Different types of bowel obstruction,including strangulated loop,mesenteric venous occlusions,mesenteric arterial occlusions and simple obstruction, were induced in rabbits.After induction of occlusion, imaging agent of 99mTc-pyrophosphate was injected intravenously.Thirty minutes later,abdominal plain image was successively taken with a single photon emission computed tomography (SPECT).At the same time,the uptake ratio of region of interest was determined.The results revealed that animals in strangulated loop group and mesenteric venous occlusion group had high radioactive concentration in the area of ischemic bowel. Uptake ratio of region of interest of imaging area in the two experimental group was higher than that in simple obstruction and control group.Whereas the mesenteric arterial occlusion group did not appearantly present the changes mentioned above.These showed that there was an accumulation of agent in strangulated ischemic bowel segment in strangulated loop group and mesenteric venous occlusion group.All results suggest that radionuclide visualization with SPECT could be a valuable method for early diagnosis of acute intestinal strangulation of strangulated loop type and mesenteric venous occlusion type.
摘要:目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)后发生严重并发症的原因、治疗措施和经验教训。方法:分析 2007 年 8 月至2009 年 4月期间华西医院胆道外科收治的LC术后发生严重并发症的7例患者的临床资料。结果:2例继发性胆总管结石合并化脓性胆管炎患者,采用内镜下十二指肠乳头切开(endoscopic sphincterotomy, EST)取出结石;3例胆道损伤患者,均进行肝门胆管成形和肝总管空肠吻合术;1例绞窄性肠梗阻患者,切除坏死空肠管后,行空肠对端吻合术;以上6例患者均顺利出院,随访8～20个月,均生活良好。1例患者LC术后发生肺动脉栓塞,积极抢救后因呼吸衰竭而死亡。结论:术中仔细轻柔的操作以及辩清肝总管、胆总管与胆囊管的三者关系是预防LC术后发生严重并发症的关键。合理可行的治疗措施是提高发生并发症的患者生活质量的保障。LC术时,胆道外科医生思想上要高度重视,不可盲目追求速度,必要时及时中转开腹。Abstract: Objective: To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy (LC). Methods:Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively. The clinical data was got from biliary department of West China Hospital. Results: Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy. Three cases of severe bile duct injury after LC had stricture of the hilar bile duct, and all of the cases were performed RouxenY hepaticojejunostomy with the diameter of stoma 2.03.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum endtoend anastomosis after cutting off the necrotic jejunum. All of the above 6 patients recovered well. Following up for 820 months, all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue. Conclusion: Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC. Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC. And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly. In necessary, the operation of LC should be turned into open cholecystectomy.
ObjectiveTo investigate the application significance of serum histidine decarboxylase (HDC) and D-lactate for early-stage of strangulated intestinal obstruction in rats. MethodsThirty male Wistar rats were randomly divided into two groups:blank control group (n=10) and experimental group (n=20). Rats of experimental group were established to be strangulated intestinal obstruction model by ligating 4 cm-long ileum, and were divided into obstruction-1 hour group (n=10) and obstruction-3 hour group (n=10) according to the time of intestinal obstruction. Rats of blank control group only underwent sham operation. When intestinal obstruction models were built, the change of pathology in ileum tissue was observed by light microscope. The Park/Chiu scale was used to evaluate the severity of intestinal lesion. At the same time, blood was drawn from the heart to measure the concentration of serum HDC and D-lactate by ELISA method. Real time quantitative PCR was used to detect the expression of HDC mRNA in ileum tissues. ResultsThe median injury score of ileum tissues of rats in blank control group, obstruction-1 hour group, and obstruction-3 hour group were 0 (0-1), 2 (2-3), and 5 (4-5) respectively, and increased in blank control group, obstruction-1 hour group, and obstruction-3 hour group one by one (P<0.01). The median concentrations of serum HDC of rats in blank control group, obstruction-1 hour group, and obstruction-3 hour group were 10.5 pg/mL (4.60-17.18 pg/mL), 87.93 pg/mL (41.33-119.03 pg/mL), and 150.67 pg/mL (67.33-198.14 pg/mL) respectively, and increased in blank control group, obstruc-tion-1 hour group, and obstruction-3 hour group one by one (P<0.05). The median concentrations of serum D-lactate in rats of blank control group, obstruction-1 hour group, and obstruction-3 hour group were 0 ng/mL (0-3.90 ng/mL), 0 ng/mL (0-15.63 ng/mL), and 4.92 ng/mL (0-48.13 ng/mL) respectively, and there was no significant difference among the 3 groups (P>0.05). The median expression levels of HDC mRNA in ileum tissue of rats in obstruction-3 hour group was 7.81 (7.05-8.39), which was significantly higher than those of the obstruction-1 hour group[1.77 (1.74-1.94)] and blank control group[0.97 (0.88-1.15)], P<0.01, but there was no significant difference between obstruction-1 hour group and blank control group (P>0.05). ConclusionsConcentration of serum HDC can be used for early diagnosis of strangulated intestinal obstruction. Serum D-lactate has no significant change at early-stage of strangulated intestinal obstruction.