海南地区胆石病的特点和临床流行病学调查

目的：探讨海南地区胆石病的临床流行病学特点及其影响因素。方法：对海南地区135例胆石病患进行回顾性流行病学因素调查,对术中取得的胆石进行化学成份测定。结果：胆管结石占51.9%,胆固醇类结石占65.9%。城镇居民、高脂饮食及肥胖的胆囊结石发病率高,而农村居民、低脂饮食的胆管结石发病率高。胆管结石患的胆汁细菌培养阳性率（65.7%）高于胆囊结石患的胆汁细胞培养阳性率（18.5%）。结论：海南地区胆石的分布部位胆囊结石与胆管结石比例接近;类型以胆固醇类结石为主。职业、生活条件、饮食习惯等因素与胆囊结石和胆管结石的发病率有关。高脂饮食及肥胖是造成胆囊结石的主要因素,而低营养、低脂饮食与胆管结石的形成有关。反复胆道细菌感染在胆管结石形成中可能起重要作用。     

对我国胆道外科几个焦点问题的思考

我国胆石病的变迁　　过去50年中,我国的胆石病状况已有明显的改变。胆石、胆道感染、寄生虫病曾是我国的主要胆道疾病,原发性胆管结石约占胆石病的50%。1983～1985年由中华外科学会组织的全国胆石病11342例手术病例的调查,结果显示52.8%为胆囊结石,11.0%为继发性胆管结石,20.1%为原发性胆管结石,肝内胆管结石占16.1%,因而胆固醇性结石的相对发病率比以往已略有升高。10年之后(1992年)的第二次全国调查,在3911例胆石手术患者中,胆囊结石相对发病率明显上升,达79.9%,原发性胆管结石发病率降至6.1%,肝内胆管结石为4.7%,此种显著…     

青岛及胶东地区胆管结石成分调查分析

半个世纪以来，原发性肝内外胆管结石病是青岛及胶东地区的常见与多发病，在胆石病病种构成比中，胆管结石始终多于胆囊结石；在胆石成分方面，始终以胆红素结石为主，是该地区胆石病的突出特点。近年来该地区胆道蛔虫病已经极少出现，肝内外胆管结石的发病率也呈现降低的趋势。我们期望通过定期胆管结石成分调查，观察胆石成分及胆石成因的变化。     

对二十一世纪胆石病研究方向的思考

２０世纪的胆石病研究与其他医学领域一样,成就与挑战并存。今年是２１世纪的开端,在新旧世纪的交替之际,回顾昨天,评估今日,以思考明天的发展方向。 胆石病研究的过去 ２０世纪的胆石病研究经历了若干阶段［１,２］。前半个世纪主要集中于胆石的形态学检查和化学成分的分析,认识到人类的胆石可分为胆固醇结石和胆色素结石两大类。进而认识到胆石的化学成分不仅与胆石产生的部位有关,而且有不同的成石机制。胆囊结石大多以胆固醇为主要成分,部分是黑色素结石。胆固醇类结石呈放射状或放射年轮状排列,镜下可见大量胆固醇结晶。胆管…     

胆石病临床流行病学调查--附8 585例分析

目的：探讨广西地区胆石病临床流行病学现状。方法：根据中华医学会胆道外科学组制定的全国胆石病临床调查表，对广西地区19年期间（1981．1－1999．12）经手术治疗的8585例胆石病患者进行回顾性临床流行病学登记调查，资料经计算机整理后用PEMS软件包进行统计分析。结果：胆石病中肝内胆管结石的构成比有上升趋势，在农民患者中肝内胆管结石在胆石症中的构成比由1981－1985年间的23．4％上升到1991－1999年间的55．8％，而性别的构成比差别不大，肝内胆管结石发病高峰年龄为31－40岁，病死率在胆石病中最高。结论：肝内胆管结石仍然是非常多见的疾病，在农民中发病率甚至有显著上升，值得引起高度重视。     

