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Expanding etiology of progressive familial intrahepatic cholestasis 预览
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作者 Sarah AF Henkel Judy H Squires +3 位作者 Mary Ayers Armando Ganoza Patrick Mckiernan James E Squires 《世界肝病学杂志:英文版(电子版)》 2019年第5期450-463,共14页
BACKGROUND Progressive familial intrahepatic cholestasis(PFIC)refers to a disparate group of autosomal recessive disorders that are linked by the inability to appropriately form and excrete bile from hepatocytes,resul... BACKGROUND Progressive familial intrahepatic cholestasis(PFIC)refers to a disparate group of autosomal recessive disorders that are linked by the inability to appropriately form and excrete bile from hepatocytes,resulting in a hepatocellular form of cholestasis.While the diagnosis of such disorders had historically been based on pattern recognition of unremitting cholestasis without other identified molecular or anatomic cause,recent scientific advancements have uncovered multiple specific responsible proteins.The variety of identified defects has resulted in an ever-broadening phenotypic spectrum,ranging from traditional benign recurrent jaundice to progressive cholestasis and end-stage liver disease.AIM To review current data on defects in bile acid homeostasis,explore the expanding knowledge base of genetic based diseases in this field,and report disease characteristics and management.METHODS We conducted a systemic review according to PRISMA guidelines.We performed a Medline/PubMed search in February-March 2019 for relevant articles relating to the understanding,diagnosis,and management of bile acid homeostasis with a focus on the family of diseases collectively known as PFIC.English only articles were accessed in full.The manual search included references of retrieved articles.We extracted data on disease characteristics,associations with other diseases,and treatment.Data was summarized and presented in text,figure,and table format.RESULTS Genetic-based liver disease resulting in the inability to properly form and secrete bile constitute an important cause of morbidity and mortality in children and increasingly in adults.A growing number of PFIC have been described based on an expanded understanding of biliary transport mechanism defects and the development of a common phenotype.CONCLUSION We present a summary of current advances made in a number of areas relevant to both the classically described FIC1(ATP8B1),BSEP(ABCB11),and MDR3(ABCB4)transporter deficiencies,as well as more recently described gene mutati 展开更多
关键词 CHOLESTASIS Progressive FAMILIAL INTRAHEPATIC CHOLESTASIS BENIGN recurrent INTRAHEPATIC CHOLESTASIS INTRAHEPATIC CHOLESTASIS of pregnancy Drug induced CHOLESTASIS BILE acids BILE transport
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加味茵陈蒿方联合熊去氧胆酸治疗肝胆湿热型妊娠期肝内胆汁淤积症的临床研究 预览
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作者 罗志平 石珍珍 +3 位作者 黄启玉 金卉 江芳 李甜甜 《河北中医》 2019年第6期891-895,共5页
目的 观察加味茵陈蒿方联合熊去氧胆酸治疗肝胆湿热型妊娠期肝内胆汁淤积症的临床疗效。方法 将88例肝胆湿热型妊娠期肝内胆汁淤积症患者按照随机数字表法分为2组。对照组44例予熊去氧胆酸胶囊治疗;治疗组44例在对照组治疗基础上加用加... 目的 观察加味茵陈蒿方联合熊去氧胆酸治疗肝胆湿热型妊娠期肝内胆汁淤积症的临床疗效。方法 将88例肝胆湿热型妊娠期肝内胆汁淤积症患者按照随机数字表法分为2组。对照组44例予熊去氧胆酸胶囊治疗;治疗组44例在对照组治疗基础上加用加味茵陈蒿方治疗。2组均治疗2周后统计临床疗效,并观察2组治疗前后中医症状积分、总胆汁酸(TBA)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、直接胆红素(DBiL)、甘胆酸(CG)和血清白细胞介素4(IL-4)、干扰素γ(IFN-γ)水平,以及妊娠结局。结果 治疗组总有效率93.18%,对照组总有效率72.23%,治疗组临床疗效优于对照组(P<0.05)。治疗后2组各中医症状积分及血清TBA、AST、ALT、DBiL、CG、IFN-γ水平均降低(P<0.05),且治疗组低于对照组(P<0.05)。治疗后2组血清IL-4水平均上升(P<0.05),且治疗组高于对照组(P<0.05)。治疗组早产、新生儿窒息、胎儿窘迫、产后出血发生率与对照组比较差异无统计学意义(P>0.05);治疗组新生儿体质量高于对照组(P<0.05),羊水污染率低于对照组(P<0.05)。结论 加味茵陈蒿方联合熊去氧胆酸治疗肝胆湿热型妊娠期肝内胆汁淤积症疗效确切,并能改善肝功能。 展开更多
