红霉素对胆囊收缩作用的探讨

红霉素对胆囊有无收缩作用尚不清楚，作者在建立动物胆囊结石模型基础上，通过胆囊离体试验和超声扫描方法分别观察了红霉素对金黄地鼠和人类胆囊运动的影响。实验结果提示，红霉素能使胆囊产生收缩作用，可试用于胆囊运动功能障碍的治疗。     

糖尿病病人胆囊运动障碍的研究进展

胆囊运动功能障碍是胆囊胆固醇结石形成的三大必要条件之一。糖尿病病人胆囊结石发病率高，并普遍存在胆囊运动功能障碍，糖尿病病人胆囊运动功能障碍由迷走神经病变，体液因素（胰岛素，胆囊收缩素等）紊乱引起，而药物（西沙必利，红霉素）可改善糖尿病病人胆囊的运动功能。     

糖尿病病人胆囊运动障碍的研究进展(文献综述)

胆囊运动功能障碍是胆囊胆固醇结石形成的三大必要条件之一。糖尿病病人胆囊结石发病率高 ,并普遍存在胆囊运动功能障碍。糖尿病病人胆囊运动功能障碍由迷走神经病变、体液因素 (胰岛素、胆囊收缩素等 )紊乱引起 ,而药物 (西沙必利、红霉素 )可改善糖尿病病人胆囊的运动功能     

红霉素收缩胆囊作用的临床观察

通过实时超声扫描，动态地观察了口服红霉素后正常人和胆囊结石病人的胆囊运动改变，结果表明红霉素可使正常人胆囊空腹容积由２８．８士１４．０ｍｌ减少至２１．８士７．５ｍｌ（Ｐ＜０．０５），残留容积由８．９±５．６ｍｌ减少至５．１士２．ｌｍｌ（Ｐ＜０．０５），胆囊排空速率由０．０１５８土０．００２９ｍｌ／ｍｉｎ增至０．０３１１土０．００１６ｍｌ／ｍｉｎ，排空分数由７３％±１０．７％增加至８１．９％土１５．９％（Ｐ＜０．０５）。红霉素对结石病人的胆囊亦有同样的收缩，而且可使结石病人的胆囊运动功能下降改善接近于正常水平。     

胆囊结石病人胆囊肌条收缩力变化的研究

胆囊运动功能障碍在胆石形成中起着非常重要的作用，本实验通过对人胆囊离体肌条的研究，来探讨消化道激素对胆石症患者胆囊平滑肌收缩力的影响。     

肝硬变患者胆囊运动功能与血浆胆囊收缩素,胃动素水平的关系

肝硬变患者胆囊运动功能与血浆胆囊收缩素、胃动素水平的关系胡望明尹朝礼吴华赖世英胆囊收缩素（ＣＣＫ）和胃动素（ＭＴＬ）均参调节胆囊运动。关于肝硬变患者胆囊运动功能的研究，结果尚不一致。我们对肝硬变患者血浆ＣＣＫ和ＭＴＬ进行检测，并通过实时超声观察了患者...     

消炎痛,红霉素预防胆囊结石形成的实验研究

为进一步探讨胆汁成份异常、胆囊动力学变化和胆囊结石形成之间的内在联系，对家兔胆囊结石动物模型进行了胆囊动力学研究。结果显示：除胆汁成份异常外，胆囊动力学变化参与了胆囊结石形成。消炎痛能减少胆汁粘蛋白含量抑制胆固醇成核过程而防止胆囊结石形成；而红霉素能通过促进胆囊收缩同时减少胆汁粘蛋白含量和促进胆囊排空，从而更有效地防止胆囊结石形成。提示：改善致石胆汁引起的胆囊动力学变化较改变胆汁成分更有利于防止胆囊结石形成。     

胆囊运动在胆固醇结石形成中的作用（综述）

胆囊运动的异常与胆囊结石的形成紧密相关。胆囊伴发结石时，可有胆囊收缩改变和排空减少。在胆固醇结石的病例，胆囊收缩减弱更与胆汁成石指数相关。在胆囊结石形成过程中，胆囊收缩异常与胆法成份改变互相影响，促进结石形成。     