胆石病成因的研究与进展

3500年以前古埃及木乃伊和2000年前长沙西汉女尸体内,已发现胆结石病。至今胆石病依然是世界范围内的一种常见病、多发病。据世界流行病学调查,成年人发病率为10％-20％,并且有日趋增加的倾向,胆囊结石70％-80％为胆固醇结石。目前国内外学者多认为代谢因素是引起胆囊胆固醇结石形成的主要因素,同时病因是多方面的,是多种基因和环境因素相互作用下的结果。现将胆石病成因方面的研究与进展加以综述。     

云南临沧佤族地区胆石病2870例临床分析

目的了解临沧佤族地区胆石病的临床特点。方法回顾性分析2000年1月至2004年12月手术治疗的2870例胆石病患者的临床资料。结果30岁以下9．9％，40～59岁53．7％。胆囊结石90．8％，胆总管结石7．6％，肝内胆管结石1.6％。胆固醇结石67．9％，胆色素结石32．1％。结论临沧佤族地区胆石病的结石类型以胆固醇结石最多（67．9％），女性多于男性（2．1：1）；胆囊结石均高于国内统计资料；高发年龄段为40～59岁。     

18 079例胆石病患者临床分析

目的:分析我院近6年所收治胆石病患者的临床特征.方法:根据中华医学会胆道外科学组制定的全国胆石病临床调查表,对我院6年期间(2000年1月-2005年12月)经手术治疗的18 079例胆石病患者分为:胆囊结石组、胆总管结石组、肝内胆管结石组、胆囊 胆总管结石组、胆总管 肝内胆管结石组、胆囊 肝内胆管结石组、胆囊 胆总管 肝内胆管结石组,进行分组统计.观察各组发病年龄、性别、职业、地域等回顾性临床流行病学资料,经计算机整理后应用SPSS10.0进行统计分析.结果:胆囊结石的比例显著升高(81.77%),并随年龄增长而增加,胆囊结石病发病的高峰年龄为40～69岁,占胆囊结石总例数的76.8%;胆囊合并胆总管结石以及单纯胆总管结石的发病高峰年龄为70～79岁,占该两组病人数量的31.29%;肝内胆管结石的高发年龄为40～59岁,占该组的55.94%;胆囊合并肝内胆管结石的高峰年龄为60～69岁,明显高于全国的统计数字,与饮食习惯及人口老龄化关系密切.不同部位胆石病男女比例明显不同,女性患者构成比明显高于男性患者.结论:随着经济不断发展胆石病的病种构成已经发生明显变化.胆石病占我院住院病人的比例较高,其中胆囊结石的构成比明显高于其他部位的胆石病患者,所收治患者中在发病高峰年龄、性别、职业构成均存在显著性差异.     

遵义地区胆石病临床流行病学调查分析

目的 探讨影响胆石病临床流行病学的相关因素,为临床决策提供科学依据。方法收集遵义医学院附属医院2000年1月至2009年12月收治的经手术治疗的胆石病患者5136例病历资料,制定胆石病临床调查表进行逐项填写,经计算机整理后用SPSS 13.0软件包进行统计,并将统计结果进行比较分析。结果胆石病男女比例1∶1.78,高峰年龄为41岁～及51岁～两个阶段;胆囊结石(4456例,占86.76％)和肝外胆管结石(554例,占10.79％)构成比例均较国内为高。结论胆囊结石是遵义地区胆石病的重要临床类型,且发病趋于年轻化;性别、饮食、职业与该地区胆石病的临床发病密切相关。     