关键词 妊娠并发症 胆汁淤积 肝内 肝胆湿热 中西医结合疗法
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STAT3在妊娠期肝内胆汁淤积症孕妇胎盘中的表达及意义 预览
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作者 叶云飞 蒙文霞 +3 位作者 陈滢 周一萍 李文怡 陈柏秀 《重庆医学》 CAS 2019年第11期1866-1869,共4页
目的探讨信号转导和转录活化因子3(STAT3)在妊娠期肝内胆汁淤积症(ICP)孕妇胎盘中的表达及意义。方法选择2016年1月至2017年12月于柳州市人民医院产科门诊产检并住院分娩、资料完整的重度ICP孕妇25例为试验组,选择同期健康顺产孕妇30例... 目的探讨信号转导和转录活化因子3(STAT3)在妊娠期肝内胆汁淤积症(ICP)孕妇胎盘中的表达及意义。方法选择2016年1月至2017年12月于柳州市人民医院产科门诊产检并住院分娩、资料完整的重度ICP孕妇25例为试验组,选择同期健康顺产孕妇30例为对照组。采用免疫组织化学链霉素抗生物素蛋白-过氧化物酶链接法(SP法)测定STAT3、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)在孕妇胎盘组织中的定位与表达水平。蛋白印迹法检测STAT3蛋白的表达水平。结果(1)试验组孕妇胎盘滋养层细胞中STAT3、IL-6和TNF-α阳性细胞率及平均光密度值明显高于对照组(P<0.05)。(2)试验组孕妇胎盘滋养层细胞中STAT3表达阳性细胞率与IL-6、TNF-α水平呈正相关(r=0.687,P<0.05)。(3)试验组STAT3蛋白的表达量明显高于对照组,差异有统计学意义(P<0.05)。结论STAT3可能参与了ICP的发病且与IL-6、TNF-α在ICP发生发展中具有共同促进作用。 展开更多
关键词 胆汁淤积 肝内 胎盘 信号转导和转录活化因子3 白细胞介素-6 肿瘤坏死因子-α
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肝圆韧带途径在肝门胆管良性狭窄中的应用
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作者 孙增鹏 彭创 +1 位作者 易为民 吴金术 《中华普通外科杂志》 CSCD 北大核心 2019年第5期381-383,共3页
目的探讨肝圆韧带途径在肝门部胆管良性狭窄疾病中的应用价值。方法回顾性分析2016年3月至2018年3月湖南省人民医院收治的62例肝门部胆管良性狭窄患者的临床资料。结果62例肝门部胆管狭窄的病因依次为肝胆管结石(37例),医源性近段胆管损... 目的探讨肝圆韧带途径在肝门部胆管良性狭窄疾病中的应用价值。方法回顾性分析2016年3月至2018年3月湖南省人民医院收治的62例肝门部胆管良性狭窄患者的临床资料。结果62例肝门部胆管狭窄的病因依次为肝胆管结石(37例),医源性近段胆管损伤(12例),胆肠吻合口再次狭窄(7例),胆管囊状扩张症(4例),桥祥结石(2例)。本组患者均经肝圆韧带途径成功进入肝内胆管,行肝门胆管整形,胆管盆式内引流术,平均历时230.3 min,平均失血量196.8 ml。按照Clavien-Dindo评分系统,Ⅰ级并发症32例,Ⅱ级并发症3例,无Ⅲ级以上并发症。出院后经过门诊、电话随访1-24个月,3例患者发生返流性胆管炎,尚未发现胆肠吻合口再次狭窄的病例。结论肝圆韧带途径是一条解除肝门部胆管良性狭窄、进入肝内胆管的有效途径。 展开更多
关键词 缩窄 病理性 胆管 肝内
益生菌对急性肝内胆汁淤积模型大鼠肝损伤的保护作用及机制研究 预览
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作者 王菊平 马姝丽 +1 位作者 李小芹 周方 《重庆医学》 CAS 2019年第14期2356-2359,共4页
目的分析益生菌对急性肝内胆汁淤积模型大鼠肝损伤的保护作用及其机制。方法60只幼年雄性SD大鼠分为正常组、模型组与干预组,每组各20只。干预组大鼠每天1次行益生菌4.2×10^8个活菌数/kg灌胃,正常组与模型组给予同等量温生理盐水... 目的分析益生菌对急性肝内胆汁淤积模型大鼠肝损伤的保护作用及其机制。方法60只幼年雄性SD大鼠分为正常组、模型组与干预组,每组各20只。干预组大鼠每天1次行益生菌4.2×10^8个活菌数/kg灌胃,正常组与模型组给予同等量温生理盐水灌胃。模型组与干预组第5天开始建立急性肝内胆汁淤积模型,造模后48、72h分别处死大鼠,取血行总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、二胺氧化酶(DAO)、D-乳酸(D-LA)检测,取肝组织测定核因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)表达。结果造模后48、72h模型组及干预组血清TBIL、DBIL、ALT、DAO、D-LA水平和肝组织NF-κB、TNF-α表达均显著高于正常组,且干预组低于模型组,差异均有统计学意义(P<0.05)。结论益生菌能有效保护急性肝内胆汁淤积模型大鼠肝损伤,其机制可能与益生菌下调血清DAO、D-LA及肝组织NF-κB、TNF-α表达有关。 展开更多
关键词 胆汁淤积 肝内 鼠李糖乳杆菌 化学性与药物性肝损伤 药理作用分子作用机制
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肝胆管结石经三维可视化辅助3D腹腔镜和胆道硬镜靶向治疗的效果 预览
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作者 韩云 韩莉 +2 位作者 杨生虎 杨立平 李晓峰 《中华普外科手术学杂志(电子版)》 2019年第5期504-506,共3页
目的 探讨肝胆管结石经三维可视化辅助3D腹腔镜、胆道硬镜靶向碎石治疗的临床疗效。方法 回顾性分析2012年1月至2017年6月行腹腔镜、胆道硬镜靶向碎石治疗的98例肝胆管结石患者资料,按照手术方式不同分为3D腹腔镜组(3D组, n =46)和普通... 目的 探讨肝胆管结石经三维可视化辅助3D腹腔镜、胆道硬镜靶向碎石治疗的临床疗效。方法 回顾性分析2012年1月至2017年6月行腹腔镜、胆道硬镜靶向碎石治疗的98例肝胆管结石患者资料,按照手术方式不同分为3D腹腔镜组(3D组, n =46)和普通腹腔镜组(2D组, n =52)。采用SPSS 21.0对数据进行分析。术中、术后各项定量指标采用(±s)描述,独立t检验;结石清除率、术后结石复发率、胆管炎复发率、并发症发生率等组间比较采用Pearson χ 2检验。P <0.05为差异有统计学意义。结果 3D组术前三维可视化重建情况与术中所见基本符合,实际手术方案与仿真手术方案符合率100%。3D组的手术时间、术中出血量、输血量、结石清除率和术后住院时间显著优于2D组( P <0.05)。术后随访(12.2±2.8)个月,3D组的结石复发率(0%)、总体并发症发生率(4.3%)显著低于2D组(9.6%,19.2%)( P <0.05)。结论 三维可视化辅助3D 腹腔镜、胆道硬镜肝胆管结石靶向碎石术实现了对肝胆管结石安全有效的微创治疗,能实现精准术前诊断,优化手术方案,提高结石清除率、减少术后并发症和结石复发,具有临床应用价值。 展开更多
关键词 结石 胆管 肝内 腹腔镜 成像 三维
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全腹腔镜肝叶切除联合经皮经肝胆道硬镜治疗左肝内胆管结石的效果 预览
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作者 何战洋 范秋红 《中华普外科手术学杂志(电子版)》 2019年第5期507-510,共4页
