胆道术后残余结石的治疗与预防

目的 探讨胆道术后残余结石的防治方法。方法 回顾性分析1996—2004年，经术中、术后胆道镜及胆道造影确诊的260例胆道残余结石患者，对其治疗方法及预防措施进行总结分析。结果 经T管窦道胆道镜子取石198例（76．2％），经内镜乳头气囊扩张取石（EPBD）11例，经内镜括约肌切开取石（EST）33例，Oddi括约肌切开成形术4例，胆肠Roux—Y吻合7例，肝左外侧叶切除术3例，保守治疗4例。其中1次结石取净112例，2次结石取净79例，3次以上结石取净51例，结石未取净18例（6．9％）。结论 胆道镜、十二指肠镜是治疗胆道术后残余结石的主要手段，合理选择手术方式是预防残余结石的根本措施。     

新疆汉族和维吾尔族胆汁中结合胆汁酸含量与胆固醇类结石形成关系的探讨

作者用高效液相色谱法（ＨＰＬＣ）对３３例汉族和维吾尔族胆固醇结石患者和２２例正常人胆汁的８种结合胆汁酸进行了测定，旨在探讨汉族、维吾尔族两民族间胆汁酸含量及构成的差异，揭示胆汁酸与胆固醇结石形成的关系。结果表明：（１）汉族和维吾尔族正常人胆囊胆汁总胆酸分别为１１２．４３ｍｇ／ｍｌ和９４．２７ｍｇ／ｍｌ，明显高于瑞典正常人，与国内资料相同，两民族间差别不明显。（２）两民族正常人胆囊胆汁各种结合胆汁酸含量、构成比和比值间存在差别。汉族鸽脱氧胆酸（ＣＤＣＡ）含量明显高于维吾尔族，脱氧胆酸（ＤＣＡ）含量明显低于维吾尔族。我们认为造成差别的原因可能是两民族膳食成分不同，提示维吾尔族正常人可能较汉族正常人易发生结石。（３）胆石患者胆囊胆汁总胆汁酸低于正常组，胆汁酸构成比在两组间无明显差别，说明结石患者胆汁酸组分为均衡减少。胆汁酸含量减少，使对胆固醇的溶解能力下降，易形成结石。     

Bioavailability, gastrointestinal transit, solubilization and faecal excretion of ursodeoxycholic acid in man

The bioavailability of ursodeoxycholic acid (UDCA), a cholesterolic gallstone dissolving agent, has been analysed in seven healthy human volunteers. After absorption of a capsule containing a 500 mg dose, the time course of plasma concentrations of the drug presented a double peak profile over a 240 min period. In order to explain this result, a second group of five subjects bearing a four-way jejunal catheter fitted with an occluding balloon, received an oral dose of 250, 500 or 750 mg of the drug. Simultaneous analyses of plasma UDCA concentrations and jejunal UDCA contents were carried out. UDCA is poorly soluble in the gastro-duodeno-jejunal contents of fasted subjects since 21-50% of the ingested doses were recovered in solid form. The profile of plasma concentration paralleled the amount of soluble UDCA present in intestinal lumen. When jejunal contents were infused below the balloon a second plasma peak appeared in cases corresponding to ingestion of higher doses of UDCA. In conclusion, pharmacological doses of UDCA are not readily soluble in the stomach and intestine of a healthy fasting man. In consequence, the bioavailability of the drug varies with its progressive solubilization in the gastrointestinal tract. The present results suggest that repeated daily doses of UDCA should improve its bioavailability in treated gallstone patients.     

胆囊结石X线特征与化学类型的相关性研究

本文探讨了胆囊结石化学类型与其Ｘ线影象特征的关系，对８８例胆囊结石病例的结石常规Ｘ线表现与结石标本的化学类型进行对照分析，发现胆囊结石的钙化、大小、大小的均匀性、数目、漂浮性、表面特性等多种Ｘ线征象以及患者性别均与结石的化学类型有密切的关系；从而可利用常规Ｘ线检查判别结石的化学类型，通过综合分析各种Ｘ线征象，可以提高判别的准确率。     

高胆固醇饮食对妊娠豚鼠胆囊AQPsmRNA及雌性激素受体的影响

目的 研究高胆固醇饮食对妊娠豚鼠胆囊运动及胆囊黏膜上皮水通道蛋白-1( AQP -1)和水通道蛋白-8(AQP -8)的影响.方法 60只妊娠豚鼠,随机分为实验组A组、B组和对照组,实验组给予致结石饮食(胆固醇含量分别为1％和0.5％)喂养8周.采用RT - PCR对其胆囊AQP -1与AQP -8进行检测,应用化学发...     

