Bacteriological investigation of bile in patients with cholelithiasis

The microflora in bile from the gallbladder and common bile duct was investigated in 303 patients who underwent surgery for cholelithiasis. The purpose of this study was to identify current bacteria and bacterial casts in the biliary tract and also to analyze the relationship between bactericholia at the time of operation and postoperative infection. Bile cultures were positive in 38% of all patients, although a higher incidence of positive bile cultures occurred in patients over 70 years of age (77%), those with common duct stones (83%), those with pigment stones (65%), and those who underwent gastrectomy (71%). The predominant organisms were Escherichia coli (22%), Klebsiella (18%), and Enterococcus (15%). Obligate anaerobes were less frequently seen (4%), being found only in patients with pigment stones and always mixed with aerobes. Four patients developed postoperative infections (1.3%) which were all caused by biliary bacteria. The following two factors may contribute to this low incidence of postoperative infections: our policy of operating electively whenever possible, and the prophylactic use of antibiotics to which the organisms cultured from bile are sensitive.     

Biophysical properties of bile and urine in patients with cholelithiasis

The electric conductivity of the hepatic bile received during and 24 hours after surgery from the drainage introduced into the common hepatic duct was studied in 94 patients with cholelithiasis. It is demonstrated that conductivity increases in cholestasis, inflammatory process in the biliary tract and depends on the hepatic morphofunctional status. The specific electric conductivity of intraoperative bile that is more than 192 S/m is considered to be criteria for the diagnosis of cholangitis. The electric conductivity of urine before and in first 4 days after surgery decreases in inflammation of the biliary tract and depends on the degree of concomitant renal dysfunction and electrolyte disturbances. There was a decrease in the conductivity of bile and urine in all studied groups. Detection of biophysical parameters of biological fluids may objectively control the postoperative period and correct treatment policy.     

无症状期胆管结石病人的胆汁细菌学分析

目的　探讨无症状期胆管结石病人的胆汁细菌构成特点。方法　择期胆道手术中获取病人胆汁作细菌培养。３２ 例胆管结石病人,按术前无症状时间１１２０ 天、２１３０ 天和３０ 天以上分Ａ、Ｂ、Ｃ３ 组,按胆管炎发作１ 次、２３ 次和３ 次以上分甲、乙、丙３ 组。结果　检出率排列前５ 位的细菌是大肠杆菌、脆弱类杆菌、肺炎杆菌、粘质沙雷氏菌和变形杆菌。Ａ、Ｂ、Ｃ 组的需氧菌和厌氧菌检出率为０－９２、０－６７、０－２１ 和０－６０、０－３３、０。组间差异显著。甲、乙、丙组的需氧菌和厌氧菌检出率为０－６３、０－５５、０－５４ 和０－４０、０－２９ 、０－３３。组间差异无显著性。结论　无症状期胆管结石病人的胆汁细菌检出率与无症状时间长短有关,与胆管炎发作次数无关。大肠杆菌、脆弱类杆菌、肺炎杆菌、粘质沙雷氏菌和变形杆菌是常见的５ 种细菌。     

Predictive factors for synchronous common bile duct stones in patients with cholelithiasis