目的 探讨模式化全腹腔镜肝叶切除联合经皮经肝胆道硬镜碎石治疗左肝内胆管结石的临床疗效。方法 回顾性选取2015年1月至2017年12月期间100例左肝内胆管结石患者为研究对象,根据手术方式分为腹腔镜联合胆道镜组(腔镜组, n =50)和开腹联... 目的 探讨模式化全腹腔镜肝叶切除联合经皮经肝胆道硬镜碎石治疗左肝内胆管结石的临床疗效。方法 回顾性选取2015年1月至2017年12月期间100例左肝内胆管结石患者为研究对象,根据手术方式分为腹腔镜联合胆道镜组(腔镜组, n =50)和开腹联合胆道镜组(开腹组, n =50),采用SPSS19.0软件进行数据分析。术中术后等计量资料采用均数±标准差描述,组间比较采用独立 t 检验;术后残石、并发症、近期疗效和复发情况等分类资料和有序资料组间比较采用 Pearson χ 2 检验、 Kruskal-Wallis 检验。 P <0.05为差异有统计学意义。结果 两组的手术时间差异无统计学意义( P >0.05);腔镜组术中出血量、术后下床锻炼时间、肠道排气时间和住院时间显著优于开腹组( P <0.05);两组患者术后2周的ALT、AST、TBIL水平均较术前显著下降,且腔镜组的ALT、AST水平显著低于开腹组( P <0.05);腔镜组总并发症发生率显著低于开腹组(10.0% vs. 26.0%), P <0.05;腔镜组的近期疗效显著优于开腹组( P <0.05),两组的术后1年复发率差异无统计学意义( P >0.05)。结论 模式化全腹腔镜肝叶切除联合经皮经肝胆道硬镜取石术治疗左肝内胆管结石安全有效,具有术后恢复快、并发症少、临床疗效好的优点,具有较好的临床使用价值。 展开更多
关键词 结石 胆管 肝内 腹腔镜 肝切除术
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Analysis of intrahepatic sarcomatoid cholangiocarcinoma:Experience from 11 cases within 17 years 预览
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作者 Dong Kyun Kim Bo Ra Kim +1 位作者 Jin Sook Jeong Yang Hyun Baek 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第5期608-621,共14页
BACKGROUND Intrahepatic sarcomatoid chonalgiocarcinoma(s-CCC)is an extremely rare disease,accounting for less than 1%of hepatobiliary system malignancies,and its pathophysiology is not well known.On the hypothesis tha... BACKGROUND Intrahepatic sarcomatoid chonalgiocarcinoma(s-CCC)is an extremely rare disease,accounting for less than 1%of hepatobiliary system malignancies,and its pathophysiology is not well known.On the hypothesis that its clinical,serologic,or radiologic diagnosis are not fully understood and its prognosis is poor,we investigated the distinguishing features of s-CCC compared with those of intrahepatic bile duct adenocarcinoma[cholangiocellular carcinoma(CCC)]in patients from a single center.AIM To analyze the clinical,serologic,imaging,and histopathologic characteristics of intrahepatic s-CCC patients diagnosed in a single center.METHODS The clinical,serologic,imaging,and histopathologic features of 227 patients diagnosed with intrahepatic cholangiocarcinoma(IHCC)in a single medical center during the last 17 years were analyzed.The characteristics of 11 patients with s-CCC were compared with those of 216 patients with CCC.RESULTS The number of patients with s-CCC who presented fever and abdominal pain and past history of chronic viral hepatitis or liver cirrhosis(LC)was higher than that of patients with CCC.In imaging studies,patients with s-CCC showed relatively aggressive features.However,no clear distinction was observed between s-CCC and CCC based on other clinical,serologic or radiologic examination results.An accurate diagnosis could be made only via a histopathologic examination through immunohistochemical staining.The clinical course of s-CCC was generally aggressive,and patients had a relatively poor prognosis.CONCLUSION In patients with s-CCC,early diagnosis through biopsy and aggressive treatment,including surgical resection,are important. 展开更多
关键词 INTRAHEPATIC SARCOMATOID CHOLANGIOCARCINOMA IMMUNOHISTOCHEMICAL STAINING Survival Prognosis Surgical RESECTION
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Effect of compound Yindan decoction on alpha-naphthylisothiocyanate-Induced acute intrahepatic cholestasis in rats
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作者 Sun Fengxia Li Xiaoling +3 位作者 Xu Chunjun Sui Jingli Li Pan Wu Jingjing 《中医杂志:英文版》 SCIE CAS CSCD 2019年第3期315-323,共9页
