham operation group and the common bile duct ligation group.Western blot was adopted to detect plasma MFG-E8 protein expression in obstructive jaundice mice on 3,7, 14 d;the MFG-E8 mRNA expression changes in liver,spleen,lymph nodes and thymus tissue were detected by RT-PCR;the MFG-E8 protein expression in the above organizations was detected by Western blot.Results Plasma MFG-E8 protein levels at each time point in the obstructive jaundice mice were significantly lower than those in the control group (P<0.05);MFG-E8 mRNA expres-sion in liver,spleen,lymph nodes and thymus tissue was significantly decreased (P<0.05),meanwhile the MFG-E8 protein levels in liver,sp

目的分析肝癌经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)术后胆管狭窄致梗阻性黄疸的外科治疗方法。方法回顾性分析1994年6月至2011年3月在浙江省人民医院及浙江大学医学院附属第二医院229例因肝癌行肝脏TACE治疗后出现胆管狭窄的9例患者的临床资料。6例为原发性肝癌,3例为转移性肝癌。肝癌经TACE治疗后出现梗阻性黄疸的时间为5~16个月,中位时间为8个月。结果 9例胆管狭窄病例均出现不同程度梗阻性黄疸,6例经外科手术,1例经皮肝穿刺胆管造影(PTC)+胆管支架放置治疗使梗阻解除,2例仅行经皮经肝胆管穿刺引流(PTCD)。术后梗阻性黄疸均获得明显缓解。2例原发性肝癌TACE术后梗阻性黄疸随访3年,无胆管梗阻再发和肿瘤的复发;其余7例随访3~13个月,死于原发病恶化。结论手术或介入手段治疗肝癌TACE术后胆管狭窄致梗阻性黄疸可以获得良好的治疗效果,根据原发病和胆管梗阻的部位、范围决定外科治疗方式。

Objective To examine the surgical treatments for obstructive jaundice caused by bile duct strictures after hepat-ic transcatheter arterial chemoembolization(TACE).Methods Clinical data were retrospectively analyzed of 9 patients who de-veloped bile duct strictures among 229 patients after TACE between June 1994 and March 2011 in People’s Hospital of Zhe-jiang Provincial and the Second Affiliated Hospital of Zhejiang University.There were 6 cases of primary liver cancer,and 3 ca-ses of metastatic liver cancer.Obstructive jaundice occurred 5 to 16 months after TACE treatment.The median time was 8 months.Results All the nine patients with bile duct strictures suffered different degrees of obstructive j aundice,which was cured after surgical operations or PTC + stenting in 7 patients and significantly relieved by percutaneous transhepatic cholangic drainage(PTCD)in 2 ones.Two patients with obstructive j aundice after TACE for primary liver cancer were followed up for 3 years,and