自制动力散预防胆囊结石形成的实验研究

为探讨中药动力散预防胆囊结石的机理，选用家兔37只，随机分为3组。对照组（n=13）给予基础饲料；高胆固醇组（n=14）给予含1．2％胆固醇的高胆固醇饲料；高胆固醇十动力散组（n=10）给予高胆固醇饲料加能促进胆囊收缩的中药动力散，分笼饲养4周后，对胆囊成石情况和胆囊管阻力等进行观察与检测。结果发现，高胆固醇组12／14只形成结石，高胆固醇十动力散组2／10只形成结石，后者动物胆囊排空率较高胆固醇组显著增加，胆汁中粘蛋白浓度和胆囊管阻力则明显降低。表明动力散能通过促进胆囊收缩而降低胆汁中粘蛋白含量，降低胆囊管阻力，促进胆囊排空，有利于减少胆囊结石形成。     

超声扫描观察胆囊结石病人的胆囊运动

经Ｂ型超声扫描观察了２０名正常人和２２名单纯胆囊结石病人空腹状态下和脂肪餐后的胆囊运动情况。发现胆囊结石病人囊空腹容积和正常人差别无显著意义，但其胆囊收缩排空功能已有明显下降，主要表现为胆囊残留容积增加、排空速率和排空分数下降；部分结石病人的胆囊收缩排空速率和排空分数与正常人的差异无显著性意义。     

Direct inhibitory effect of erythromycin on the gallbladder muscle

Erythromycin, a macrolide antibiotic, stimulates motor activity in various parts of the gastrointestinal tract in humans and animals. This effect of erythromycin resembles that of motilin, a gastrointestinal hormone, in evoking contractions similar to phase 3 activity of the migrating motor complex. Motilin induces contractions in the canine gallbladder but fails to evoke any response, either in vivo or in vitro, in the human gallbladder. Surprisingly, erythromycin stimulates human gallbladder emptying in healthy volunteers and in persons with diabetic autonomic neuropathy. In the present study we examined the effect of erythromycin on chemically and electrically evoked contractions of isolated gallbladders from guinea pigs and humans by use of isometric force measurements. Carbachol, a muscarinic cholinergic agonist, evoked gallbladder contractions that were diminished by erythromycin in a concentration-dependent manner: at 200 μ mol/L the contractions were 86% ±20% of the control response, at 500 μmol/L they were 63%±21% of control, and at 1000 μmol/L they wer 41%±20% of control (P<0.05, N=10, mean ±standard deviation). Electrically evoked gallbladder contractions were reduced to 68%±18% of the control response with the addition of 500 μmol/L of erythromycin and to 56%±19% of control after the addition of 1000 μmol/L (P<0.05, N=8). Guinea pig but not human gallbladders contracted after stimulation with the alpha-adrenergic agonist phenylephrine. Erythromycin reduced these contractions in a concentration-dependent manner but had no effect on gallbladder contractions induced by bradykinin. In human gallbladder strips, erythromycin at 500 μmol/L reduced the contractile response to electrical stimulation to 71%±16% of the control value (N=10 [5 patients],P<0.01) and the carbachol-evoked contractions to 53%±24% (P<0.01, N=32). The inhibitory effect of erythromycin persisted in the presence of the nerve blocker tetrodotoxin at 1 μmol/L. It is concluded that erythromycin has a direct inhibitory effect on guinea pig and human gallbladder contractions.     

