Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic)

In this chapter the epidemiology, pathogenesis, and natural history of CBD stones (choledocholithiasis) and intrahepatic stones (hepatolithiasis) have been reviewed. Gallstones are extremely common in Western countries, where the prevalence of bile-duct stones is relatively low. In contrast, primary choledocholithiasis and hepatolithiasis appear to be more frequent in East Asian countries than in Western societies, where bile-duct stones are mostly secondary to gallbladder stones passing through the cystic duct. Primary bile-duct stones are composed predominantly of calcium bilirubinate, namely brown-pigment stones. The pathogenesis of primary bile-duct stones is based upon bile stasis and infection, which are associated with bile-duct strictures, extrahepatic anomalies and biliary parasites. In contrast, secondary stones are considered to originate from gallbladder stones, and are commonly composed of cholesterol. Congenital and acquired risk factors predisposing to bile-duct stones include anatomical anomalies, genetic diseases of bilirubin and cholesterol, bacterial infection, and socio-economic problems. Bile-duct stones typical present with fever, abdominal pain, and jaundice (Charcot's triad), and in severe cases also hypotension and mental confusion (Raynold's pentad) which predicts a poor clinical outcome. Furthermore, silent cholangiocarcinoma develops in 10% of the intrahepatic stone cases even after the removal of stones, and therefore the follow-up of these cases is of clinical importance.     

腹腔镜治疗胆结石患者的手术室护理分析

目的:分析腹腔镜治疗胆结石患者的手术室护理相关内容及其护理要点。方法:将某院2016年8月~2017年8月接受腹腔镜手术治疗的86例胆结石患者作为此次研究的对象,根据患者的护理方式差异分为观察组和对照组各43例。观察组患者接受全面的手术室护理,对照组患者接受常规护理,对比两组患者护理效果差异。结果:观察组患者的手术情况明显优于对照组,观察组患者术后恢复情况以及其护理满意度要优于对照组,差异具有统计学意义(P<0.05)。结论:腹腔镜治疗胆结石手术中,为患者提供周全的手术室护理可以保障患者的手术顺利完成,提高手术质量,改善患者身体条件,促进患者康复,并且提升护理质量与患者对护理服务的满意度,应用情况良好,值得推广使用。     

中青年健康饮食行为与胆结石患病风险的相关性

目的 了解中青年健康饮食行为现状及影响因素,并分析其与胆结石患病风险的相关性,为制订中青年饮食干预方案提供指导。方法 选取健康体检的中青年1 038人为调查对象,使用基本情况问卷和成年人健康饮食行为评价量表进行调查。结果 中青年健康饮食行为总分为73.93±12.85。多元线性回归分析结果显示,性别、文化程度、居住情况、胆结石既往病史和家族胆结石史是中青年健康饮食行为的影响因素(P<0.05,P<0.01)。随访1年,饮食行为不健康中青年胆结石患病率显著高于饮食行为健康者(P<0.01)。多因素Cox回归分析结果显示,年龄、胆结石既往病史、家族胆结石史、健康饮食意识、规律用餐态度、健康饮食习惯是中青年患胆结石的影响因素(HR 0.091～0.299,均P<0.01)。结论 中青年健康饮食行为处于中等水平,其健康饮食行为受多因素影响。医护人员应加强健康指导,引导其建立良好的饮食行为,以预防胆结石发生。     

Lysosomal enzyme activities in gallbladder mucosa of gallstone-free subjects and patients with gallstones

Background/Aims: Gallstone patients have a reduced cellular lysosome content in the gallbladder mucosa cells compared with gallstone-free subjects. The purpose of the study was to further evaluate the possible role of lysosomes in the pathogenesis of cholesterol gallstone formation in humans.Methods: Lysosomal enzyme activities were assayed in gallbladder mucosa and for comparison in liver specimens of 19 gallstone-free subjects and 24 gallstone patients undergoing cholecystectomy.Results: Gallstone patients had 25–50% lower activities of the lysosomal proteases cathepsin B, D and L in their gallbladder mucosa compared with gallstone-free subjects. The activity of acid phosphatase also tended to be decreased in gallstone patients. The liver lysosomal enzyme activities were not significantly different between the two groups.Conclusions: The results show that gallstone patients have diminished lysosomal enzyme activities in the gallbladder mucosa, a finding which may be related to decreased intracellular degradation of proteins and/or mucin in the mucosal cells. This may lead to a higher concentration of mucin in gallbladder bile and thus an increased risk of precipitation of cholesterol crystals and gallstone formation.     