胆囊结石发病机理的研究进展

胆囊结石是我国的常见病之一。长期以来 ,许多学者致力于胆固醇性结石发病机理的研究。胆固醇性结石病是一种多因素疾病 ,其发病机理的主要方面是胆汁胆固醇分泌增加导致的胆汁胆固醇饱和指数升高。近年来遗传流行病学和动物模型的分子生物学研究表明 ,基因研究有可能成为揭示胆石发病机理的一个突破点。本文就胆囊结石成因的研究进展作如下综述。1　致石基因遗传流行病学和动物模型的分子生物学研究显示 ,基因因素对胆囊结石的形成有重大影响 ;胆石病的遗传模式可能是多基因参与。1.1　流行病学调查结果显示 ,胆固醇结石的发生具有一定的遗…     

Anaerobes in biliary tract infection

Bile specimens from sixty-nine patients who had undergone biliary tract surgery or PTC have been subjected to bacteriological study by anaerobic and aerobic techniques. Among 50 specimens from the patients with hepatolithiasis, anaerobes were detected in 74.0%, and aerobes in 98.0%. 11 bile specimens from cholecystolithiasis, only 27.3% anaerobes and 36.4% aerobes were detected. Eight patients with biliary duct tumour had sterile bile. The most common isolated anaerobes was bacteroides and with an average of 1.7 species detected. All bile specimens are mixed infections. The incidence of bacterial infection are higher in the pigmented calcium stone than cholesterol stone. This study showed that metronidazole is the drug of choice in the treatment of anaerobic bile infection.     

Choledochoscopic electrohydraulic lithotripsy and lithotomy for stones in the common bile duct, intrahepatic ducts, and gallbladder.

Choledochoscopic lithotomy with the aid of electrohydraulic lithotripsy was performed in 40 patients, including 16 patients with choledocholithiasis, 15 with hepatolithiasis, and 9 with cholecystolithiasis. As a route for the choledochoscopy, a T-tube tract, external cholecystostomy, or jejunal limb of hepaticojejunostomy was used in nine patients, while percutaneous transhepatic biliary drainage followed by dilatation of the track was established in 31 patients. The largest cholesterol stone measured 55 mm by 33 mm and the largest bilirubinate stone measured 52 mm by 37 mm. The stones were disintegrated in all but one patient in whom choledochoscopic access to a gallstone was difficult due to deformity of the gallbladder. Complete removal of the stones was achieved in 38 of 39 patients. In a patient with hepatolithiasis, small stones located deep in inaccessible branches of the intrahepatic duct remained unremovable. There were no serious complication. Minor complications occurred, including bleeding from the bile duct mucosa in four patients and postprocedure chills and fever in three. Choledochoscopic lithotomy with electrohydraulic lithotripsy is efficient and useful to remove biliary calculi in patients who are poor surgical risks.     

成核效应蛋白在泡凝聚融合过程中作用的初步研究

为了探讨成核效应蛋白在泡凝聚、融合过程中的作用，作者研究了胆汁中主要的促成核蛋白系统—ＣｏｎＡ结合蛋白对模拟胆汁泡的形态与脂类组成的影响，发现ＣｏｎＡ结合蛋白在加快泡凝聚与融合的同时，也使泡胆固醇增加，磷脂减少，泡胆固醇／磷脂比增高，认为成核效应蛋白促泡凝聚与融合的本质是改变了泡胆固醇饱和度。作者的初步研究还发现泡相蛋白虽量微却具有强的促成核活性；几种已知的成核效应蛋白在泡相与微胶粒相的分布有差异；胆固醇结石患者与色素结石患者相比，泡蛋白的量与促成核活性均增高。通过泡蛋白亲和染色技术，还发现ＣｏｎＡ结合蛋白能与模拟胆汁泡形成脂质－蛋白复合体。作者认为，泡中成核效应蛋白的存在或量与质的改变，在泡凝聚与融合过程中起重要作用。     