Direct inhibitory effect of erythromycin on human alimentary tract smooth muscle

BACKGROUND: Erythromycin was found to stimulate motor activity in the upper gastrointestinal tract. However, in several smooth muscle preparations, it also elicited an inhibitory effect. Our aim was to study the effect of erythromycin in various human alimentary tract smooth muscles. METHODS: Using force measurements, we assessed the effect of erythromycin on electrically and chemically evoked contractions of isolated muscle strips of human gallbladder, small intestine, and colon. RESULTS: The muscarinic receptor agonist carbachol evoked contraction in gallbladder, ileum, and colonic smooth muscle that were reduced by erythromycin at 10(-4) M to 72% +/- 24%, 77% +/- 22%, and 76% +/- 22% of control values, respectively. Erythromycin did not affect contractions evoked by noncholinergic agents. Erythromycin's inhibitory effects were not altered by nerve blockade, indicating a direct muscle effect. Eryrthromycin also reduced contractions evoked by electrical stimulation at frequencies of 5, 10, and 20 Hz in the human gallbladder, ileum, and colon preparations. These contractions were reduced by erythromycin in a reversible and dose-dependent manner. CONCLUSIONS: Erythromycin antagonized direct cholinergic effects on various smooth muscles from the human alimentary tract in a concentration-dependent manner.     

Bile exposure of the denervated stomach as an esophageal substitute

Background. Both the supine position and the existence of a gastric drainage procedure are suspected to promote reflux of duodenal juice into the denervated intrathoracic stomach. Erythromycin has been shown to weaken pyloric resistance to gastric outflow and to enhance antral motility, gastric emptying, and gallbladder contractility.

Methods. The presence of bile in the gastric transplant of 79 patients was monitored over a 24-hour period with use of the Bilitec 2000 optoelectronic device 3 to 195 months after subtotal esophagectomy. Ten patients were reinvestigated after a 3-year period. Five groups were studied: group I: N = 12, no gastric drainage, never given erythromycin, group 2: N = 40, gastric drainage, never given erythromycin, group 3: N = 7, no gastric drainage, given erythromycin, group 4: N = 13, gastric drainage, given erythromycin, and group 5: N = 7, no longer given erythromycin (with or without gastric drainage). The percentage of time gastric bile absorbance was more than 0.25 was calculated for the total, supine, and upright periods of recording in reference to data from 25 healthy volunteers.

Results. The Bilitec test was pathologic in 9 of the 12 patients of group 1 whereas it was normal in three. Gastric exposure to bile was longer in group I patients than in controls for the total (p = 0.012) and supine (0.036) periods, but the difference did not reach statistical significance for the upright period (p = 0.080). Bile exposure in group 4 did not significantly differ from controls (total: p = 0.701; supine: p = 0.124; upright: p = 0.712). Bile exposure for the total period did not significantly differ whether patients were taking erythromycin or the drug had been discontinued at the time of the study (p = 0.234); and it tended to decrease with time in patients investigated twice (p = 0.046).

Conclusions. Gastric exposure to bile after truncal vagotomy and transposition of the stomach up to the neck is pathologic in three quarters of patients. It is more marked in the supine than in the upright position and tends to decrease with time. The addition of a gastric drainage procedure in combination with erythromycin therapy tends to normalize gastric exposure to bile. The effects of erythromycin may persist after discontinuation of the drug.     

Effect of estrogen on rabbit gallbladder prostaglandin biosynthesis

Male and female gallbladder prostaglandin biosynthesis was compared by radiochromatographic analysis of microsomal membrane fractions. Normal female rabbit gallbladder total prostaglandin activity was 10-fold higher than the normal male rabbit gallbladder total prostaglandin activity. The normal male rabbit extracts produced PGF₂α and PGE₂ as the major arachidonic acid metabolites. The normal female rabbit extracts synthesized PGI₂ and PGE₂ (20-fold higher activity than the normal male) as the major arachidonic acid metabolites present. The effect of estrogen was studied by comparing prostaglandin activity in ovariectomized female rabbits given high-dose estrogen, low-dose estrogen, and no estrogen. The zero estrogen group prostaglandin activity was 5-fold lower than the normal female group. Treatment with low- or high-dose estrogen restored the gallbladder prostaglandin activity to the level of the normal rabbit gallbladder prostaglandin activity.     