Background: To determine the predictive factors of synchronous common bile duct (CBD) stones, data from 878 consecutive patients who underwent cholecystectomy in a university clinic from June 1991 to June 1996 were retrospectively analyzed. Methods: Based on clinical, biochemical, and ultrasonographic criteria, 194 patients were selected for ERCP, 180 preoperative and 14 postoperative. Results: Cannulation of CBD was successful in 192 (99%) patients. Stones were identified in 62 (32%) patients and sphincterotomy was performed in 56 (90%). Duct clearance was achieved in 43 (77%) cases. There was a high predictive value for the presence of CBD stones in patients with cholangitis, present jaundice, and dilated CBD with evidence of stones on ultrasound (75%, 72%, and 67% respectively). A dilated CBD without stone on ultrasound and elevated liver enzymes had less than 40% positive predictive value. History of previous jaundice, pancreatitis, previously raised liver enzymes, and present pancreatitis was predictive in less than 20% of the cases. Univariate analyses revealed that clinical findings of cholangitis and obstructive jaundice, elevated liver enzymes (previous and present), and ultrasonographic findings of stones in a dilated CBD were significant positive predictors. Subanalysis of each elevated liver enzyme revealed that alanine transaminase, aspartate transaminase, alkaline phosphatase, and gamma glutamyl transpeptidase were significant predictors. Both elevated conjugated and total bilirubins were also significant predictors for CBD stones. Conclusion: Multivariate logistic regression analysis on these significant predictors showed that cholangitis (odds ratio [OR]: 10.5), dilated CBD with evidence of stones on ultrasound (OR: 7.4), elevated aspartate transaminase (OR: 2.9), and conjugated bilirubin (OR: 5.3) were jointly significant. The likelihood of having stones in the duct without any of these predictors was 7%, but 99% when all the predictors were positive.     

The differing effects of early and chronic cholelithiasis on hepatic bile lithogenicity

The hypothesis that increasing chronicity of cholelithiasis is associated with a progressive alteration of the enterohepatic circulation, resulting in a decrease in bile salt pool size and reversion of hepatic bile composition to a less lithogenic state, was tested in the prairie dog gallstone model. During the early phases of cholesterol cholelithiasis, both hepatic and gallbladder bile were saturated with cholesterol, and the bile salt pool size was normal. As stones became more chronic, the gallbladder was increasingly removed from the enterohepatic circulation, bile salt recycling increased and the pool size decreased. Despite this decrease in pool size and persistence of lithogenic gallbladder bile, hepatic bile composition reverted to a less lithogenic state. These data suggest that the sequelae of functional cholecystectomy are analogous to those of cholecystectomy. In addition, it appears that the liver and gallbladder interact in a dynamic manner, continually influencing the function of each other.     

单纯胆囊结石患者胆囊胆汁淀粉酶改变及其意义探讨

目的探讨单纯胆囊结石患者胆囊胆汁淀粉酶(amylase,AMY)的改变及其意义。方法影像学诊断明确的单纯胆囊结石患者50例,均行LC术,术中取胆囊胆汁3 mL,采用干化学法检测AMY,与血AMY比较,并对切除的胆囊行常规病理检查。结果 50例患者中胆囊胆汁AMY为30~3 020 U/L,平均(474.7±753.2)U/L,与血清AMY(64.3±17.1)U/L比,胆汁AMY明显升高(P0.05)。其中胆固醇性结石19例,胆色素性结石14例,混合性结石17例,胆色素性结石组和混合性结石组均高于胆固醇性结石组的胆汁AMY(P0.05)。腺肌症胆汁AMY水平高于非腺肌症的AMY水平(P0.01)。结论胆囊结石患者存在胰胆反流,胆汁中AMY升高可能与结石形成及胆囊的病理学改变密切相关。     

腹腔镜胆管探查术在老年胆石症中的应用

目的探讨腹腔镜胆管探查术在老年胆石症中的应用价值。方法回顾性分析2003年7月至2009年7月应用腹腔镜胆管探查处理103例老年胆石症病人的临床资料。结果103例经积极术前处理合并疾病,均安全度过围手术期。其中直接切开胆管探查93例,经胆囊管探查胆管6例,中转开腹4例。行T管引流22例,一期缝合77例,一期缝合术后39例发生胆漏,无胆管残余结石及胆管狭窄发生。结论选择合适病例,腹腔镜胆管探查微创治疗老年胆石症安全、有效。     

A simple scoring system for predicting bile duct stones in patients with cholelithiasis

A means of accurately predicting the presence of stones in the bile duct in patients undergoing laparoscopic cholecystectomy for gallbladder stones is lacking. With the use of a three-stage analysis, a predictive score was developed from seven common parameters. Initially the score was formulated by using data from a retrospective series of patients undergoing laparoscopic cholecystectomy; the system was then tested prospectively over a l-year period in patients undergoing laparoscopic cholecystectomy for gallbladder stones. This simple scoring system demonstrated an ability to predict bile duct stones with a sensitivity in excess of 70%. The use of such a score may allow the development of preoperative strategies for treating patients undergoing laparoscopic cholecystectomy.     