有胆道手术史肝胆管结石的腹腔镜胆总管切开取石术的应用

目的 探讨腹腔镜胆总管切开取石术在有胆道手术史的肝胆管结石患者中的应用价值。 方法 2009年3月至2013年3月期间,中航工业三六三医院普外科收治的86例肝胆管结石患者接受了腹腔镜胆总管切开取石术,其中26例既往有胆道手术史（PBS组）,60例无胆道手术史（NPBS组）。左肝内胆管结石15例,右肝内胆管结石52例,双侧肝内胆管结石19例。回顾性分析患者围手术期的临床资料。 结果 PBS组与NPBS组手术时间分別为（161.4±31.5） min和（155.7±28.1） min,其差异无统计学意义（P＞0.05）;术中出血量分别为（69.2±50.7） mL及（44.1±27.4） mL,PBS组多于NPBS组（P＜0.05）;PBS组术后并发症发生率为53.8%,尤其是腹腔积液明显多于NPBS组（P＜0.05）;2组总残余结石发生率为15.1%,总结石清除率为98.8%;PBS组术后远期并发症发生率为23.1%,明显高于NPBS组（P＜0.05）。 结论 腹腔镜胆总管切开取石术是有胆道手术史肝胆管结石患者一项安全可行且有效的微创治疗选择,尤其适用于无肝萎缩肝胆管结石、结石弥漫分布合并胆管狭窄的双侧肝胆管结石以及合并胆汁性肝硬变的肝胆管结石。     

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.     

十二指肠乳头旁憩室与胆结石的关系（附92例分析）

目的 探讨十二指肠憩室在胆结石发病中的作用。方法 回顾性分析广州市番禺中心医院行逆行胰胆管造影检查的462例患者,其中合并乳头憩室92例（憩室组）,无合并乳头憩室370例（非憩室组）。分析比较两组患者年龄、胆结石的发病率、结石发生部位及结石成分方面的差异。结果 本组462例患者中,憩室组92例,占19.9%。憩室组平均年龄61.8岁,明显高于非憩室组(61.8 vs 51.2岁,P<0.O1),且憩室发生率随年龄的增大而增高(P<0.01)。本组发现患者中,72例十二指肠憩室合并胆结石,憩室合并胆结石发生率78.3%,而非憩室组370例中仅97例合并胆结石,占26.2%。十二指肠憩室组并结石的发生率明显高于非憩室组。本组中乳头旁憩室胆结石发生率明显高于乳头周围型憩室者,有显著性差异。乳头旁憩室患者的原发性胆总管结石发生率明显高于继发性胆总管结石及胆囊结石,且结石成分主要为胆色素结石。结论 十二指肠乳头旁憩室患者胆结石发病率显著增高,且主要与原发性胆总管结石相关。     

继发于肝内胆管结石症的肝胆恶性肿瘤27例分析

目的：探讨继发于肝内胆管结石的肝胆系统恶性肿瘤的发病率。临床特点和预防方法。方法：对合并肝内胆管结石的肝胆恶性肿瘤患者进行临床回顾性研究。结果：自1996－2000年连续收治556例肝内胆管结石患者，其中27例合并存在肝胆系统恶性肿瘤，其平均发病率为4．8％。本组术前明确诊断仅4例。肝内胆管结石继发恶性肿瘤的临床表现包括非典型肝脓肿，难以控制的感染，不明原因的进行性黄疸，CT和B超检查中可疑的肿瘤性改变和腹部肿块。本组患者以中晚期病例为主，仅3例患者作了肿瘤切除术。结论：肝内胆管结石继发恶性肿瘤的概率较高，切除结石所在的病灶肝段可能对继发的恶性肿瘤有预防作用。     

人两种胆囊结石的胆汁差异蛋白质组学研究

目的 比较胆固醇性与胆色素性胆囊结石患者的胆囊胆汁蛋白质表达谱差异,寻找两种不同胆囊结石形成及调控相关的蛋白质.方法 采集胆囊结石患者胆囊胆汁及结石,结石胆固醇比例＞70%入选胆固醇结石组,胆色素比例＞40%入选胆色素结石组.胆汁予脱盐、脱脂等预处理后,二维色谱/串联质谱分析,Mascot检索数据库.结果 分别从胆固醇和胆色素结石胆汁中鉴定出495和511种蛋白质.两组共检测到抗成核因子1种,促成核因子12种,其中Mucin-5B等两种蛋白在胆固醇组高表达,载脂蛋白A-I等11种蛋白在胆色素组高表达.结论 二维色谱/串联质谱技术是高效的人胆汁蛋白质组研究技术.两组胆汁的蛋白质差异表达提示两种结石的形成机制差异,胆色素结石形成与促成核因子密切相关,载脂蛋白A-I抗成核作用减弱参与胆固醇结石形成.