内镜微创保胆取石术后胆囊功能的中长期随访报告

目的观察内镜微创保胆取石术后患者胆囊收缩功能,探讨结石复发率、胆囊壶腹部结石嵌顿术后胆囊壁厚度变化。方法对85例术后1年以上的内镜微创保胆取石术进行随访,B超测量脂肪餐前后胆囊壁厚度和胆囊内有无结石等情况。设定胆囊收缩率≥50％为胆囊收缩功能良好,胆囊收缩率〈50％为胆囊收缩功能差。胆囊壁厚度≥3mm为增厚,〈3mm为正常。术前胆囊壁厚度正常40例（正常组）,其余45例为炎症组。结果胆囊收缩率42％-98％,（67．7±18．9）％,其中胆囊收缩功能良好72例（84．7％）,功能差13例（15．3％）。40例正常组内镜保胆取石术后胆囊颈、体、底厚度正常38例（95．0％）,增厚2例（5．0％）;45例炎症组内镜保胆取石术后胆囊颈、体、底厚度正常34例（75．6％）,增厚11例（24．4％）。正常组术后7-8年结石复发1例,炎症组术后结石复发10例。结论术前胆囊正常为保胆取石手术的最佳选择,胆囊伴炎症、结石嵌顿的患者也可行保胆手术,但要严格适应证,两镜联合取净结石,术后随访。     

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??Association of gallbladder carcinoma and anomalous pancreaticobiliary ductal junction TIAN Fu-zhou, LUO Zhu-lin, ZHANG Bing-yin??et al. PLA General Surgery Center, Chengdu General Military Hospital, Chengdu 610083, China
Corresponding author: TIAN Fu-zhou, E-mail: tfz30061@yahoo.com.cn
Abstract Incidence of gallbladder carcinoma in patient with anomalous pancreaticobiliary ductal junction ??APBD??has been noted as high as 50% or more. The patients with APBD have an earlier age of onset comparing with the “normal people”. It found the similar result in 694 pancreaticobiliary ductal image materials admitted between 1995—2007 at PLA General Surgery Center of Chengdu General Military Hospital. Incidence of gallbladder carcinoma in patients with APBD was 21.8%. It is noteworthy that the length of common channel (CC) more than 15 mm is considered as the gold standard for the diagnosis of APBD in the world. The literature about characteristics of gallbladder carcinoma in “normal people” with the length of CC less than 15mm is rare. All the “normal people” were divided into short CC group and long CC group except for 28 patients with APBD in 694 pancreaticobiliary ductal image materials. Incidence of the latter was 10 times higher than that of the former. The concentration of amylase in bile in long CC group was higher than that in short CC group. The mechanism of the high incidence of gallbladder carcinoma may the reflux of the pancreatic juice into the bile duct. Measuring the length of CC and detecting the concentration of amylase in bile might be a method for predicting the onset risk of gallbladder carcinoma.     

胆囊结石及胆囊癌与ABO血型相关性研究

目的 探讨胆囊结石及胆囊癌的发病机会与ABO血型分布有无关联。方法 分析600例胆囊结石和57例胆囊癌病人的ABO血型分布情况,并与2363例自然人群的血型分布做对比研究。结果本组胆囊结石病人的ABO血型分布与对照组相比无显著性差异（P>0.05）,而胆囊多发性结石较多发生于A血型病人（P<0.05）;与对照组相比,A型血者患胆囊癌的机会明显增加（P<0.05）。结论 胆囊癌的发病机会与A血型有明显关联,而胆囊结石的发病机会与ABO血型无关。     

