胆宁片对胆囊胆固醇结石的防治作用

目的：研究胆宁片对胆囊胆固醇结石有无防治作用并初步探讨其机制。方法：豚鼠120只随机均分为4组：胆宁片组建立胆囊胆固醇结石模型后给予胆宁片,同时与熊去氧胆酸(UDCA)组及空白组、致石组对照,测定血、胆汁生化及肝、胆囊病理。结果：胆宁片组成石率为17％显著低于致石组的73％．其致石指数(LI)及血甘油三酯(TG)与肝脂肪变性显著低于致石组。结论：胆宁片对胆囊胆固醇结石有良好的防治作用并可缓解肝脂肪变性。     

饮酒对胆固醇结石的预防作用的实验研究

大耳白兔３０只均分三组，对照组饲正常饲料，致石组饲含１．２％胆固醇和０．５％胆盐的高胆固醇饲料及麦芽糖糊，防石组饲高胆固醇饲料及正醇。一月后心脏穿刺测甘油三酯及胆固醇，并剖腹取胆囊及肝胆管胆汁测各种胆汁成分。结果：防石组血清胆固醇和胆囊胆汁中胆固醇、磷脂、钙等明显低于致石组，提示饮酒对胆固醇结石有预防作用。     

碎,溶,排中西医结合非手术治疗胆石病

本文报道采用体外震波、自制中药舒胆合剂和西药熊去氧胆酸三者中西医结合的碎、溶、排非手术治疗胆石病２６４例。结果，经平均１８个月随访，临床症状１６２例（７０．７％）消失，４２例（１８．４％）好转，总有效率８９．１％；结石消失９０例（３９．３％），减少或明显缩小９４例（４１％），影像诊断随访有效率８０．３％。其疗效优于长期口服ＵＤＣＡ或单纯震波治疗，认为舒胆合剂起到了相当作用。本文还对舒胆合剂的作用机     

前列腺素E2及粘蛋白在胆固醇结石形成过程中作用机理的探讨

目的　探讨前列腺素Ｅ２ 和粘蛋白在胆固醇结石形成过程中的作用机理。方法　用仓鼠制成胆固醇结石模型,腹腔内注入外源性ＰＧＥ２。肉眼和偏光镜下观察成石情况,光镜及电镜下观察胆囊上皮粘蛋白分泌的变化。结果　光镜及电镜下成石组胆囊上皮表现为粘蛋白分泌增加,ＰＧＥ２组粘蛋白分泌增加更为显著。ＰＧＥ２ 组成石率有下降趋势,但统计学差异不显著（ Ｐ＞ ０－０５） 。结论　ＰＧＥ２ 和粘蛋白不是胆固醇结石形成的始动因素,粘蛋白分泌的增加可能是胆囊本身的防护机理。ＰＧＥ２ 可能从多方面影响胆固醇结石的形成。     

自制复方溶石剂的体外溶石作用及毒性的初步研究

目的 评价自制复方溶石剂的体外溶石效果和毒性作用。方法 用甲基叔丁醚(MT—BE)作用对照，在体外对胆固醇、混合性、胆色素性结石进行溶石实验以及在20只兔胆囊内灌注溶石剂后观察血生化和各脏器的病理改变。结果 自制复方溶石剂对胆固醇、混合性、胆色素性结石的溶石比例分别达到97．20％、88．43％、82．69％；毒性比MTBE小。结论 自制复方溶石剂是一种相对低毒、安全、对大多数胆道结石有良好效果的直接溶石剂。     

肝切除治疗肝内胆管结石疗效评价

目的:评价肝切除治疗肝内胆管结石的疗效。方法:回顾性分析6年来采用不同手术方法治疗的178例肝内胆管结石患者临床资料，比较各种治疗方法的疗效。 结果:行胆总管切开取石，T管引流37例（20.79%），肝切除、胆总管探查取石、T管引流141例（79.21%）。149例（83.71%）获得随访，随访时间1～6年。肝切除组与胆总管切开取石组的术后残石率、结石复发率分别为6.67%和20.69%（χ2=3.86,P<0.05）及8.33%和24.14%（χ2=4.30,P<0.05）。 结论:肝切除治疗肝内胆管结石可明显提高其疗效。     