从胆石成因研究谈胆石病预防的新策略

胆囊胆固醇结石病发病率有不断增加趋势。在胆石病发病机制中,胆汁胆固醇过饱和是胆石形成的必要条件。近年来的研究显示,胆石病患者肝肠循环脂质代谢异常是导致胆汁胆固醇过饱和的分子生物学基础：包括肝脏高密度脂蛋白受体增加胆固醇的摄入、胆小管侧膜胆固醇转运蛋白增加向胆汁中分泌以及经小肠摄人体内的胆固醇增加。大量实验证据表明,对肝肠循环脂质代谢异常进行有效干预,通过降低肝脏胆固醇负荷及其分泌,抑制小肠胆固醇摄取等多个环节,维持胆汁胆固醇的平衡,有望成为预防胆石形成的一系列新的措施。     

骨桥蛋白在胆固醇结石患者胆汁中的表达及成核作用研究

目的 探讨骨桥蛋白在人胆固醇结石形成中的作用.方法 36例胆固醇结石患者为结石组,19例肝移植供体为正常组,分别测定骨桥蛋白、钙离子及脂质成分在胆囊胆汁中的含量,用成核时间法研究骨桥蛋白在胆汁中的成核作用.结果 骨桥蛋白呈剂量依赖性地抑制胆固醇自发成核.50 μg/ml的骨桥蛋白可分别使结石组和正常组胆汁的成核时间延缓48.90％和17.07％,100 μg/ml的骨桥蛋白可使成核时间延缓91.51％和32.93％;并可抑制钙离子诱导的促成核作用.50μg/ml骨桥蛋白+钙离子可分别使结石组和正常组胆汁成核时间延缓75.78％和33.96％,而100μg/ml骨桥蛋白+钙离子则使成核时间分别延缓125.90％和62.26％.结石组胆汁中胆固醇、磷脂、胆汁酸及胆固醇饱和指数均显著高于正常组胆汁(P＜0.05),而骨桥蛋白和钙离子含量则明显低于正常组胆汁中的含量(P＜0.05).结论 骨桥蛋白可抑制胆固醇成核,并参与胆结石的发生发展.     

An alternative surgical approach to a difficult case of Mirizzi syndrome： A case report and review of the literature

INTRODUCTION Mirizzi syndrome (MS) is a rare complication of long- standing cholelithiasis, which results from impaction of a large calculus or multiple small stones in the cystic duct or in the neck of the gallbladder causing extrinsic narrowing of the c…     

Hyperleptinaemia and hypoadiponectinaemia are associated with gallstone disease

BACKGROUND: Gallstone disease has been regarded as an obesity-related disease. Therefore, we hypothesized that leptin and adiponectin, mainly produced by adipose tissue, may play roles in gallstone disease. PATIENTS AND METHODS: The RIA method was used to analyze serum leptin and adiponectin levels of 90 gallstone patients and 91 healthy subjects. RESULTS: Our results showed that BMI, fasting glucose, serum AST and ALT, and leptin were significantly increased in the gallstone patients as compared with the healthy subjects (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.013, respectively). Intriguingly, serum adiponectin was the only variable to be significantly decreased in the gallstone patients (P = 0.002). Furthermore, serum AST, leptin, and adiponectin were significantly associated with gallstone disease (P < 0.001, P = 0.021, and P = 0.006, respectively). Overweight (BMI >or= 25 kg m(-2)), but not normal-weight, gallstone patients had an increased serum leptin and a decreased serum adiponectin level as compared with matched healthy subjects (P < 0.001 and P = 0.024, respectively). In addition, serum leptin was positively correlated with BMI and serum cholesterol, while serum adiponectin was inversely correlated with serum triglyceride in the gallstone patients. CONCLUSIONS: Our study indicated that hyperleptinaemia and hypoadiponectinaemia might be involved in the occurrence of gallstone disease. However, the causal relationship of hyperleptinaemia and hypoadiponectinaemia with gallstone disease might require further investigation.