- 期刊
肝內膽管注射以評估阻塞性黃疸之膽汁逆流之研究
Assessment of Bile Regurgitation in Obstructive Jaundice by an Intrahepatic Choledochal Injection Method
摘要
阻塞性黃疸之膽汁逆流途徑或機轉在近幾十年來一直是未完全解決的問題，本研究中選擇5位因肝外膽道惡性腫瘤者，其有高度全身性黃疸發生，而且手術證實。本實驗之目標藉以了解膽汁逆流途徑將阻塞性黃疸病例5例，手術T-型管引流後第三週再以膽道鏡伸入右後肝葉膽管枝，再注入1%之bromosulfaphthalein sodium溶液(BSP)保持50公分水柱後約5分鐘後，抽其手側週邊血液驗其BSP之存在，發現阻塞性黃疸病例，均可驗出其濃度在6.2%至11.5%間，而在無黃疸對應組則均小於1%，且在術後的膽道造影時可發現造影劑進入肝實質部份及靜脈部份，可見膽管及血液相通性，在持久性阻塞性黃疸是相通的，也就是造影膽汁逆流途徑之證明。
關鍵字
無資料並列摘要
Bile duct obstruction which is of a long duration usually has a poor prognosis. This is because bile will regurgitate directly back through the canaliculi to Disse's space. In a clinical investigation, 1% of bromosulfaphthalein sodium (BSP) was selectively injected through a choledochoscope with the pressure of 50 cm H2O into the intrahepatic cuct of patients with severe obstructive jaundice. After 5 minutes, the existence of BSP was detected in the peripheral vascular system. In severe obstructive jaundice, the concentration of BSP ranged from 6.2% to 11.5% and less than 1% in non-jaundiced patients. In addition, a contrast media, Urographin (45%) was given by intracholedochal injection into the same branch and a series of cholangiograms were taken. This contrast media was then found in the parenchyma and vessels and then disappeared. Such a finding may indicate the existence of a direct communication between the circulatory blood system and the biliary system in severe obstructive jaundice.