OBJECTIVE:To investigate the therapeutic mechanism of compound Yindan decoction (CYD) in a rat model of acute intrahepatic cholestatic (AIC).METHODS:A total of 108 adult male rats were randomly divided into control (n... OBJECTIVE:To investigate the therapeutic mechanism of compound Yindan decoction (CYD) in a rat model of acute intrahepatic cholestatic (AIC).METHODS:A total of 108 adult male rats were randomly divided into control (n =18) and AIC groups (n =90).AIC was induced in rats using alpha-naphthylisothiocyanate (ANIT)(75 mg/kg,10 mL/kg in corn oil,p.o.).Then,90 AIC rats were randomly divided into five groups:a control group (n =18),a CYD high dose group (n =18),a CYD middle dose group (n =18),a CYD low dose group (n =18),and a ursodeoxycholicacid (UDCA) group (n =18).According to sampling time,each group was subdivided into three subgroups:24 h (n =6),48 h (n =6),and 72 h groups (n =6).The CYD-high,-middle and-low groups were orally administered 24.48,12.24,and 6.12 g.kg-1.d-1 modified CYD,respectively,while the model group was given 20 mL/kg of body weight of distilled water once a day.The UDCA group was given 67.5 mg.kg-1.d-1 UDCA once a day.Radioimmunity assay was used to detect the activity of alanine aminotransferase (ALT),aspartate aminotransferase (AST),alkaline phosphatase (ALP),gamma-glutamyl transpeptidase (GGT) and the levels of total bilirubin (TBil) and indirectbiliruin (DBil) in rats.Reverse transcription quantitative polymerase chain reaction (qRT-PCR),Western blot analysis,and immunohistochemistry were used to detect multidrug resistance-associated protein 2 (MRP2) expression.In vitro,HepG2 hepatocellular carcinoma cells were treated with CYD medicated serum at a concentration of 15 mol/L.MRP2 and retinoid X receptor alpha (RXRα) expression was analyzed by qRT-PCR and Western blotting.RESULTS:Serum levels of ALT,AST,GGT,ALP,TBil,and DBil were significantly reduced in the CYD and positive drug groups compared with the control group (P < 0.05 and P < 0.01,respectively).Pathological changes in rat liver tissues at 72 h in the CYD-high and-medium dose groups and positive drug group were not significant compared with the control group.CYD and UDCA treatment ameliorated ANIT-induced biliary epithelial cell pro 展开更多
关键词 Cholestasis intrahepatic MULTIDRUG resistance-associated proteins RETINOID X receptor alpha COMPOUND Yindan DECOCTION
Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma 预览
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作者 Shi-Hua Luo Jian-Guo Chu +1 位作者 He Huang Ke-Chun Yao 《世界临床病例杂志》 2019年第13期1599-1610,共12页
BACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hyper... BACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hypertension. However, because of the risk of postoperative liver failure, severe complications, and low survival rate for HCC, TIPS is contraindicated in patients with portal hypertension and liver cancer. We studied a large cohort of patients with cirrhosis and HCC who underwent TIPS for recurrent variceal bleeding and/or ascites. AIM To assess the safety, efficacy, and survival rate in patients with HCC who underwent TIPS. METHODS Group A comprised 217 patients with HCC and portal hypertension who underwent the TIPS procedure between 1999 and 2014. After TIPS deployment, these patients received palliative treatment for HCC. Group B comprised a cohort of 136 HCC patients with portal hypertension who did not undergo TIPS placement. Group B received palliative treatment for HCC plus medical therapy for portal hypertension. The clinical outcomes and survival rate were assessed. RESULTS In Group A, the primary technical success rate was 97.69% for TIPS placement,and no severe procedure-related complications of TIPS placement were reported. The control of variceal bleeding (VB) within 1 mo did not differ significantly between the groups (P = 0.261). Absorption of refractory ascites