恶性梗阻性黄疸的病理生理改变
摘要
<正>黄疸是临床常见症状与体征,其发生是由于胆红素代谢或排泄障碍而引起血清胆红素浓度升高所致。临床上表现为巩膜、黏膜、皮肤及其他组织黄染。肿瘤阻断胆管系统使胆汁排泄受阻而引起的黄疸,称之为恶性梗阻性黄疸(malignant obstructive jaundice,MOJ)。本研究针对恶性梗阻性黄疸的病理生理改变作一论述,以期更好地分析出现各种临床症状的深层原因,以指导临床治疗。1胆道梗阻引起肝脏损伤的机制
引文
[1]Gouma DJ,Coelho JC,Fisher JD,et al.Endotoxemia after relief of biliary obsturetion by internal andexternal drainage in rats[J].Am J Surg,2007,151:476-479.
[2]龙跃平,肖谷欣,戴立人,等.胆盐在胆道梗阻所致肠道细菌易位中的作用[J].中华实验外科杂志,1995,12(2):109-110.
[3]Tomioka M,Iinuma H,Okinaga K.Impaired Kupffer cell function and effect of inmunotherapy in obstruetive jaundice[J].J Surg Res,2000,92(2):276-282.
[4]罗琪,黄正接.阻塞性黄疽内毒素血症对肝组织血流和肝能量代谢的影响[J].重庆医学,2001,30(2):111-113.
[5]Scott-Conner CE,Grogan JB.The pathophysiology of biliary obstruction and its effect on phagocytic and immune function[J].J Surg Res,2012,57(2):316-336.
[6]严东旺,张炳彦,王炳煌,等.血小板活化因子对梗阻性黄疸机体细胞免疫功能的影响[J].肝胆外科杂志,2003,11(6):473-475.
[7]胡根林,郭汉身.血小板活化因子与胃肠损伤[J].国外医学:消化系疾病分册,1995,15(1):17-19.
[8]龚瑾,龙刚,张水军,等.一氧化氮和内皮素在无心跳供肝缺血再灌注损伤中的作用[J].天津医药,2004,32(12):763-766.
[9]方学军,迟彦邦,李靖.胆道梗阻再通后犬肝MDA和SOD含量的变化[J].广东医学,1997,18(10):692-693.
[10]金头峰,金恩鸿,李光燮,等.内皮素在梗阻性黄疽大鼠血液、肝、肾、胃及肺组织中的含量变化和作用研究[J].吉林医学,2001,24(l):13-15.
[11]Shibayama Y.Sinusoidal circulatory disturbance by microthrombosis as a cause of endotoxin-induced hepatic injury[J].J Pathol,2011,151(4):315-321.
[12]杨翔,吴天鸣,石民生,等.胆道梗阻再通前后病理转归的研究[J].中华实验外科杂志,1996,13(1):43-44.
[13]Mathie RT,Nagorny DM,Lewis MH.et al.Hepatic hemodynamic after chronic obstruction of the biliary tract in the dog[J].Surg Gynecol Obstet,2008,166(2):125-130.
[14]张少辉,吴伟,王尧华.Oddi括约肌生理与病理生理的动力学研究状况[J].中国中西医结合外科杂志,2004,10(5):398-400.
[15]刘凌云,杨定华,彭民浩.恶性梗阻性黄疸患者外周血CD4+CD25+调节性T细胞的变化及意义[J].实用医学杂志,2011,27(5):800-802.
[16]Clements MD,Mc Caigue M,Erwin P,et al.Biliary decompression promotes Kupffer cell recovery in obstructive jaundice[J].Gut,2012,38(6):925-929.
[17]Fialkow L,Fochesatto Filho L,Bozzetti MC,et al.Neutrophil apoptosis:a marker of disease severity in sepsis and sepsisinduced acute respiratory distress syndrome[J].Crit Care,2006,10(6):155.
[18]Leon CG,Tory R,Jia J,et al.Discovery and development of toll-like receptor 4(TLR4)antagonists:a new paradigm for treating sepsis and other diseases[J].Pharm Res,2008,25(8):1751-1761.
[19]吴涌宏,关养时.内毒素血症在梗阻性黄疸发生发展中作用的研究进展[J].中国普通外科杂志,2010,19(8):912-915.
[20]Takeda K,Akira S.Toll-like receptors in innate immunity[J].Int Immunol,2005,17(1):1-14.
[21]Matsuda T,Saito H,Fukatsu K,et al.Cytokine-modulated inhibition of neutrophil apoptosis at local site augments exudative neutrophil functions and reflects inflammatory response after surgery[J].Surgery,2010,129(1):76-85.
[22]陈强谱,管清海,张帆,等.梗阻性黄疸术后早期肠内营养对全身炎症反应综合征的影响[J/CO].中华普通外科学文献:电子版,2009,3(5):392-396.
[23]蔺觅,宋志春.梗阻性黄疸肾脏血流动力学变化[J].当代医学,2011,17(8):33-34.
[24]谷化剑,冯贤松,陈俊华,等.甲硫氨酸维B1与丹参酮ⅡA磺酸钠对梗阻性黄疸大鼠血浆肿瘤坏死因子、肾功能及肾组织丙二醛与超氧化物歧化酶的影响[J].中华实验外科杂志,2012,29(6):1098-1101.