Abstract：

Objective By comparing gallbladder bile samples from cholesterol cholelithiasis patients with pigment cholelithiasis patients, we try to find out proteins participating in gallstone formation for revealling two kinds of stone formation mechanisms. Methods Gallstones and bile were collected from cholelithiasis patients. These patients were divided into two groups by stone chemical compositon analysis.Patients with stone cholesterol levels greater than 70% were assigned into cholesterol stone group, and those with bilirubin levels greater than 40% into pigment stone group. After removing the bile salt and lipid, peptide fragments were separated by 2D-LC, analysed by MS/MS, and searched against Swiss Prot database by Mascot. Results There were 495 and 511 proteins identified from cholesterol stone group and pigment stone group respectively. There was 1 anti-nucleation factor and 12 pro-nucleation factors, including 2 proteins up-regulated in cholesterol stone group and 11 proteins down-regulated in pigment stone group. Conclusion 2D-LC/MS/MS is an efficient technology in bile proteomics research. Differentially expressed proteins reveal 2 kinds of different stone formation mechanisms. Pro-nucleation factors are closely related with pigment stone formation, while down-regulation of apolipoprotein A- I is closely related with cholesterol stone formation.     

Liver resection for intrahepatic stones

HYPOTHESIS: Long-term outcome is good for a selected group of patients with hepatolithiasis treated with liver resection. Liver resection should also be offered to patients with complex hepatolithiasis such as bilateral stones or those with strictures. DESIGN: Retrospective study. SETTING: Regional hospital. PATIENTS: A total of 174 patients with hepatolithiasis (201 procedures) treated between January 1, 1989, and September 30, 2003. INTERVENTIONS: Liver resection (52 procedures) or removal of stones primarily by percutaneous choledochoscopy (149 procedures). MAIN OUTCOME MEASURE: Recurrence of cholangitis. RESULTS: Most patients in the liver resection group had stones localized to the left side. The overall success rate in this group was 98.0% (49 of 50 patients, excluding 2 patients found to have cholangiocarcinoma). The chance of biliary sepsis at 5 years after resection was 13.3%. The overall success rate of stone removal primarily by percutaneous choledochoscopy was 70.5%. The bilaterality of stones, the presence of stricture, and the presence of atrophy were found to be significant risk factors for a poor long-term outcome after stone removal alone. The chance of biliary sepsis at 5 years was 26.4% and 43.2% for those without and with stricture, respectively. CONCLUSIONS: The long-term outcome after liver resection for hepatolithiasis was excellent for a selected group of patients. Poor outcomes were recorded for patients whose intrahepatic stones were removed primarily by percutaneous choledochoscopy, especially those with strictures. The indication for liver resection for hepatolithiasis should be extended to patients with strictures and those with bilateral stones. A combination of different treatment modalities is necessary to improve the outcome of these patients.     

胆、肠菌群差异性与胆囊胆固醇结石形成关系

目的 基于胆囊胆固醇结石患者胆道菌群、肠道菌群差异性,探讨胆、肠菌群交互与胆囊胆固醇结石形成关系.方法 选择2020年1月至2020年6月由沧州市人民医院诊疗的胆囊胆固醇结石患者42例为研究对象,记入胆固醇结石组;胆囊炎、胆囊息肉诊治等非胆固醇结石患者40例为非胆固醇结石组.采用Illumina测序技术测序并进行细菌O...