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Hormonal contributions to biliary secretion. 荷尔蒙对胆道分泌的贡献。
Pub Date : 1984-01-01
P Calhoun, J B Hanks

Gastrointestinal hormones appear to be important modulators of bile flow and composition. Insulin and glucagon induce choleresis at physiologic levels and may alter lipid output and concentration as well. The effects of many hormones such as insulin, glucagon, secretin, and pancreatic polypeptide are at least partially independent of their effects on neurovascular factors. Furthermore, recently studied hormones such as somatostatin, vasoactive intestinal polypeptide, and pancreatic polypeptide have also been shown not only to alter bile flow but to affect bile composition. Understanding the role of gastrointestinal hormones in hepatic physiology may elucidate the causes of gallstone formation, disorders of biliary excretion, and hypercholesteremic states.

胃肠激素似乎是胆汁流动和组成的重要调节剂。胰岛素和胰高血糖素在生理水平上诱导胆汁分泌,并可能改变脂质输出和浓度。许多激素如胰岛素、胰高血糖素、分泌素和胰多肽的作用至少部分独立于它们对神经血管因子的作用。此外,最近研究的激素如生长抑素、血管活性肠多肽和胰腺多肽也被证明不仅可以改变胆汁流量,而且可以影响胆汁成分。了解胃肠激素在肝脏生理中的作用可能有助于阐明胆结石形成、胆汁排泄紊乱和高胆固醇状态的原因。
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引用次数: 0
Surgical management of cysts of the head of the pancreas. 胰头囊肿的外科治疗。
Pub Date : 1984-01-01
J W Braasch, J M Gubern, R L Rossi

Thirty patients with cysts of the cephalic portion of the pancreas treated by operation between 1966 and 1980 were reviewed to determine whether any variation existed from the usual treatment of cysts of the body and tail of the gland. Sixteen patients had chronic pancreatitis, six had acute pancreatitis, four had cysts of indeterminate causes, three had adenocarcinoma of the pancreas, and in one patient a cyst developed after external trauma. External drainage was used in 14 patients, internal drainage in ten patients, and combinations of cyst drainage and anastomosis of Wirsung's duct or resection were performed in six patients. No operative deaths occurred, and the rate of cyst recurrence was minimal. Diabetes mellitus developed in 40% of patients with chronic pancreatitis despite conservative management. Recurrent pain in 13 patients and the discovery of associated carcinoma in one patient at initial treatment and later in two others cast doubt on the usefulness of simple internal or external drainage of cysts for pain except in a setting of acute pancreatitis. Resection of the pancreatic head or drainage of dilated pancreatic ducts should more often be carried out in the primary treatment of cephalic cysts with pain due to chronic pancreatitis.

本文回顾了1966年至1980年间30例经手术治疗的胰腺头部囊肿患者,以确定是否存在与通常治疗体部和腺体尾部囊肿的差异。16名患者患有慢性胰腺炎,6名患有急性胰腺炎,4名患有原因不明的囊肿,3名患有胰腺腺癌,1名患者在外部创伤后出现囊肿。14例采用外引流,10例采用内引流,6例采用囊肿引流联合Wirsung管吻合或切除。无手术死亡发生,囊肿复发率极低。尽管保守治疗,40%的慢性胰腺炎患者仍发生糖尿病。13例患者复发性疼痛,1例患者在最初治疗时发现相关癌,后来在另外2例患者中发现相关癌,这使人们怀疑单纯的囊肿内或外引流治疗疼痛的有效性,除非是急性胰腺炎。在慢性胰腺炎引起的疼痛性头囊肿的初步治疗中,应更多地采用胰头切除术或胰管引流术。
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引用次数: 0
Cholelithiasis in children in a Chinese hospital: report of 52 cases. 某医院儿童胆石症52例报告
Pub Date : 1984-01-01
C S Chu

Over a period of 22 years (1958-1980), 52 children with cholelithiasis were treated in the Hunan Medical College Hospital in Ghangsha, China. Enteric helminthiasis is a common endemic disease in China and the countries of the Far East. Common in this region also is biliary ascariasis, which can precipitate an abdominal emergency in children. Both these conditions make differentiation of primary acute cholecystitis from the acute cholecystitis that is a complication of biliary ascariasis difficult in children. But, whatever the etiology of the disease, cholelithiasis was confirmed in all 52 children, an incidence of 1:62.4 the frequency of this disease in adults, or eight times higher than that which occurs in Western countries. Table 1 shows the distribution according to sex and age in our patients.