胆结石患者垂体－性腺轴激素变化的研究

采用放射免疫法测定１６０例胆结石患者血清ＦＳＨ、ＬＨ和血浆Ｅ２、Ｔ、Ｐ的含量，并与６２例年龄相仿的正常健康者对照分析。实验结果表明育龄女性胆囊结石患者Ｅ２含量升高（Ｐ＜０．０１），Ｔ含量减少（Ｐ＜０．０５）；绝经后胆囊结石患者Ｔ含量减少．Ｐ含量升高（Ｐ＜０．０１）；男性胆囊结石患者Ｐ含量升高（Ｐ＜０．０５），男性肝胆管结石患者Ｔ含量减少（Ｐ＜０．０１）；男性和育龄女性胆囊结石患者Ｔ和ＬＨ含量均减少（Ｐ＜０．０１）。提示胆结石患者存在明显的垂体一性腺轴激素合成或代谢的异常。     

胆石症合并门静脉高压术式选择分析

目的：探讨不同手术方式对胆石症合并门静脉高压患者的临床疗效比较。方法：对我院收治的132例不同手术方法治疗的病例资料进行回顾性分析,将其分为3组,并对A组、B组、C组患者治疗预后、并发症以及随访结果进行比较。结果：3组患者的治疗效果有明显的差异性（P〈0.05）;3组患者并发症的发生率也有明显的差异性（P〈0.05）;3组患者远期随访结果差异无统计学意义（P〉0.05）。结论：胆石症合并门静脉高压患者无论是选择行胆道手术或行门静脉减压术,手术的死亡率以及术后并发症均会明显增加,根据患者的病情情况以及手术耐受情况选择正确的手术方式,有助于降低手术风险,改善预后。     

肝胆管结石患者胆总管切开取石术后Oddi括约肌肌电的研究

目的 研究肝胆管结石患者胆总管切开取石术后Oddi括约肌(SO)肌电的特点,旨在寻找临床研究、检测SO功能的新方法.方法 对2010年1月至10月在第三军医大学西南医院复诊的33例行胆总管切开取石术的肝胆管结石患者经T管窦道胆道镜辅助行SO压力与肌电检测,根据SO测压结果将33例患者分为低压力组、正常压力组及高压力组,比较各组患者SO峰电位丛(SOSB)幅值、频率和持续时间.结果 低压力组、正常压力组、高压力组患者分别有14、13、6例,平均SO基础压力分别为(3.1±1.2)、(18.5 ±7.6)、(39.8 ±4.8)mm Hg(1 mm Hg=0.133 kPa).低压力组、正常压力组、高压力组患者SOSB幅值、频率、持续时间分别为(41±27)、(150±71)、(301±109)μV,(5.8 ±1.6)、(6.9 ±1.4)、(7.8 ±1.2)次/min,(2.7±0.6)、(3.4±0.7)、(4.2±0.7)s,各组比较,差异有统计学意义(F=50.751,4.293,13.159,P<0.05).结论 SO肌电检测可以从电生理的层面反映SO的功能,有望成为临床研究、检测SO功能的新方法.

