上海江湾地区成年人胆囊结石发病情况调查

目的：了解当前上海江湾地区成年人胆囊结石的发生状况。方法：采用B超对社区中3419名居民作胆囊结石发病情况的调查。结果：20岁以上人群中有1．9％已施行胆囊切除术。胆囊结石的患病率为6．5％(男性为5．1％，女性为8．6％)，其中无症状者占70．5％。在静止胆囊结石患者中，有54．5％并不知晓自己的病情。胆囊结石的患病率随年龄的增加而升高，而年龄越大，胆爱切除率越高。结论：与十余年前相比，上海地区人群胆囊结石患病率有所提高，尤其在50岁以上年龄群中更为明显。其中静止胆囊结石的比例以及患者对病情知晓度均有上升。     

新疆温宿县成年人胆囊结石患病率调查

目的 了解新疆温宿县成年人胆囊结石的发病情况。方法 2003年7月至2004年7月对多级抽样的18岁以上3199名温宿县居民作空腹胆囊超声检查及问卷调查。统计分析采用SPSS11．5软件包。卡方检验，多因素分析采用Logistic逐步回归。结果 2．4％已行胆囊切除术；温宿县成年人胆囊结石的患病率为13．2％（男性为6．6％，女性为16．6％），其中无症状者占70．9％（292／412）；胆囊结石患病率随年龄的增加而升高，40岁以后高发；维吾尔族（13．7％）和其他少数民族（12．6％）均显著高于汉族（3．8％）（P〈0．001），每日肉食摄入量〉100g者（16．4％）高于肉食摄入〈50g者（14．4％），喜欢油腻食物者（15．6％）显著高于不喜欢油腻食物者（9．6％），脑力劳动者（13．4％）高于体力劳动者（11．8％）。睡眠时间不足8小时者（16．2％）高于超过8小时者（11．6％），肥胖指数〉25者胆囊结石患病率20．9％，高于肥胖指数为23-25者（15．8％）和〈23者（10．0％）。结论 新疆温宿县成年人胆囊结石患病率较高，多因素分析显示胆囊结石发病率与性别、年龄、民族、饮食结构、营养状况、工作性质、睡眠时间、肥胖指数等相关。     

胆囊切除术中取胆汁和胆囊壁组织行同步细菌培养(附42例分析)

为正确反映胆道中菌群情况及指导术后抗生素的应用,我院前瞻性地对４２例胆囊切除术患者进行胆汁和胆囊底壁组织同步细菌培养,现报告如下。 材料与方法 １．一般资料 连续调查我院胆囊切除患者共４２例,男１３例,女２９例,年龄２３～８０岁,＞６０岁２２人,平均６０．７岁。手术方式有２种：胆囊切除同时行胆总管探查术１９例,单纯胆囊切除术２３例;急性胆囊炎胆囊结石５例,慢性胆囊炎胆囊结石２２例,急性胆源性胰腺炎７例。这７例手术前血、尿淀粉酶都明显升高;以上病例术中均证实胆囊有结石。同时伴有胆总管结石８例,术中亦…     

胆囊胆固醇结石与低血总胆固醇及低心脑血管疾病患病风险的相关性研究

目的：探讨胆囊胆固醇结石与低血总胆固醇及心脑血管疾病患病的可能关联性。方法：选取2011—2012年天津市南开医院住院患者22 150例,收集胆囊结石患者与心脑血管疾病患者的年龄、性别及高血压、糖尿病、高脂血症患病情况,观察其空腹血糖、三酰甘油、总胆固醇等指标的水平。使用多因素Logistic回归模型分析胆囊结石与心脑血管疾病患病的关联性。结果：22 150例住院患者中,胆囊结石组8 032例,女性占61.4%,平均年龄56.8(95%CI 56.4～57.5)岁;非胆囊结石组14 118例,女性占51.0%,平均年龄57.3(95%CI 57.0～57.6)岁,两组间年龄、高血压、高脂血症患病率差异无统计学意义（P>0.05）,两组性别比例、糖尿病、心脑血管疾病发生率差异有统计学意义（P <0.001）。胆囊结石患者的心脑血管疾病（包括冠心病、脑卒中）的患病率较非胆囊结石低（29.5%vs 43.2%, P <0.001）。胆囊结石患者的血总胆固醇较非胆囊结石患者低（4.31 mmol/L vs 4.34mmol/L, P <0.001）。结论：胆囊结石与低血...     