在22年(1958-1980)期间,在中国长沙的湖南医学院附属医院治疗了52例胆石症患儿。肠蠕虫病是中国和远东地区常见的地方病。胆道蛔虫病在该地区也很常见,可引起儿童腹部急症。这两种情况使得原发性急性胆囊炎与急性胆囊炎(胆道蛔虫病的并发症)在儿童中难以区分。但是,无论病因如何,所有52名儿童都被证实患有胆石症,其发病率是成人的1:6 . 2.4,比西方国家高8倍。表1显示了我们的患者按性别和年龄的分布。
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引用次数: 0
Hydrostatic balloon dilatation for stomal stenosis after gastric partitioning. 胃分流术后胃口狭窄的静压球囊扩张治疗。
Pub Date : 1984-01-01
F E Eckhauser, J A Knol, W E Strodel, K Cho

Hydrostatic balloon dilatation has been used successfully to treat several patients with stomal stenosis occurring as a late complication of gastroplasty. The technique of hydrostatic balloon dilatation practiced in this institution is reviewed in detail. This technique appears to offer several advantages over previous techniques: 1) the procedure can be accomplished with intravenous sedation eliminating the need for general anesthesia; 2) trauma to the gastric channel is minimized because no attempt is made to manipulate the endoscope through the stoma into the distal stomach; 3) radiopaque markers on the polyethylene balloon catheter permit easy and accurate positioning of the balloon within the gastric channel; 4) the low compliance characteristics of the polyethylene balloon used permit inflation to a predetermined outer diameter with minimum risk of balloon deformity or overdistention and rupture; and 5) the procedure is easily standardized and can therefore be expected to yield reproducible results. Late stomal stenosis after gastric partitioning may respond to conservative therapy including nutritional support and dietary counselling. Hydrostatic balloon dilatation should be considered as the preferred method of stomal dilatation in patients refractory to alternative forms of management.

静压球囊扩张术已成功地用于治疗胃成形术晚期并发症中的几例造口狭窄。详细介绍了该所采用的静压球囊扩张技术。与以前的技术相比,这项技术似乎有几个优点:1)手术可以通过静脉镇静完成,不需要全身麻醉;2)对胃通道的创伤被最小化,因为没有试图通过胃口操纵内窥镜进入远端胃;3)聚乙烯球囊导管上的不透射线标记允许球囊在胃通道内轻松准确地定位;4)所用聚乙烯球囊的低顺应性特性允许充气到预定的外径,使球囊畸形或过度膨胀和破裂的风险最小;5)该程序易于标准化,因此可以期望产生可重复的结果。胃分流后晚期口狭窄可能对保守治疗有反应,包括营养支持和饮食咨询。对于难以采用其他治疗方法的患者,应考虑采用静压球囊扩张作为首选的口扩张方法。
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引用次数: 0
Role of the autonomic nervous system in the rabbit sphincter of Oddi. 自主神经系统在兔Oddi括约肌中的作用。
Pub Date : 1984-01-01
J C Sarles, R Awad

In vivo myoelectrical activity and pressure of the SO have been studied in intact, vagotomized and splanchnicectomized rabbits. Preganglionic nerve sections made no significant differences compared to the control group. Acetylcholine (3-11 mu g/kg) and adrenaline (1-50 micrograms/kg) increased and decreased respectively the myoelectrical activity. Hyoscine (0.5 mg/kg) and verapamil (35 micrograms/kg/min.) but not pentolinium (2 mg/kg) inhibited the excitatory activity of ACh; phentolamine (3 mg/kg) but not propranolol (3 mg/kg) antagonized the inhibitory activity of adrenaline. It can be concluded that the neurotransmission in the rabbit SO has both pathways: excitatory transmission mediated by cholinergic muscarinic receptors which are calcium dependent, and relaxation mediated by inhibitory alpha-adrenoceptors.