胆囊Ⅲ号方预防胆固醇结石的实验研究

胆囊Ⅲ号方对诱石饲料诱发豚鼠胆囊产生的胆固醇结石有预防作用，主要通过其多种药理作用，包括：改善脂代谢紊乱，抑制肝细胞脂肪变性，促使胆汁分泌，降低胆汁胆固醇浓度，增加胆盐和磷脂浓度，从而降低胆汁的致石性，胆囊Ⅲ号方还能升高血清Ａ／Ｇ比率，改善豚鼠肝功能及营养状况。     

胆囊穿刺造瘘后双通道胆道镜保胆取石与腹腔镜胆囊切除术治疗老年患者结石性胆囊炎疗效的比较

目的比较超声引导双通道胆囊穿刺造瘘联合胆道镜保胆取石与胆囊穿刺造瘘后行腹腔镜胆囊切除术（1aparoscopiccholecystectomy,LC）治疗老年患者急性结石性胆囊炎的临床疗效。方法回顾性分析2012年1～9月接受双通道胆囊穿刺造瘘联合胆道镜保胆取石治疗的30例老年结石性胆囊炎（保胆取石组）和胆囊穿刺造瘘后行Lc治疗的30例老年结石性胆囊炎（Lc组）的临床资料,比较2组手术操作时间、术中出血量、住院时间、消化不良症状发生率等。结果60例均穿刺置管成功,带管时间14d-2个月,平均30d。4～8周后,保胆取石组30例成功行胆道镜取石,结石取净率100％,取石过程中无出血、漏胆、继发胆总管结石、切口感染等手术并发症。LC组28例三孔法完成LC,2例因粘连组织难以分离中转开腹手术,术中、术后均无严重并发症。保胆取石组术中出血量（8．8±1．7）ml,显著少于LC组（18．9±1．2）ml（t=-25．968,P=0．000）;保胆取石组住院时间（4．4±0．6）d,显著短于LC组（5．6±0．5）d（t=-8．243,P=0．000）。保胆取石组术后随访3、6、12个月,B超检查1例复发,5例有上腹部不适、腹泻、食欲不佳等消化不良症状,发生率16．7％（5／30）,LC组术后21例有消化不良症状,发生率70．o％（21／30）,2组比较有显著性差异（x2=17．376,P=0．000）。结论超声引导双通道胆囊穿刺造瘘联合胆道镜保胆取石操作简便,在术中出血量、住院时间、远期生活质量等方面均优于胆囊造瘘后行LC。     

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。     

胆结石溶石疗法现状

胆结石溶石疗法现状李可为综述施维锦审校我国胆石症的发病率至少为自然人群的７％（１），近年有上升趋势。手术虽然有效，但大多数人更愿意接受保守治疗，其中溶石疗法历史最长，研究最多，在实验与临床上都已有了较为系统的了解。口服溶石１胆固醇结石溶解剂１．１胆酸...     

Leptin-resistant obese mice have paradoxically low biliary cholesterol saturation

BACKGROUND: Human obesity is associated with leptin resistance, elevated serum glucose and lipids, hepatic steatosis, and cholesterol gallstone formation. These gallstones are thought to result from hypersecretion of biliary cholesterol as well as biliary stasis. Leptin-resistant Lep(db) obese mice, which are known to have elevated serum leptin, glucose, and lipids, as well as hepatic steatosis, should be an appropriate model for human gallstone formation. Therefore, we tested the hypothesis that leptin-resistant mice would have increased gallbladder volume, biliary cholesterol saturation, and cholesterol crystal formation. METHODS: Sixty lean control mice and 60 Lep(db) obese mice on a low cholesterol chow diet were studied. Gallbladder volumes were measured and bile was pooled to calculate cholesterol saturation index. Serum cholesterol, glucose, and leptin levels were determined from pooled serum. Hepatic fat vacuoles were counted. Bile from a second group of 90 lean control and 59 obese mice was observed microscopically for cholesterol crystal formation. RESULTS: Leptin-resistant obese mice have significantly higher serum cholesterol, glucose, and leptin levels, hepatic fat vacuoles, and gallbladder volume than lean control mice. However, biliary cholesterol saturation index and cholesterol crystal formation were significantly diminished in the obese mice. CONCLUSIONS: These data suggest that leptin-resistant Lep(db) obese mice have (1) increased gallbladder volume, (2) decreased biliary cholesterol saturation despite elevated serum cholesterol and hepatic steatosis, and (3) decreased in vitro cholesterol crystal formation. We conclude that the link between obesity and gallstone formation does not require hypersecretion of biliary cholesterol.     