腹腔镜联合内镜治疗胆囊结石合并胆总管结石652例

目的探讨腹腔镜胆囊切除术(LC)联合内镜乳头括约肌切开术(EST)治疗胆囊结石合并胆总管结石的临床效果。方法回顾性分析LC联合EST治疗胆囊结石合并胆总管结石652例病例情况。结果 652例中EST成功634例(97.2%),再行LC成功621例(97.9%)。LC后平均住院4 d(2~15 d)。652例中有EST前伴有急性胰腺炎171例;不伴有急性胰腺炎481例,但EST后并发胰腺炎62例(13.1%)。621例LC后,合并胆汁漏8例(1.2%),经术中引流而愈;合并胆囊区积液120例(19.0%),其中118例自愈,另外2例脓肿形成在超声引导下经皮穿刺置管引流而愈。结论 LC联合EST治疗胆囊结石合并胆总管结石有治愈率高、住院时间短、并发症轻等优点,安全有效。     

家兔胆石模型肝组织固醇携带蛋白2表达的意义

目的:复制家兔胆固醇结石模型,检测模型家兔肝组织固醇携带蛋白2(SCP2) mRNA的表达. 方法:健康北京大耳白家兔16只,随机分为2组,每组8只:对照组喂普通饮食,模型组喂高胆固醇饮食(含12 g/kg胆固醇). 4 wk时剖杀动物,采用半定量RT-PCR检测SCP2 mRNA在家兔肝组织的表达. 结果:对照组无结石形成;模型组成石率达87.5%. 与对照组相比,模型组动物肝组织SCP2 mRNA表达升高(0.79±0.17 vs 0.44±0.07,P＜0.05). 结论:高胆固醇膳食致家兔胆囊结石形成时肝组织SCP2 mRNA表达升高.     

H1型调宁蛋白mRNA在胆道中的表达与妊娠豚鼠胆囊结石形成关系的实验研究

目的探讨妊娠胆囊结石形成过程中h1型调宁蛋白mRNA表达变化对胆道动力学改变的影响，从分子水平上阐明妊娠胆结石形成的机制。方法将30只成年雌性豚鼠随机等分为未孕组、孕30d组和孕60d组3组，每组各10只。实验组豚鼠按雌雄4：1比例搭配同笼喂养交配，建立豚鼠妊娠胆结石模型。动物剖腹后穿刺胆囊收集胆汁；采集门静脉血，分离血清；取除胆囊及Oddi括约肌。分别测定胆汁中总胆固醇（TC）、总胆红素（TBiL）、总胆汁酸（TBA）浓度，血清雌二醇（E2）及孕酮（Pg）含量，应用半定量RT—PCR法测定胆囊平滑肌和Oddi括约肌中h1型调宁蛋白（h1-Calponin）mRNA的表达量变化。结果妊娠豚鼠胆汁呈成石性胆汁生化改变。孕60d组胆汁TC、TbiL较非孕组明显增高（P〈0．05），TBA浓度显著降低（P〈0．01）；血清E2、Pg含量较非孕组明显升高（P〈0．001）；孕60d组豚鼠胆囊平滑肌中h1-calponin mRNA表达量明显高于非孕组（P〈0．001），而Oddi括约肌中h1-calponin mRNA表达量较非孕组明显降低（P〈0．01）。结论妊娠豚鼠h1-calponin mRNA表达在胆囊平滑肌中增高，在Oddi括约肌中下降，导致胆道运动功能紊乱和胆汁淤滞，可能是妊娠胆囊结石形成的关键因素。