细胞核仁形成区酸性非组蛋白在胆囊癌诊断与监测中的价值

目的探讨检测细胞核仁形成区酸性非组蛋白在胆囊癌诊断与监测中的价值。方法应用细胞银染技术对体外激活的外周血和胆汁淋巴细胞染色 ,并对胆囊组织作核仁形成区嗜银蛋白银染 ,计算外周血和胆汁中硝酸银染色酸性非组蛋白 (Ag) NORs面积与核面积的比值 (IS % )和组织切片中AgNOR颗粒面积。结果正常人 (2 0例 )、慢性胆囊炎 (90例 )与胆囊癌之间 (2 1例 )外周血、胆汁T细胞Ag NORs面积与核面积的比值和组织切片中AgNOR面积差异均有显著性意义 ,血清、胆汁中T细胞Ag NORs面积与核面积的比值 (IS % )逐级降低 ,组织切片中AgNOR面积逐级升高 ,且血清、胆汁中T细胞Ag NORs面积与核面积的比值 (IS % )、组织中AgNOR面积三者相互间有良好的直线相关性 (P均 <0 0 1)。结论监测胆囊病变过程中患者外周血、胆汁中T细胞Ag NORs面积与核面积的比值 (IS % )和组织切片中AgNOR面积的变化 ,有助于胆囊癌的诊断     

Shh和Ptch在胆囊癌组织中的表达及其意义

目的 研究表明,Shh和Ptch是Hh传导通路的核心,消化系肿瘤中Hh通路的高度激活状态与消化系肿瘤的发生相关.本研究检测人胆囊腺癌标本中Shh和Ptch的表达,并探讨其意义.方法 采用免疫组化SP法对41例胆囊癌、21例胆囊腺瘤和20例正常胆囊组织中Shh和Ptch基因蛋白进行检测.结果 41例胆囊癌组织标本中Shh的阳性表达率为75.6%(31/41),Ptch的阳性表达率为78.0%(32/41).Shh和Ptch染色主要位于胆囊癌细胞的胞质和胞膜.20例正常胆囊组织中,Shh的阳性表达率为5%(1/20),Ptch的阳性表达率为10%(2/20).21例胆囊腺瘤组织中Shh的阳性表达率为4.7%(1/21),Ptch的阳性表达率为9.6%(2/21),各组间Shh和Ptch阳性表达率差异均有统计学意义(P＜0.001),而在不同性别、不同年龄组(年龄≥60岁及＜60岁)、不同病理组织学分级、Nevin不同分期、组织学不同分化程度、有无淋巴结或远处转移、有无伴发胆囊结石组间的Shh和Ptch阳性表达率表达差异均无统计学意义(P＞0.05).胆囊癌组织中Shh阳性表达率为75.6%与Ptch阳性表达率为78.0%之间存在显著正相关(r=0.72,P＜0.01).结论 原发性胆囊癌的发生可能与Hedgehog-Gli信号通路的异常活动密切相关.     

基于深度神经网络Mask R-CNN胆囊癌辅助识别系统临床应用价值研究

目的探讨基于深度神经网络的目标检测技术在腹部双源CT胆囊癌辅助识别系统的临床应用价值。方法选取2017年1月至2019年12月上海交通大学医学院附属新华医院普外科、吉林大学第一医院肝胆胰外一科和吉林大学中日联谊医院普外科收治的88例病理学检查诊断明确的胆囊癌,28例慢性胆囊炎胆囊结石病人和29例正常胆囊(影像学检查胆囊正常)病人,均行腹部双源CT检查。随机选取101例作为训练组,29例作为验证组,15例作为测试组。首先,利用已标注的10409张腹部双源CT图像对Mask R-CNN模型进行学习,从而建立自动胆囊癌辅助识别系统。然后对验证组的2974张CT图像通过专业的医师对其进行判断识别,与Mask R-CNN得出的结果进行对比分析。通过不同交并比阈值(IoU)下的平均检测精度(AP)和平均召回率(AR)来对性能进行评估。结果计算机通过学习组不断迭代训练,Mask R-CNN的损失函数值收敛,诊断误差不断降低。在IoU为0.5时,Mask R-CNN的边界框和掩膜的AP分别为0.929和0.929,IoU为0.75时的边界框和掩膜AP分别为0.901和0.890,IoU为0.5:0.95时的边界框和掩膜AP分别为0.723和0.707,平均召回率分别为0.794和0.774,模型的性能良好。结论基于深度神经网络的Mask R-CNN胆囊癌辅助识别系统具有较高的准确率和性能,可辅助进行临床诊断。