在完整、迷走神经切除和内脏切除的家兔的体内肌电活动和压力进行了研究。与对照组相比,节前神经切片无显著差异。乙酰胆碱(3 ~ 11 μ g/kg)和肾上腺素(1 ~ 50 μ g/kg)分别使肌电活动升高和降低。莨菪碱(0.5 mg/kg)和维拉帕米(35微克/kg/min)抑制乙酰胆碱的兴奋活性,而戊油酸(2 mg/kg)未抑制乙酰胆碱的兴奋活性;酚妥拉明(3mg /kg)拮抗肾上腺素抑制活性,而心得安(3mg /kg)无拮抗作用。由此可见,大鼠神经传递有两种途径:一是钙依赖性胆碱能毒蕈碱受体介导的兴奋性传递,二是抑制性肾上腺素受体介导的松弛性传递。
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引用次数: 0
Endoscopic removal of squamous cell papilloma of esophagus: a case report and review of literature. 内镜下食管鳞状细胞乳头状瘤切除1例并文献复习。
Pub Date : 1984-01-01
A N Shah

Squamous papilloma of the esophagus is a rare benign tumor. A 51-year-old patient had chronic symptoms of esophagitis, and squamous papilloma was found in the mid-esophagus. The endoscopic appearance and histology are described, after endoscopic polypectomy.

食管鳞状乳头状瘤是一种罕见的良性肿瘤。患者51岁,慢性食管炎,食管中部发现鳞状乳头状瘤。内镜下的外观和组织学描述后,内镜息肉切除术。
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引用次数: 0
Control of bleeding esophageal varices by transabdominal esophageal transection, gastric devascularization, and splenectomy. 经腹食管切断术、胃断流术及脾切除术对食管静脉曲张出血的控制。
Pub Date : 1984-01-01
J L Weese, J R Starling, C E Yale

Between November 1980 and October 1982, 11 patients underwent modified Sugiura procedures (esophageal transection, gastric devascularization, and splenectomy) for bleeding esophageal varices, with an operative mortality of 36%. One patient rebled at 2 months and was successfully managed by sclerotherapy. Intraoperative portal pressure fell approximately 25% after splenectomy. We contend that esophageal transection and gastric devascularization provide good short-term control of bleeding varices, and that the decrease in portal pressure provided by splenectomy allows scars to form during a period of reduced portal pressure, providing long-term arrest of variceal hemorrhage.

1980年11月至1982年10月间,11例患者接受改良的Sugiura手术(食管切断术、胃断流术和脾切除术)治疗食管静脉曲张出血,手术死亡率为36%。1例患者在2个月时复发,并通过硬化疗法成功治疗。脾切除术后术中门静脉压力下降约25%。我们认为食管横断术和胃断流术可以在短期内很好地控制静脉曲张出血,脾切除术降低门静脉压力可以在门静脉压力降低期间形成疤痕,从而长期抑制静脉曲张出血。
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引用次数: 0
Nationwide survey of cases of choledochal cyst. Analysis of coexistent anomalies, complications and surgical treatment in 645 cases. 全国胆总管囊肿病例调查。645例合并畸形、并发症及手术治疗分析。
Pub Date : 1984-01-01
N Komi, T Tamura, Y Miyoshi, K Kunitomo, H Udaka, H Takehara

