Objective To investigate the changes of renal medulla aquaporin 2 expression and morphological changes of epithelia of collecting tube after bile duct recanalizaiton operation. Methods Thirty rats were divided into two groups randomly. Common bile duct ligation was performed on 20 experimental rats with silicon tubes 2 mm in extre-diameter, and sham operation on the other 10 rats. Seven days later, bile duct recanalizaiton was performed on obstructive jaundice group and sham operation on contrast group. Experimental rats were divided into two subgroups randomly. Half of them were killed immediately and the others would be killed 24 hours later. Serum of each rat was collected to detect hepatic function and renal function. Renal medulla was fixed for microscopic examination and was kept in the -80 ℃ refrigerator for aquaporin 2 expression measurement by Western blot technique. Results All of the animals accomplished the experiment smoothly. Golden ascites were found in the rats of obstructive jaundice group. Twenty-four hours after recanalization, serum bilirubin levels decreased 〔(45.95±8.39) μmol/L〕, P＜0.01, and there was no significant change in blood urine and creatine level. Compared with sham operation group (21 966.20±1 544.70), expression of aquaporin 2 decreased significantly after common bile duct ligation in obstructive jaundice group (15 665.30±1 181.85), P＜0.01. After recanalizaion, the expression of aquaporin 2 in obstructive jaundice group increased (19 490.80±4 239.32), P＜0.01. Conclusion Common bile duct obstruction would lead to epithelium injury of renal collecting tube, and down regulate the aquaporin 2 expression.
Objective To investigate the imaging features of intestinal volvulus on multi-detector row spiral CT (MDCT). MethodsThirty-one patients with surgically confirmed intestinal volvulus were included in this study. Nine patients received MDCT plain scan, 22 received contrast enhanced MDCT scan and 5 of them had additional CT angiography. Two abdominal radiologists analyzed the MDCT imaging features of intestinal volvulus observed, such as the location, direction of rotation, degree of volvulus, appearance rate of the “whirl sign” and the “beak sign”, bowel wall thickening and ascites and the possible causes of volvulus, which were recorded with review of surgical findings. Results The location of volvulus included duodenum (1 case), jejunum (23 cases), ileum (3 cases), entire small intestine (2 cases) and sigmoid colon (2 cases). The location of volvulus was correctly diagnosed based on MDCT findings in 27 patients (27/31; 87.0%). The direction of volvulus was correctly diagnosed for all patients based on MDCT findings (clockwise in 11 cases and counterclockwise in 20 cases). The degrees of volvulus assessed on MDCT findings were respectively 180° in 13 cases, 360° in 12 cases, 540° in 2 cases, 720° in 2 cases and 900° in 2 cases, as compared with surgical findings of 180° in 17 cases, 360° in 10 cases, 540° in 1 case, and 720° in 3 cases. The diagnostic accuracy of MDCT for assessing the degree of volvulus was 74.2%. The “whirl sign” and “beak sign” appeared in 18 and 20 patients, respectively. Bowel wall thickening and ascites were showed in 9 patients. In 5 patients with reconstructed images, the images obtained by maximum intensity projection (MIP) and volume rendering (VR) techniques showed the abnormality of mesenteric vessels in all patients, and the multi-planar reconstruction (MPR) image of one patient showed the “whirl sign” and the “beak sign”. The causes of intestinal volvulus were identified on MDCT in 10 patients. Conclusion The “whirl sign” and the “beak sign” are the characteristic images of intestinal volvulus on MDCT. Bowel wall thickening and ascites may indicate the hemody-namic images impairment of volvulus. MDCT plays valuable role in the diagnosis of intestinal volvulus.
【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.
目的 探討先天性十二指腸梗阻的病因、臨床表現、手術方法及術后處理。方法 回顧性分析我院1993年10月至2010年10月期間治療的26例先天性十二指腸梗阻患者的臨床資料。結果 26例先天性十二指腸梗阻患者中腸旋轉不良16例，行Ladd手術，其中1例因術中發現廣泛腸壞死家屬放棄治療，其余15例痊愈。4例單純十二指腸膈膜者行十二指腸膈膜切除術（縱切橫縫），3例單純十二指腸狹窄者行十二指腸空腸吻合術，均痊愈。單純環狀胰腺2例，行十二指腸-十二指腸菱形吻合術或十二指腸空腸吻合術后均痊愈。腸系膜上動脈壓迫綜合征1例，行十二指腸空腸吻合術后痊愈。結論 先天性十二指腸梗阻是常見的新生兒急癥，早期診斷，正確處理不同類型梗阻，加強圍手術期處理，是提高治愈率的關鍵。
目的 探討腹腔鏡粘連松解術治療粘連性腸梗阻的應用價值。方法 對我院2005年7月至2011年9月期間采用腹腔鏡進行腸粘連松解術的27例患者的臨床資料進行回顧性分析。結果 27例患者中除2例因術中探查發現小腸壞死而中轉開腹行腸切除外，其余25例均手術成功，手術時間（65±15） min （40～115min）。27例均獲隨訪，隨訪時間（14±6）個月（8個月～2年），1例患者于術后1個月時有陣發性腹痛，經保守治療緩解，其余病例均無腹脹、腹痛等癥狀發生。結論 腹腔鏡粘連松解術治療粘連性腸梗阻具有創傷小、恢復快的優點，是較理想的治療術后腸粘連的手段。
Objective To establish interstitial cells of Cajal （ICC） loss models caused by incomplete small intestinal obstruction in rats with modified method and verify it. Methods Modified method was used to establish the models， making the ring around the small intestine but not through it. Morphological changes were observed by general signs， pathological changes were tested by HE staining and transmission electron microscope （TEM）， and changes of ICC number were tested by immunohistochemistry staining. Results Success rate of this method was 56% （28/50）， weight loss happened compared with before operation in ileus group （P＜0.01）. Hyperemia and swelling were observed in ileus group， and gastric retention was obvious. Results of HE staining and TEM showed that there was obvious inflammatory change， and ICC reduced was observed by immunohistochemistry. Conclusion ICC loss models caused by incomplete small intestinal obstruction meet the basic performance， and can be used for further research.
ObjectiveTo summarize the recent advancements in the researches on the pathogenesis of postoperative ileus and explain the clinical significances of postoperative ileus mechanisms for the diagnosis, treatment, and prevention. MethodsRelevant literatures about the postoperative ileus mechanism published recently were collected and reviewed. ResultsThe occurrence of postoperative ileus were related to postoperative nerve reflex inhibition, inflammatory response, effects of drugs, and other factors, it was a variety of mechanisms modulating each other. ConclusionThe gastrointestinal motility of postoperative ileus is mainly regulated by neural reflexes, inflammatory reactions, and drug interactions, three of which act differently but as a whole in different time segments while the inflammatory response play a key role of postoperative ileus persistence.