社区成年女性胆囊结石发生现状的调查报告

目的：调查和了解当前社区女性人群中胆囊结石的发生状况。方法：通过问卷调查表和Ｂ超对社区中４３３名女性作临床流行病学调查。结果：发现胆囊结石病人６８例（１５．７％）,其中无症状者４３例（６３．２％）。此４３例中２６例（６０．５％）并不知晓自己的病情。结合病史发现在社区成年女性中７．４％已施行胆囊切除术。研究表明,胆囊结石的患病率随年龄的增加而升高,且年龄越大,胆囊切除率越高。结论：与１０余年前相比,上海地区胆囊结石患病率升高明显,社区中女性胆囊结石的患病率已与西方国家相近。     

Caffeine prevents cholesterol gallstone formation

Methylxanthines are known to inhibit in vitro gallbladder absorption. Increased gallbladder absorption has been observed during formation of cholesterol gallstones. Therefore we tested the hypothesis that caffeine would inhibit in vivo gallbladder absorption and thus prevent formation of cholesterol gallstones. Sixteen adult male prairie dogs received a control nonlithogenic diet, and 16 were fed a diet containing 1.2% cholesterol. Half of the animals in each group received caffeine in their drinking water. Gallbladder and hepatic bile were examined microscopically and analyzed for biliary lipids and electrolytes. The gallbladder/hepatic bile ratios of bile acids and sodium were calculated as indices of gallbladder absorption. All eight animals receiving the 1.2% cholesterol diet formed cholesterol gallstones, whereas none of the eight animals fed the cholesterol diet plus caffeine formed gallstones. The cholesterol saturation index was similar, however, in both groups. In animals fed a control diet, the administration of caffeine significantly increased hepatic bile flow and decreased the gallbladder/hepatic bile ratio for both bile acids (5.4 +/- 0.9 vs 3.6 +/- 0.3; p less than 0.05) and sodium (1.26 +/- 0.03 vs 1.12 +/- 0.03; p less than 0.01). In animals fed the high-cholesterol diet, caffeine significantly decreased the ratios for both bile acids (9.0 +/- 1.6 vs 5.3 +/- 0.6; p less than 0.05) and sodium (1.37 +/- 0.06 vs 1.21 +/- 0.01; p less than 0.05), lowered gallbladder bile protein levels, normalized gallbladder stasis, and lowered serum cholesterol levels. In summary, caffeine prevented formation of cholesterol gallstones in this experimental model. The effect of caffeine may be the result of alterations in multiple biliary parameters including the inhibition of gallbladder absorption.     

Relationship of obesity to bile lithogenicity in man.

Gallbladder bile was aspirated and analyzed for content of bile salts, cholesterol, and phospholipids in 97 patients undergoing jejunoileal bypass. Lithogenic indices (LI) (mole % cholesterol in sample/mole % cholesterol at saturation) were correlated with age, sex, lipid levels and hepatic fatty metamorphosis. The overall incidence of gallstones in the group was 43%(N = 121). Cholelithogenesis was unrelated to age, serum lipid concentrations, LI, or hepatic morphology. A significant relationship was noted between cholelithogenesis and female sex (p less than .03). The incidence of gallstones was greater in patients weighing more than 270% of ideal body weight and the LI greater in those weighing more than 230%. The mean LI of bile was greater than 1.0 (supersaturated) in all patients except nongallstone forming diabetics. The lithogenic index in diabetics without gallstones was 0.88 +/- 0.11, while in nondiabetics without gallstones, the LI was 1.49 +/- 0.10 (p less than 0.001). These observations indicate that grossly obese patients have an increased incidence of cholelithiasis, probably related to supersaturation of bile with cholesterol. In addition, female patients are especially at risk, while other parameters had little or no detectable influence on cholelithogenesis in this group of patients.     