within 1 mo, recurrence of VB, and recurrence of refractory ascites differed significantly between the groups (P = 0.017, 0.023, and 0.009, respectively). By comparison, the rate of hepatic encephalopathy in Group B was lower than that in Group A (P = 0.036). The 1-, 2-, 3-, 4-, and 5-year survival rates were significantly different between Groups A and B (χ^2 = 12.227, P = 0.018;χ^2 = 12.457, P = 0.014;χ^2 = 26.490, P = 0.013;χ^2 = 21.956, P = 0.009, and χ^2 = 24.596, P = 0.006, respectively). The mean survival time was 43.7 mo in Group A and 31.8 mo in Group B. Median survival time was 50.0 mo in Group A and 33.0 mo in Grou 展开更多
关键词 HEPATOCELLULAR carcinoma PORTAL hypertension Transjugular INTRAHEPATIC portosystemic SHUNT Transarterial CHEMOEMBOLIZATION RADIOFREQUENCY ablation
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Temporal trends of cirrhosis associated conditions 预览
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作者 Tomoki Sempokuya Guangxiang Zhang Kazuma Nakagawa 《世界肝病学杂志:英文版(电子版)》 2019年第1期74-85,共12页
AIM To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. METHODS The publicly available Healthcare Cost and Utilization Projec... AIM To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. METHODS The publicly available Healthcare Cost and Utilization Project National Inpatient Sample database was utilized to examine the temporal trends of total number of discharges, mortalities and inpatient costs related to hospitalization with a primary diagnosis of HC, transjugular intrahepatic portosystemic shunt (TIPS), esophageal varices with bleeding (EV) and spontaneous bacterial peritonitis (SBP) from 2005 to 2014. The ten-year temporal trends were assessed using simple linear regressions and multiple regression analysis. Two-sided P < 0.05 was considered statistically significant. RESULTS From 2005 to 2014, the total number of discharges with cirrhosis-associated complications trended up for HC, SBP and EV (HC by 70% increase, P < 0.0001; SBP by 819% increase, P = 0.0002; EV by 9% increase, P = 0.016), but not for TIPS (P = 0.90). HC related to viral hepatitis showed faster increase by 357%(P < 0.0001) in comparison to HC not related to viral hepatitis by 33 %(P = 0.0006). Overall, in-hospital mortality rates for each condition decreased from 2005 to 2014 (HC by 29% reduction, P = 0.0024; SBP by 26% reduction, P = 0.0038; TIPS by 32% reduction, P = 0.021) except for EV (P = 0.34). After adjustment for inflation, aggregate cost of hospitalization for EV, HC, and SBP significantly increased by 20%, 86%, and 980%, respectively, from 2005 to 2014 (all P < 0.02), while TIPS had trend toward decreasing cost by 3%(P = 0.95). CONCLUSION The number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. However, the inpatient mortality rates for most of these conditions decreased. 展开更多
关键词 CIRRHOSIS Hepatic ENCEPHALOPATHY Spontaneous bacterial PERITONITIS Esophageal VARICES Transjugular INTRAHEPATIC portosystemic SHUNT
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腹腔镜、胆管镜、扩张导管、T管支架捆绑引流治疗胆结石、乳头部梗阻52例 预览
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作者 陈安平 曾乾桃 +5 位作者 周华波 高原 索运生 刘安 刘进衡 张胜龙 《中华普外科手术学杂志(电子版)》 2019年第2期193-195,共3页
目的探讨腹腔镜、胆管镜、扩张导管(逐级扩张导管、球囊导管)、T管支架捆绑引流(LCDTS)治疗胆囊结石、胆总管结石及十二指肠乳头部梗阻或狭窄的应用体会。方法回顾性分析1999年11月至2017年9月期间,符合入选标准的52例患者的临床资料。... 目的探讨腹腔镜、胆管镜、扩张导管(逐级扩张导管、球囊导管)、T管支架捆绑引流(LCDTS)治疗胆囊结石、胆总管结石及十二指肠乳头部梗阻或狭窄的应用体会。方法回顾性分析1999年11月至2017年9月期间,符合入选标准的52例患者的临床资料。结果腹腔镜下行胆囊切除术和胆总管探查取石术52例。逐级导管扩张乳头并留置T形管+塑料胆管支架75.1%(39/52),逐级导管联合球囊导管扩张乳头并留置T形管+塑料胆管支架11.5%(6/52),因逐级导管扩张乳头不成功而中转为腹腔镜术中内镜乳头切开术并留置T形管+塑料胆管支架9.6%(5/52),因塑料胆管支架放置失败而中转为T管引流术3.8%(2/52)。术后残石1例(1.9%),胆汁漏1例(1.9%),经T管瘘道拔支架失败2例(3.8%)。无肠穿孔、胆管穿孔、大出血、急性胰腺炎等并发症,无死亡患者。术后总并发症发生率为7.7%(4/52)。结论从本研究初步研究发现,只要病例选择合适,LCDTS治疗胆囊结石、胆总管结石及十二指肠乳头部梗阻或狭窄是可行、有效和安全的。 展开更多