A nationwide survey of cases of choledochal cyst was conducted to obtain the data on cases of choledochal cyst in Japan between 1972 and 1982. A total of 645 cases in 73 institutions, including 52 cases from this hospital, were surveyed. Choledochal cyst was associated with an anomalous arrangement of the pancreaticobiliary ductal system in 90.2% of the cases which were examined extensively. The serum amylase level was elevated in 26.6% of the cases. Calculus disease of the biliary duct was recognized in 28.5% of the cases. Biliary carcinoma developed in 54 (8.4%) of 645 cases. The incidences of biliary carcinoma were 0.3% (1/306) in cases in children and 15.6% (53/339) in adult cases; carcinoma was found in the wall of the choledochus in 30, and in the gallbladder in 16 of these 54 cases. The nationwide survey showed that an anomalous arrangement of the pancreaticobiliary ductal system was closely associated with choledochal cyst and that cases of biliary carcinoma developed with the advance of age. Therefore, early resection of the cyst wall and reconstruction of the biliary duct is proposed as suitable surgical treatment for stopping reflux of pancreatic juice into the biliary duct.

本文对1972年至1982年日本胆总管囊肿病例进行了全国范围的调查,以获得胆总管囊肿病例的资料。共调查了73个机构的645例,其中该医院的52例。经广泛检查,90.2%的病例胆总管囊肿与胰胆管系统的异常排列有关。26.6%的患者血清淀粉酶水平升高。28.5%的病例确诊为胆管结石病。645例中有54例(8.4%)发生胆道癌。儿童胆道癌发生率为0.3%(1/306),成人为15.6% (53/339);在这54例中,有16例发生在胆囊,30例发生在胆总管壁。全国范围内的调查显示,胆总管囊肿与胰胆管系统的异常排列密切相关,胆道癌的发生与年龄的增长有关。因此,建议早期切除囊肿壁,重建胆管,作为阻止胰液反流进入胆管的合适手术治疗方法。
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引用次数: 0
A prospective randomized study of effect of proximal gastric vagotomy and vagotomy and antrectomy on bile reflux, endoscopic mucosal abnormalities and gastritis. 胃近端迷走神经切开术与迷走神经切开术联合前切开术对胆汁反流、内镜下粘膜异常和胃炎影响的前瞻性随机研究。
Pub Date : 1984-01-01
A M Hoare, I A Donovan, M R Keighley, H Thompson, N J Dorricott, J Alexander-Williams

71 patients participated in a double-blind trial which compared proximal gastric vagotomy (PVG) with vagotomy and antrectomy (V & A). 82 percent of the patients subsequently volunteered for endoscopy 6 to 12 months after operation and 65 percent for measurement of fasting bile reflux (FBR) and peak acid output (PAO). The results of these follow-up assessments are given in this paper. None of the 36 patients who had undergone V & A had a recurrent ulcer; in contrast ulcers or fresh scars were found in 5 of 35 patients after PGV, even in 2 who had no symptoms. Erythema of the gastric mucosa was seen more commonly after V & A than PGV. Such erythema was associated with high levels of fasting bile reflux (an objective measure of reflux of bile into the stomach) and with symptoms of bile vomiting and mild epigastric pain. High levels of fasting bile reflux were not found after PGV. Histological gastritis of the proximal stomach was equally common after both operations in patients without a recurrent ulcer. Gastritis was not related to endoscopic mucosal erythema or fasting bile reflux, but did correlate with peak acid output. These results confirm that bile reflux is associated with mucosal erythema and symptoms after V & A but that significant bile reflux does not occur after PGV. However, bile reflux is not related to gastritis, which appears to be the result of an operation (either PGV or V & A) which successfully reduces peak acid output.