[25]巩鹏,王忠裕,宝全.胆道梗阻后心脏损害的研究[J].肝胆外科杂志,2003,11(6):465-467.
[26]Padillo J,Puente J,Gomez M,et al.Improved cardiac function in patients with obstructive jaundice after internai biliary drainage:hemodynamic and hormonalassessment[J].Ann Surg,2012,234(5):652-656.
[2]龙跃平,肖谷欣,戴立人,等.胆盐在胆道梗阻所致肠道细菌易位中的作用[J].中华实验外科杂志,1995,12(2):109-110.
[3]Tomioka M,Iinuma H,Okinaga K.Impaired Kupffer cell function and effect of inmunotherapy in obstruetive jaundice[J].J Surg Res,2000,92(2):276-282.
[4]罗琪,黄正接.阻塞性黄疽内毒素血症对肝组织血流和肝能量代谢的影响[J].重庆医学,2001,30(2):111-113.
[5]Scott-Conner CE,Grogan JB.The pathophysiology of biliary obstruction and its effect on phagocytic and immune function[J].J Surg Res,2012,57(2):316-336.
[6]严东旺,张炳彦,王炳煌,等.血小板活化因子对梗阻性黄疸机体细胞免疫功能的影响[J].肝胆外科杂志,2003,11(6):473-475.
[7]胡根林,郭汉身.血小板活化因子与胃肠损伤[J].国外医学:消化系疾病分册,1995,15(1):17-19.
[8]龚瑾,龙刚,张水军,等.一氧化氮和内皮素在无心跳供肝缺血再灌注损伤中的作用[J].天津医药,2004,32(12):763-766.
[9]方学军,迟彦邦,李靖.胆道梗阻再通后犬肝MDA和SOD含量的变化[J].广东医学,1997,18(10):692-693.
[10]金头峰,金恩鸿,李光燮,等.内皮素在梗阻性黄疽大鼠血液、肝、肾、胃及肺组织中的含量变化和作用研究[J].吉林医学,2001,24(l):13-15.
[11]Shibayama Y.Sinusoidal circulatory disturbance by microthrombosis as a cause of endotoxin-induced hepatic injury[J].J Pathol,2011,151(4):315-321.
[12]杨翔,吴天鸣,石民生,等.胆道梗阻再通前后病理转归的研究[J].中华实验外科杂志,1996,13(1):43-44.
[13]Mathie RT,Nagorny DM,Lewis MH.et al.Hepatic hemodynamic after chronic obstruction of the biliary tract in the dog[J].Surg Gynecol Obstet,2008,166(2):125-130.
[14]张少辉,吴伟,王尧华.Oddi括约肌生理与病理生理的动力学研究状况[J].中国中西医结合外科杂志,2004,10(5):398-400.
[15]刘凌云,杨定华,彭民浩.恶性梗阻性黄疸患者外周血CD4+CD25+调节性T细胞的变化及意义[J].实用医学杂志,2011,27(5):800-802.
[16]Clements MD,Mc Caigue M,Erwin P,et al.Biliary decompression promotes Kupffer cell recovery in obstructive jaundice[J].Gut,2012,38(6):925-929.
[17]Fialkow L,Fochesatto Filho L,Bozzetti MC,et al.Neutrophil apoptosis:a marker of disease severity in sepsis and sepsisinduced acute respiratory distress syndrome[J].Crit Care,2006,10(6):155.
[18]Leon CG,Tory R,Jia J,et al.Discovery and development of toll-like receptor 4(TLR4)antagonists:a new paradigm for treating sepsis and other diseases[J].Pharm Res,2008,25(8):1751-1761.
[19]吴涌宏,关养时.内毒素血症在梗阻性黄疸发生发展中作用的研究进展[J].中国普通外科杂志,2010,19(8):912-915.
[20]Takeda K,Akira S.Toll-like receptors in innate immunity[J].Int Immunol,2005,17(1):1-14.
[21]Matsuda T,Saito H,Fukatsu K,et al.Cytokine-modulated inhibition of neutrophil apoptosis at local site augments exudative neutrophil functions and reflects inflammatory response after surgery[J].Surgery,2010,129(1):76-85.
[22]陈强谱,管清海,张帆,等.梗阻性黄疸术后早期肠内营养对全身炎症反应综合征的影响[J/CO].中华普通外科学文献:电子版,2009,3(5):392-396.
[23]蔺觅,宋志春.梗阻性黄疸肾脏血流动力学变化[J].当代医学,2011,17(8):33-34.
[24]谷化剑,冯贤松,陈俊华,等.甲硫氨酸维B1与丹参酮ⅡA磺酸钠对梗阻性黄疸大鼠血浆肿瘤坏死因子、肾功能及肾组织丙二醛与超氧化物歧化酶的影响[J].中华实验外科杂志,2012,29(6):1098-1101.
[25]巩鹏,王忠裕,宝全.胆道梗阻后心脏损害的研究[J].肝胆外科杂志,2003,11(6):465-467.
[26]Padillo J,Puente J,Gomez M,et al.Improved cardiac function in patients with obstructive jaundice after internai biliary drainage:hemodynamic and hormonalassessment[J].Ann Surg,2012,234(5):652-656.