关键词 胆结石 胆汁淤积 肝内 腹腔镜 扩张术
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Incidence of portal vein thrombosis after splenectomy and its influence on transjugular intrahepatic portosystemic shunt stent patency 预览
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作者 Fang Dong Shi-Hua Luo +4 位作者 Li-Juan Zheng Jian-Guo Chu He Huang Xue-Qiang Zhang Ke-Chun Yao 《世界临床病例杂志》 2019年第17期2450-2462,共13页
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension.TIPS has been used to treat portal vein thrombosis... BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension.TIPS has been used to treat portal vein thrombosis (PVT) in many centers since the 1990s.Although TIPS has good therapeutic effects on the formation of PVT,the effect of PVT on TIPS stenting has rarely been reported.Patients with splenectomy and pericardial devascu-larization have a high incidence of PVT,which can markedly affect TIPS stent patency and increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.AIM To investigate the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.METHODS Four hundred and eighty-six patients with portal hypertension for refractory ascites and/or variceal bleeding who required TIPS placement between January 2010 and January 2016 were included in this retrospective analysis.Patients without prior splenectomy were defined as group A (n = 289) and those with prior splenectomy as group B (n = 197).The incidence of PVT before TIPS was compared between the two groups.After TIPS placement,primary patency rate was compared using Kaplan–Meier analysis at 3,6,9 and 12 mo,and 2 and 3 years.The clinical outcomes were analyzed.RESULTS Before TIPS procedure,the incidence of PVT in group A was lower than in group B (P = 0.003),and TIPS technical success rate in group A was higher than in group B (P = 0.016).The primary patency rate in group A tended to be higher than in group B at 3,6,9 and 12 mo,2 years and 3 years (P = 0.006,P = 0.011,P = 0.023,P = 0.032,P = 0.037 and P = 0.028,respectively).Recurrence of bleeding and ascites rate in group A was lower than in group B at 3 mo (P ≤ 0.001 and P = 0.001),6 mo (P = 0.003 and P = 0.005),9 mo (P = 0.005 and P = 0.012),12 mo (P = 0.008 and P = 0.024),2 years (P = 0.011 and P = 0.018) and 3 years (P = 0.016 and P = 0.017),respectively.During 3-years follow-up,the 1-,2- and 3-yea 展开更多
关键词 PORTAL hypertension Transjugular INTRAHEPATIC portosystemic SHUNT SPLENECTOMY PORTAL vein THROMBOSIS
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肝内胆管癌的综合治疗
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作者 唐陈伟 童焕军 汤朝晖 《中国普通外科杂志》 CAS CSCD 北大核心 2019年第8期903-909,共7页
肝内胆管癌(ICC)具有恶性程度高,发现晚,容易发生淋巴结转移、脉管侵润及肝内播散等特点,导致患者预后较差。根治性手术仍然是目前唯一可以使患者获得长期生存的治疗方式,但存在根治性切除率低、术后容易复发等诸多难题以及肝切除范围... 肝内胆管癌(ICC)具有恶性程度高,发现晚,容易发生淋巴结转移、脉管侵润及肝内播散等特点,导致患者预后较差。根治性手术仍然是目前唯一可以使患者获得长期生存的治疗方式,但存在根治性切除率低、术后容易复发等诸多难题以及肝切除范围和切缘宽度确定、淋巴结清扫与否等诸多争议。辅助治疗是综合治疗的重要组成部分,但放化疗尚无规范、有效的方案,靶向治疗与免疫治疗正处于临床探索阶段。随着分子生物学技术的进展,发现ICC在基因突变、信号传导以及临床病理特征上展现出高度的异质性。笔者从ICC生物学特性及临床特点的异质性出发,结合ICC治疗策略和新的综合治疗理念,为其个体化治疗提供新的思路与研究方向。 展开更多
关键词 胆管肿瘤 胆管 肝内 异质性 肿瘤治疗方案
RCAS1/EBAG9与P53蛋白在肝内胆管癌中的表达及临床意义
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作者 王逸君 徐自强 +3 位作者 王志明 乐冬友 袁伟杰 许可 《中国普通外科杂志》 CAS CSCD 北大核心 2019年第8期952-959,共8页