老年胆石病的围手术期护理

老年胆石病成为影响老年健康的突出问题之一，胆石病随着年龄的增加，胆囊外并发症增加，手术危险性增高。我院自１９９０～２０００年完成老年胆石病２４７例，其中胆囊结石１８５例，占７４．９％；胆管结石１５例，占６．０７％；胆囊胆管均有结石４７例，占１９．０３％。通过实践与探索，我们总结老年胆石病围手术期的护理方法，现介绍如下。临床资料本组２４７例老年胆石病患者，手术方式分别采取腹腔镜胆囊切除术（１４２例）、开腹胆囊切除术（４３例）、胆囊切除术＋胆总管切开引流术（３２例）、经乳头括约肌切开取石术（８例）、…     

精神分裂症患者治疗依从性及有关因素分析

为降低精神分裂症患者的复发率，对８０例康复期精神分裂症患者治疗依从性及有关因素进行调查。结果显示，完全依从３５例（４３．７％），部分依从３３例（４１．３％），不依从１２例（１５．０％）。其中年龄、文化、家庭状况。护理质量、护患关系、药物不良反应、自知力及社区医疗服务现状与治疗依从性关系密切。提示，医务人员的优质服务、伙伴式护患关系，有效的健康教育方式以及良好的社区护理网络均有利于维持治疗的落实。     

胆囊结石病人ApoB基因XbaⅠ多态性及其与血脂的关系

研究胆囊结石病人Ａｐｏ Ｂ基因中ＸｂａⅠ位点的多态性及其与血脂的关系。方法 ：对１９０例胆囊结石病人组和４４２例正常人对照组，采用ＰＣＲ－ＲＦＬＰ法分析ＸｂａⅠ多态性的基因型，测定血脂。结果；胆石组的Ｘ＾＋／＾－基因型频率显著高于对照组（男性：１６．７％比８．０％，Ｐ＝０．０１；女性：２６．７％比７．７％，Ｐ〈０．００１；总体：２０．６％比７．９％，Ｐ〈０．００１）。胆石组的Ｘ＾＋等位基因频率显著     

上海闵行区胆囊结石与大肠癌相关性流行病学调查

目的 探讨胆囊结石与大肠癌之间的关系。方法 应用大样本、回顾性病例对照方法,对上海市闵行区七大工矿企业职工中胆囊结石病例数、大肠癌病例数、胆囊结石患大肠癌的病例数、性别、年龄、肿瘤发生部位等进行调查和统计学分析;对胃癌作同样分析。结果 （1）胆囊结石（胆囊未切除）患大肠癌与无胆囊结石患大肠癌比较：RR＝3．65（95％CI,1．73－6．31）,P＝0．0003;（2）胆囊结石患胃癌与无胆囊结石患胃癌比较：RR＝0．60（95％CI,0．16－2．41）,P＝0．4744。结论 胆囊结石增加大肠发病的危险性,是大肠癌发生的高危因素。胆囊结石胃癌与无胆囊结石患胃癌相比,二者无显著差异。     

胆囊切除术致胆管损伤六例分析

我院１９９０年１０月至１９９８年１０月共行经腹胆囊切除术４３７例，发生胆管损伤６例（１３７％），现报告如下。一、临床资料１．一般情况：本组６例均属因胆囊结石而行胆囊切除术，年龄最小３６岁，最大５８岁，其中女性５例，男性１例，１例既往有胃大部分切除的手术历史。２．胆囊切除术中情况：５例择期手术，１例急诊手术，１例因有上腹部手术史，第一肝门区广泛粘连将肝十二指肠韧带误认为粘连带剪断导致大出血，其余５例胆囊切除过程顺利。３．诊断：（１）时间：术中即时发现４例，术后第七天，第２０天各发现１例。（２）方…     

胆囊壁内结石290例临床分析

胆囊壁内结石的临床分析。方法：7500例结石性胆囊手术（腹腔镜胆囊切除7418例，中转开腹82例）胆囊壁内结石290例。结果：胆囊壁内结石平均发病年龄在52岁，胆囊壁多发性结石230例（79．3％），胆囊壁单发性结石60例（20．7％），胆囊壁结石伴胆囊结石250例（86．2％）。结论；罗一阿氏窦变化是形成壁内结石的基本条件，胆囊切除是有效的治疗方法。     

Complications of gallstone disease in kidney transplantation patients.

