提高灌注溶石疗法的研究(附87例分析)

应用2%复方去氧胆酸钠、2%复方偏磷酸钠及Ⅰ号或Ⅱ号复方桔皮油乳剂等溶石剂经胆道引流管灌注治疗87例胆道残石病例。治疗前经 X 线或胆道镜确诊。残石部位:肝外胆管31例;肝内胆管37例;肝内外胆管19例。治疗中从引流瓶及大便淘洗中发现大量胆石碎片,经化学分析及电镜检查,与体外溶石试验结果一致。治疗结果:56例全溶,占64.37%;19例残石变小或变少,占21.24%;4例因肝内胆管病变中转手术,占4.86%;8例因治疗反应停止溶石,占9.20%。4例肿大的肝脾缩小,脸色由灰暗变为红润。对改善溶石治疗的有关措施进行了讨论。

A Study on the Dissolution of Retained Gallstones by Perfusion An Analysis of 87 Cases

Eighty seven patients suffering from retained calculis were treated by perfusion with a varity of dissolving agents,Among them 28 were tr- eated with 2% compositus sodium deoxycholic acid (2% CO)22 with 2% compositus sodium hexametaphosphate(2% CO)15 with the of orange -peel oil emulsion(compositum No.1),and 22 cases with the(composi- turn No2)of the Latter.All these patients were examined with cholani- ography or cholangioscopy before and after treatment to confirm the change of the size,number and location of the retained stones.Among them, 31 patients had calculi located in the extra-hepatic duct,37 in the in- tra-hepatic duct and 19 in both intra and extra-hepatic ducts.Fragments of the retained calculis were found in both bile and foces during treat- ment.A study on the change of composition and utrastructure of the sto- ne fragments by means of chemical analysis,atomic absorption spectroph- 0tometry,and scanning eletronmicroscopy showed that the amount of cho- lesterol,bilirubin,calcium and magnesium of the fragments were remar- kably reduced The change in the stonn fragment and in the samples of dissolving-stones in vitro was the same The result after treatment sho- wed the retained stones disappeared in 56 cases(64.37%),became fewer or smaller in 19 cases(21.24%),4cases under went operation because of pathalogical change in the intrahepatic biliary duct(4.86).8cases stopped- to be treated due to reaction(9.20%).In4cases,the enlarged liver and spleen became normal,smaller and the color of their face changed from dark gray to healthy looking.Problems concerning the improvement of technique in dissolving gall-stones are discussed