目的:探讨RCAS1/EBAG9与P53蛋白在肝内胆管癌(ICC)组织中的表达及临床意义。方法:用免疫组化法检测41例ICC组织及9例正常胆管组织中RCAS1/EBAG9和P53蛋白的表达,分析RCAS1/EBAG9与P53蛋白的表达与ICC患者的临床病理因素和预后的关系。结... 目的:探讨RCAS1/EBAG9与P53蛋白在肝内胆管癌(ICC)组织中的表达及临床意义。方法:用免疫组化法检测41例ICC组织及9例正常胆管组织中RCAS1/EBAG9和P53蛋白的表达,分析RCAS1/EBAG9与P53蛋白的表达与ICC患者的临床病理因素和预后的关系。结果:RCAS1/EBAG9与P53蛋白在ICC组织中阳性率均明显高于与正常胆管组织(均P<0.05);RCAS1/EBAG9蛋白表达与肿瘤大小、病理分级、TNM分期以及淋巴结转移有关(均P<0.05),而P53蛋白表达与肿瘤大小、病理分级以及TNM分期有关(均P<0.05)。ICC中RCAS1/EBAG9与P53蛋白表达正相关(r=0.329,P=0.018)。RCAS1/EBAG9与P53蛋白阴性表达患者术后总生存期明显长于RCAS1/EBAG9与P53蛋白阳性表达患者(χ^2=3.862,P=0.049;χ^2=4.977,P=0.026)。单因素与多因素Cox回归分析表明,RCAS1/EBAG9蛋白表达是ICC患者预后的独立危险因素(HR=3.657,95%CI=1.111~12.040,P=0.033)。结论:RCAS1/EBAG9与P53蛋白在ICC组织中表达增加,并且与ICC患者不良临床病理特征及预后密切相关,其中RCAS1/EBAG9可能起了关键作用。 展开更多
关键词 胆管肿瘤 胆管 肝内 抗原 肿瘤 免疫组织化学 预后
一例高龄、高危孕妇案例分析并文献复习 预览
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作者 李杰 白玉芳 +2 位作者 穆碗如 南连玲 张红 《国际妇产科学杂志》 CAS 2019年第5期523-526,共4页
随着“全面二孩”政策的放开,高龄孕产妇的人数越来越多,孕妇年龄的增加,合并内外科疾病的概率也明显增加,这也导致高龄孕妇及围生儿的不良结局增加。在实行“全面二孩”政策前,国内诸多医院的头胎剖宫产率远高于世界卫生组织推荐的15%... 随着“全面二孩”政策的放开,高龄孕产妇的人数越来越多,孕妇年龄的增加,合并内外科疾病的概率也明显增加,这也导致高龄孕妇及围生儿的不良结局增加。在实行“全面二孩”政策前,国内诸多医院的头胎剖宫产率远高于世界卫生组织推荐的15%的水平;随着“二胎政策”的落地,当初选择剖宫产的高龄妇女再次孕育新生命。育龄女性随着年龄的增加,身体各项机能逐步下降,生殖系统的功能也逐步衰退,瘢痕子宫伴随着年龄的增加逐渐老化,收缩能力下降。如何确保具有瘢痕子宫,且合并多种内外科疾病的高龄产妇安全分娩,是产科医师面临的一个新难题。通过查阅相关文献及总结青海大学附属医院1例高龄妊娠合并脑动脉瘤、颈动脉瘤、妊娠期肝内胆汁淤积症、妊娠期糖尿病的资料加深产科医师对相关疾病的重视与理解。 展开更多
关键词 孕妇 妊娠并发症 胆汁淤积 肝内 糖尿病 妊娠 颅内动脉瘤 颈动脉疾病
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肝内胆管癌分子水平研究进展
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作者 李雪鹏 刘苏来 蒋波 《中国普通外科杂志》 CAS CSCD 北大核心 2019年第2期219-226,共8页
肝内胆管癌(ICC)是位于2级胆管以上胆管上皮的恶性肿瘤,术后易复发、化疗效果不明确,远期生存率不高。ICC目前缺乏特异性早期诊断标志物,确诊时往往已是中晚期或者晚期。随着对ICC分子水平的深入研究,发现了一些关键调节子如抑癌基因p53... 肝内胆管癌(ICC)是位于2级胆管以上胆管上皮的恶性肿瘤,术后易复发、化疗效果不明确,远期生存率不高。ICC目前缺乏特异性早期诊断标志物,确诊时往往已是中晚期或者晚期。随着对ICC分子水平的深入研究,发现了一些关键调节子如抑癌基因p53、p16,原癌基因Ras以及miRNA和组蛋白的修饰等,这些调节因子可能成为治疗靶点。笔者就DNA-RNA-蛋白质中心法则为线索对ICC分子水平研究进展进行综述。 展开更多
关键词 胆管肿瘤 胆管 肝内 分子靶向治疗 综述文献
Interventions to improve sarcopenia in cirrhosis:A systematic review 预览
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作者 Maliha Naseer Erica P Turse +3 位作者 Ali Syed Francis E Dailey Mallak Zatreh Veysel Tahan 《世界临床病例杂志》 2019年第2期156-170,共15页
BACKGROUND Sarcopenia,i.e.,muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis.Hence,it is ... BACKGROUND Sarcopenia,i.e.,muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis.Hence,it is imperative to study interventions which targets to improve sarcopenia in cirrhosis.AIM To examine the relationship between interventions such nutritional supplementation,exercise,combined life style intervention,testosterone replacement and trans jugular intrahepatic portosystemic shunt(TIPS)to improve muscle mass in cirrhosis.METHODS We search PubMed,EMBASE and Cochrane between June-August 2018,without a limiting period and the types of articles(RCTs,clinical trial,comparative study)in adult patients with sarcopenia and cirrhosis.The primary outcome of interest was improvement in muscle mass,strength and physical function interventions mentioned above.In the screening process,154 full text articles were included in the review and 129 studies were excluded.RESULTS We identified 24 studies that met review inclusion criteria.The studies were diverse in terms of the design,setting,interventions,and outcome measurements.We performed only qualitative synthesis of evidence due to heterogeneity amongst studies.Risk of bias was medium in most of the included studies and low quality of evidence showed improvement in the muscle mass,strength and physical function following aerobic exercise.60%of the included studies on the nutritional intervention,100%of the studies on testosterone replacement in hypogonadal men and trans-jugular portosystemic shunt were proved to be effective in improving sarcopenia in cirrhosis.CONCLUSION Although the quality of evidence is low,the findings of our systematic review suggest improvement in the sarcopenia in cirrhosis with exercise,nutritional interventions,hormonal and TIPS interventions.High quality randomized controlled trials needed to further strengthen these findings. 展开更多