BACKGROUND: We studied the complications of gallstone disease in kidney transplantation patients and evaluated whether the screening and treatment of gallstones before acceptance to the kidney waiting list is relevant. METHODS: Complications of gallstone disease were evaluated in 1608 kidney transplantation patients on cyclosporine and long-term steroid treatment with median age 45.5 years, transplanted between 1990 and 2000. To evaluate the prevalence of cholecystolithiasis after kidney transplantation an abdominal ultrasound examination was cross-sectionally performed to a subgroup of 304 patients and the results were correlated to their serum lipid values, changes in BMI and use of statins. RESULTS: Pre-transplant cholecystectomy due to cholecystolithiasis (prerequisite for acceptance to kidney waiting list) had been performed on 71 (4%) of the patients. Thirty (15%) patients with diagnosed post-transplant gallstones and four without gallstones developed biliary complications. There were 25 cases of cholecystitis of which three resulted in gallbladder perforations. Seventeen patients (50%) with biliary complications required urgent surgery and one (3%) patient died of post-operative complications. In the subgroup of ultrasound examination patients (median 7 years post-transplant follow-up) 81% of the patients had no gallstones and 9% of the patients had gallstones had developed after transplantation. Patients with pre-transplant gallstones were older (P < 0.01) and patients with post-transplant gallstones gained the most weight during the follow-up. No differences in lipid values were found. CONCLUSION: In transplantation patients, the complications of gallstone disease may be severe. Screening and treatment of pre- and post-transplantation gallstone disease are recommended.     

胆囊结石病家系遗传特征的初步研究

目的: 探讨胆囊结石病家系的遗传特征. 方法: 胆囊结石病家系定义为家系内至少有2名患者;采用B超检查和问卷调查方式了解上海地区胆石病家系成员的疾病史和发病情况,系谱分析胆石病的遗传特点. 结果: 被调查家系总数93个,涵盖家庭成员563人,患者总数304人,患病率达54.0%.女性患病率(占61.0%)显著高于男性(占44.3%)(P=0.003).64个家系含有≥3个患者(即67.7%的胆石病先证者)具有两名以上(含两名)胆石病一级亲属;双亲之一或两者均为胆石病患者的家系占74.2%;先证者的同胞患病率达58.0%,双生子均发病;年龄大于60周岁的先证者,其子女的胆石病患病率达59.0%.胆石病家系中有高脂血症家族史为36.6%,高血压家族史为66.7%,糖尿病家族史为29.0%.男女性别间的子代发病率无差异,男性受遗传因素的影响可能性较大,母亲对后代的影响大于父亲. 结论: 胆石病是多基因遗传疾病,存在明显的家族聚集性,具有常染色体显性延迟遗传的特点,与代谢相关的多基因疾病关系密切.     

Gallstone disease following antrectomy and gastroduodenostomy with or without vagotomy.

The incidence and prevalence of gallstones has been documented in 289 consecutive patients with peptic ulcer disease, at the time of antrectomy and gastroduodenostomy (with or without truncal or selective vagotomy) and again during a 5-year follow-up period. By comparing the preoperative prevalence of gallstone disease in one age group with the prevalence 5 years after the gastric operation in another group of patients who were 5 years younger at the operation, the incidence of gallstone production due to the gastric operation could be calculated independent of the age factor. Within 5 years of the gastric operation, 18% of the patients who were normal at the time of operation produced gallstones. The incidence of new gallstones during the 5-year postgastrectomy follow-up was the same in men and women, and was increased by 7 to 15% in each age group of men. The incidence of new gallstones was 30% after truncal and 12% after selective vagotomy (p less than 0.05). Gallstone formation seems to be a sequel of Billroth I gastric resection. Truncal vagotomy in addition to the gastrectomy increases the risk of gallstone disease; patients with selective vagotomy and antrectomy had an incidence of postoperative gallstones which was the same as patients with antrectomy alone.     

Gallstones at autopsy and cholecystectomy: a comparative study

An examination of 613 post-mortems gave a prevalence of biliary disease at autopsy of 36.5%, higher than reported previously in Australia. This consisted of an asymptomatic gallstone prevalence of 18.9%, with a further 5.7% of the autopsies having granular biliary sludge and 11.9% having had a previous cholecystectomy. Although the rate of occurrence of cholesterol gallstones was approximately half that of the pigment gallstones and pigment biliary sludge combined, no significant association between the sex of the postmortems and stone type was observed at autopsy (chi 2(1) = 0.1: P greater than 0.05). The ratio of biliary disease between females and males was approximately 2:1. Gallstones and biliary sludge from 310 cholecystectomy patients showed that cholesterol gallstones were approximately twice as common in men, and approximately six times as common in women than pigment gallstones. In this group of patients there was a significant association between the sex of the patient and the rate of occurrence of stone type. The rate of occurrence of cholesterol gallstones was significantly higher than pigment gallstones in both the males and females at cholecystectomy (chi 1(2) = 18.97; P less than 0.0001). A female to male ratio of approximately 2:1 was also observed. A statistically significant higher rate of pigmented biliary disease was observed at autopsy than at cholecystectomy. (chi 2 = 101.0; P less than 0.0001). Analyses on biliary sludge, a filterable, fine granular pigmented material in bile, suggest that it may be the direct precursor for a number of different gallstone types.     

Lovastatin inhibits gallstone formation in the cholesterol-fed prairie dog.