变异右肝管横跨与左肝管汇合的解剖学特点和临床意义

目的探讨变异右肝管横跨与左肝管汇合的解剖学特点和临床意义。方法回顾性分析经胆道影像学检出的52例变异右肝管横跨与左肝管汇合病例的临床经过和手术情况，并对其中部分特殊病例进行了随访。结果变异右肝管结石[60．52％（23／38）]和左肝管结石[86．84％（33／38）]的比例较高，伴随的胆管扩张和狭窄也较多见。变异导致的胆汁流体力学紊乱和血管鞘压迫可能是感染和结石高发的原因。变异右肝管的结石漏诊率为34．78％（8／23），结石残留比例高达86．95％（20／23）。1例在行左半肝切除时不慎将变异右肝管切断。结论变异右肝管横跨与左肝管汇合有易发生肝内胆管结石的倾向，其诊断治疗有其特殊性及困难性，应引起临床重视。     

The effects of amiloride on biliary calcium and cholesterol gallstone formation.

Recent studies indicate that gallbladder absorption increases during the early stages of experimentally-induced cholesterol gallstone formation. The purpose of the present study was to ascertain whether pharmacologic inhibition of gallbladder ion transport and absorption reduces the incidence of experimentally-induced cholesterol gallstones. Prairie dogs were fed either a control chow or a 1.2% cholesterol-enriched chow for 15 days. One group of cholesterol-fed animals received saline via an orogastric tube; another group received amiloride, a drug known to inhibit in vitro ion transport in the prairie dog gallbladder. The incidence of gallstones in cholesterol-fed animals was reduced from 83% to 13% (p less than 0.025) when the animals were treated with amiloride; this occurred despite a cholesterol-saturation index comparable to that observed in gallstone animals. Additionally, although biliary calcium decreased in the gallbladder, hepatic bile did not in the amiloride-treated animals. These data provide further evidence that altered gallbladder absorption and increased biliary calcium are important factors in the pathogenesis of cholesterol gallstones.     

Effects of cholecystokinin on gallbladder stasis and cholesterol gallstone formation

Recent studies suggest an etiologic role for gallbladder stasis in the genesis of cholesterol gallstones. The effect of periodic gallbladder emptying on stone prevention is not clear. Using the prairie dog model, we tested the hypothesis that daily cholecystokinin-octapeptide (CCK-OP) prevents gallbladder stasis and cholesterol gallstone formation. Prairie dogs were fed either a control or a 0.4% cholesterol-enriched chow for 6 weeks. Cholesterol-fed animals received a daily intramuscular injection of either saline, CCK-OP, 0.2 μg/kg or CCK-OP, 1.0 μg/kg. Gallbladder bile lithogenic index (LI), bile salt pool size (BSPS), and the degree of radioisotope equilibration between gallbladder and hepatic bile (Rsa-an index of stasis) were determined. The more physiologic dose of CCK-OP (0.2) significantly reduced BSPS and bile lithogenicity, prevented stasis and reduced the incidence of gallstones. Our data suggest that (1) periodic gallbladder emptying decreases bile lithogenicity, prevents stasis, and reduces the incidence of cholelithiasis, (2) stasis is essential to gallstone formation and (3) daily physiologic doses of CCK-OP may be useful for gallstone prophylaxis in high-risk patients.     

Epidermoid Cyst—A Rare Mediastinal Mass

Gallstone disease is a common gastrointestinal problem in day-to-day practice. The Old concept that a typical gallstone sufferer is fat, fertile, flatulent female of 50. This is partially true as the disease has been found in women soon after their first delivery who are thin and underweight and in males also. Conditions that favor the formation of cholesterol gallstones are super saturation of bile with cholesterol, kinetically favorable nucleation and presence of cholesterol crystals in the gall bladder long enough to agglomerate into a stone. Recent studies have defined the role of trace elements (Fe, Ca, Zn and Cu) and defective pH in the formation of gallstones. The aim of the study was to correlate iron-deficiency anemia with gallstone disease. To estimate the serum ferritin level as a diagnostic tool of iron deficiency anemia in patients with gallstone disease, this prospective study of 100 patients was conducted over a period of 24 months in the Department of General Surgery, Jaipur Golden Hospital, New Delhi, India. Serum cholesterol, iron and ferritin levels were compared in patients having gallstones and healthy individuals. A low serum iron level is a factor in bile super saturation with respect to cholesterol, leading to gallstone formation.