关键词 SARCOPENIA CIRRHOSIS Treatment Intervention Nutrition Therapy Exercise TESTOSTERONE Trans JUGULAR INTRAHEPATIC portosystemic SHUNT
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糖皮质激素治疗感染性胆管炎引起肝内胆汁淤积1例报告 预览
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作者 赵优优 张端 +2 位作者 殷鑫 温晓玉 高普均 《临床肝胆病杂志》 CAS 北大核心 2019年第2期386-387,共2页
1 病例资料患者男性,46岁,因“间断发热、上腹痛半月,加重伴尿黄10 d”于2018年1月11日入本院。患者半月前劳累受凉后出现发热,体温最高39℃,伴寒战,无盗汗、关节肿痛等,于当地医院给予消炎等对持治疗(具体不详),症状未见明显好转,并出... 1 病例资料患者男性,46岁,因“间断发热、上腹痛半月,加重伴尿黄10 d”于2018年1月11日入本院。患者半月前劳累受凉后出现发热,体温最高39℃,伴寒战,无盗汗、关节肿痛等,于当地医院给予消炎等对持治疗(具体不详),症状未见明显好转,并出现中上腹部胀痛,无放射痛,伴恶心、呕吐、尿黄,皮肤瘙痒,白陶土样便。给予保肝、褪黄、降酶等对症治疗(具体不详),腹痛好转,但胆红素呈进行性升高,遂行胆囊造瘘术,并因右肾结石、积水,血清肌酐明显升高行右侧肾盂造瘘术,病情无明显好转,遂就诊于本院。既往:8年前因发热、皮肤黄染,不伴腹痛,于当地医院诊断为胰腺炎,给予对症治疗(具体不详)后,症状好转,未明确胰腺炎病因,自行口服“优思弗、奥美拉唑、水林佳,各1片/d”,否认肝炎病史、酗酒史。查体:皮肤、巩膜重度黄染,右上腹留置胆囊造瘘引流管1枚,右侧肾盂造瘘引流管1枚。当地医院2018年1月4日检查结果示降钙素原(PCT)4.01μg/L;血常规:WBC 3.88×10 9/L,中性粒细胞3.45×10 9/L,中性粒细胞百分比88.8%,PLT 98×10 9/L。本院2018年1月11日肝功能检查结果示:AST 127.7 U/L,ALT 242.3 U/L,GGT 368.2 U/L,ALP 267.3 U/L,总蛋白56.0 g/L,Alb 28.9 g/L,TBil 389.0μmol/L,DBil 311.7μmol/L,IBil 77.3μmol/L,总胆汁酸165.2μmol/L;尿常规:尿胆红素(+++)。血常规、CRP、PCT、凝血常规、抗核抗体、抗线粒体抗体、风湿三项、免疫五项、IgG4未见明显异常。自身免疫性肝炎相关抗体阴性,甲、乙、丙、戊型肝炎标志物阴性。胆汁培养:3 d无菌生长。腹部CT(2018年1月12日,图1)示:(1)肝左叶外侧段可疑低密度影;(2)胆囊造瘘中,胆囊炎,胆囊泥沙样结石。肺CT(2018年1月12日)示:(1)双肺散在少许炎症;(2)右肺上叶磨玻璃影。经内镜逆行胰胆管造影(2018年1月16日)示:十二指肠降段见乳头肿大明显,开口明显狭窄,肝内外胆管显影纤细,无明确占位� 展开更多
关键词 胆管炎 胆汁淤积 肝内 糖皮质激素类 病例报告
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Iodine-125 implantation with transjugular intrahepatic portosystemic shunt for main portal vein tumor thrombus 预览
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作者 Yue Zhang Yi-Fan Wu +6 位作者 Zhen-Dong Yue Hong-Wei Zhao Lei Wang Zhen-Hua Fan Fu-Liang He Tao Wang Fu-Quan Liu 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第4期310-321,共12页
BACKGROUND Main portal vein tumor thrombus (MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepa... BACKGROUND Main portal vein tumor thrombus (MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma (HCC). Therefore, attention should be paid to the treatment of MPVTT and its complications. AIM To evaluate the efficacy of transarterial chemoembolization/transarterial embolization (TACE/TAE)+125I seeds implantation with transjugular intrahepatic portosystemic shunt (TIPS) in treating MPVTT and its complications. METHODS From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and 125I implantation (TIPS-125I group) or TACE/TAE + TIPS only (TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-125I.RESULTS During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-125I group, whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively (P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%, respectively, in the TIPS-125I group, whereas those in the TIPS only group were 31.1%, 62.2%, and 82.2%(P < 0.05). The rates of stent restenosis were 12.5%, 27.5%, and 42.5%, respectively, in the TIPS-125I group, and 42.2%, 68.9%, and 84.4%, respectively, in the TIPS only group (P < 0.05). TIPS-125I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC. CONCLUSION TACE/TAE+125I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality. 展开更多
关键词 IODINE-125 Transjugular INTRAHEPATIC portosystemic SHUNT MAIN PORTAL vein tumor THROMBUS Metastasis PORTAL hypertension
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