71例患者参加了一项双盲试验,比较了近端胃迷走神经切开术(PVG)与迷走神经切开术和前切开术(v&a)。82%的患者随后在手术后6至12个月自愿接受内窥镜检查,65%的患者接受空腹胆汁反流(FBR)和峰值酸输出(PAO)的测量。本文给出了这些后续评估的结果。36例接受v&a的患者均无溃疡复发;相比之下,35例PGV患者中有5例发现溃疡或新鲜疤痕,即使在2例无症状的患者中也是如此。胃粘膜红斑在V & A术后较PGV更为常见。这种红斑与高水平的空腹胆汁反流(胆汁反流进入胃的客观测量)以及胆汁呕吐和轻度胃脘痛症状相关。PGV后未发现高水平的空腹胆汁反流。组织学胃炎的近端胃是同样常见的手术后,患者没有复发性溃疡。胃炎与内镜下粘膜红斑或空腹胆汁反流无关,但与酸输出峰值相关。这些结果证实,胆汁反流与胃脘痛和胃脘痛后的粘膜红斑和症状有关,但胃脘痛后不发生明显的胆汁反流。然而,胆汁反流与胃炎无关,这似乎是手术(PGV或v&a)成功降低酸输出峰值的结果。
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引用次数: 0
The importance of the distal stomach in gastric emptying of liquids in man. 远端胃在人体胃排空液体中的重要性。
Pub Date : 1984-01-01
C M White, V Poxon, J Alexander-Williams

The effects of pyloroplasty and vagal denervation of the distal stomach on gastric emptying of 10% dextrose have been compared. In a randomized trial, 38 male patients having elective surgery were treated by proximal gastric vagotomy (PGV, N = 10), proximal gastric vagotomy and pyloroplasty (PGV + P, N = 9), total gastric vagotomy (TGV, N = 9), and total gastric vagotomy and pyloroplasty (TGV + P, N = 10). Gastric emptying was recorded using an external scanning technique before and after operation. Compared with before operation, all four procedures resulted in significantly faster emptying during ingestion of the meal (the filling phase). This is attributable to failure of receptive relaxation of the proximal stomach. The emptying phase (after ingestion of the meal) was unchanged by PGV, but was significantly altered by PGV + P, TGV, and TGV + P (Principal Component Analysis). Before operation and after PGV, emptying fitted a monoexponential curve. In contrast, after PGV + P, TGV, and TGV + P, the emptying phase fitted a double exponential curve. Emptying was precipitate initially, but slowed later, leaving a large residual volume. We conclude that, when the proximal stomach is denervated, the intact, innervated distal stomach can restore the emptying of hypertonic dextrose to normal; however, when the distal stomach is denervated or pyloroplasty has been performed emptying remains uncontrolled. Since pyloroplasty and vagal denervation have the same effect, it is concluded that the mechanism retarding the emptying of hypertonic dextrose is an active mechanism that resides in the terminal antrum or pylorus.

我们比较了幽门成形术和远端胃迷走神经去支配术对10%葡萄糖胃排空的影响。在一项随机试验中,38例择期手术的男性患者接受了胃近端迷走神经切开术(PGV, N = 10)、胃近端迷走神经切开术及幽门成形术(PGV + P, N = 9)、胃全端迷走神经切开术(TGV, N = 9)和胃全端迷走神经切开术及幽门成形术(TGV + P, N = 10)。手术前后采用外扫技术记录胃排空情况。与手术前相比,所有四种方法都显著加快了进食期间的排空(填充阶段)。这是由于近端胃的接受性松弛失败所致。排空期(进食后)未受PGV影响,但PGV + P、TGV和TGV + P(主成分分析)显著改变了排空期。术前和术后排空均呈单指数曲线。而PGV + P、TGV和TGV + P后的空期则呈双指数曲线。排空最初是沉淀,但后来缓慢,留下大量的残余体积。我们认为,当近端胃去神经支配时,完整的、神经支配的远端胃可以恢复高渗葡萄糖的排空正常;然而,当远端胃去神经或幽门成形术后,排空仍然不受控制。由于幽门成形术和迷走神经去支配具有相同的效果,因此我们认为延缓高压葡萄糖排空的机制是一种活跃的机制,这种机制存在于幽门末腔或幽门。
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引用次数: 0
期刊
Surgical gastroenterology
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