The efficacy of lovastatin, an inhibitor of hepatic cholesterol synthesis in the prevention of cholesterol gallstone formation, was evaluated in the prairie dog model. Two groups of animals were maintained on either nonlithogenic or 1.2% cholesterol-enriched chow for 21 days. Seven of the animals in each group received lovastatin, and the remaining six received only distilled water. All of the cholesterol-fed/water-treated animals had crystals and 83% had gallstones, but none of the cholesterol-fed/lovastatin-treated animals had gallstones and only three had microscopic crystals. These data indicate that lovastatin inhibits cholesterol gallstone formation in a diet-induced model of gallstone disease.     

Gallstones

Gallstones represent one of the commonest surgical problems in the developed world. Post-mortem studies have found gallstones in 12% of men and 24% of women of all ages. Gallstones may be symptomatic or found incidentally. Symptoms arise due to stones in the gallbladder, in the bile duct, or both. It is estimated that 10-30% of patients with gallstones develop symptoms, of which a majority eventually require endoscopic or surgical intervention. Complications of gallstone disease include acute cholecystitis, obstructive jaundice, acute pancreatitis, gangrene of the gallbladder and gallstone ileus. Laparoscopic cholecystectomy is currently the treatment of choice for symptomatic gallstone disease and common bile duct stones can be treated surgically or at endoscopic retrograde cholangiopancreatography.     

The spectrum and cost of complicated gallstone disease in California

HYPOTHESIS: We hypothesized that complications of gallstone disease are more common than previously recognized and are related to treatment delay. DESIGN: Retrospective review. PATIENTS: Data for 248 consecutive patients from a university hospital in 1995-1996 and 40,571 patients identified through the 1996 California Office of Statewide Health Planning and Development database who underwent cholecystectomy for gallstone disease were reviewed. MAIN OUTCOME MEASURES: Diagnosis, length of hospital stay, hospital mortality, type of admission, type of surgical procedure, hospital cost, and interval of delay between onset of initial symptoms, ultrasound diagnosis, and cholecystectomy. RESULTS: The spectrum of gallstone disease included biliary colic in 56%, acute cholecystitis in 36%, acute pancreatitis in 4%, choledocholithiasis in 3%, gallbladder cancer in 0.3%, and cholangitis in 0.2%. Community hospitals, public or county hospitals, and academic health centers had a similar distribution of diagnoses. Patients undergoing cholecystectomy for biliary colic had a significantly shorter length of hospital stay, lower operative mortality rate, were more likely to have their operations completed laparoscopically, and had lower hospital charges than patients undergoing cholecystectomy for complications such as acute cholecystitis. Over half of the patients requiring cholecystectomy for complications of gallstones initially presented with biliary colic. Patients with gallstone complications had an average delay from ultrasound confirmation to surgery of 6 months. CONCLUSION: Complications of gallstone disease are (1) common, (2) costly, and (3) potentially preventable.     

Gallstones: genetics versus environment

OBJECTIVE: The aim of this study was to determine if a significant genetic component contributes to the pathogenesis of symptomatic gallstones. SUMMARY BACKGROUND DATA: Gallstones represent a polygenic disorder that affects more than 30,000,000 Americans and results in more than 750,000 cholecystectomies in the United States annually. Risk factors include age, gender, race, parity, obesity, and diabetes. A family history of gallstones also has been identified as a risk factor suggesting that genetics play a role in gallstone formation. However, the role of genetics in the pathogenesis of gallstone formation has not been determined. METHODS: A gallbladder disease-specific questionnaire was administered to 904 healthy unrelated adult volunteers (association study). The questionnaire ascertained a history of cholecystectomy and gallstone disease in first-degree relatives, as well as medical history, demographic, and anthropometric data. A logistic regression model was used to identify risk factors for symptomatic gallstone disease in a multivariate analysis. A maximum likelihood based variance decomposition approach was then used in 1,038 individuals from 358 families (family study) to estimate the additive genetic heritability of symptomatic gallstone disease. RESULTS: In the association study significant risk factors for symptomatic gallstone disease were female gender (relative risk 8.8, P <.003), obesity (BMI > 30, relative risk 3.7, P <.001), age > 50 (relative risk 2.5, P <.001), and a positive family history of previous cholecystectomy in a first-degree family member (relative risk 2.2, P <.01). In the family study the additive genetic heritability of symptomatic gallstones was 29% (P <.02), age and gender were significant covariates and explained 9.3% of the phenotypic variation in gallbladder disease. CONCLUSIONS: These data suggest that genetic factors are responsible for at least 30% of symptomatic gallstone disease. However, the true role of heredity in gallstone pathogenesis is probably higher because data based on symptomatic gallbladder disease underestimates the true prevalence in the population.