Abstract：

Objective To observe the characteristics of electromyography of sphincter of Oddi (SO) in patients with cholelithiasis after common bile duct exploration,and investigate new methods for detecting the motility of SO.Methods The basal pressure of SO(SOBP)and electromyography of SO were detected in 33 patients with cholelithiasis who were reexamined at the Southwest Hospital from January to October,2010.All patients were divided into low SOBP group,normal SOBP group and high SOBP group.The amplitude,frequency and duration of SO spike burst(SOSB)of the three groups were compared.Results The numbers of patients in the low SOBP group,normal SOBP group and high SOBP group were 14,13 and 6,respectively.The mean SOBP of the low SOBP group,normal SOBP group and high SOBP group were(3.1±1.2),(18.5±7.6),(39.8±4.8)mm Hg (1 mm Hg=0.133 kPa).The amplitude,frequency and duration of SOSB were(41±27)μV,(5.8±1.6) times/minutes and(2.7±0.6)s in the low SOBP group,and(150±71)μV,(6.9±1.4)times/minutes and (3.4±0.7)s in the normal SOBP group,and(301±109)μV,(7.8±1.2)times/minutes and(4.2±0.7)s in the high SOBP group,respectively,with significant difference among the three groups(F=50.751,4.293,13.159,P<0.05).Conclusion The results of electromyography of SO could reflect the function of SO,and it is possible to be a prospective method in the clinical research of SO.     

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目的 分析、探讨胆石症合并肝硬变外科处理的危险性及经验。方法 结合文献回顾性分析总结胆石症合并肝硬变外科处理的病案。结果 治愈37例,治愈率94．8％,好转1例（2．6％）,死亡1例（2．6％）。发生并发症11例（28．2％）,依次为胆囊床出血、腹水、切口感染、切口裂开、败血症。结论 要充分认识胆石症合并肝硬变手术的危险性以及采取相应的措施,才能提高治愈率,减少并发症和降低病死率。     

胆固醇结石病人与正常人胆囊胆汁的蛋白质表达谱比较分析

目的 比较分析胆日同醇结石病人与正常人胆囊胆汁蛋白表达谱的差异,为阐明胆石成因提供实验依据.方法 提取胆固醇结石病人和正常人胆囊胆汁总蛋白,构建相应的双向电泳蛋白质表达谱,应用lmageMaster图像分析软件获得差异蛋白点信息.结果 胆固醇结石病人与正常人胆囊胆汁总蛋白浓度分别为(6.4824±0.3403)mg/ml和(2.3156±0.3064)mg/ml(P<0.01).两组组内蛋白质平均匹配点数分别为465±71和407±85,平均匹配率为71.70%和68.38%,组间269个蛋白质点相互匹配,匹配率为61.70%.胆固醇结石组蛋白表达谱显著差异点34个,16个表达上调,18个表达下调.结论 初步建立了胆固醇结石病人和正常人胆囊胆汁蛋白表达谱.发现两者存在差异蛋白质点,为筛选胆石形成关键调控子提供基础.     

Congenital web of the common bile duct in association with cholelithiasis

Congenital web formations are extremely rare anomalies of the extrahepatic biliary tree. The age at presentation and the clinical symptomatology of these anomalies depend on the grade of the biliary obstruction. We report a case of a common bile duct septum in association with cholelithiasis in a 30-year-old woman. The diagnosis was made on preoperative magnetic resonance cholangiopancreatography (MRCP) and confirmed with intraoperative cholangiography. Because all known causes of acquired web formation were excluded, a congenital origin of the web was assumed. The patient was treated with a hepaticoduodenostomy above the level of the septum. The embryological aspects of this rare anomaly are described. Received: September 21, 2001 / Accetped: February 8, 2002     

Natural history of cholelithiasis in patients with alcoholic cirrhosis (cholelithiasis in cirrhotic patients).

To assess the natural history of cholelithiasis in patients with cirrhosis, 32 charts coded for both diseases were retrospectively reviewed. Cholecystectomy was performed in 22 patients. Only two patients met criteria for acute cholecystitis and two patients had suspected choledocholithiasis. Despite the high incidence of preoperative jaundice (32%), no common duct stones were documented. There was no operative mortality. The complication rate was 45%. In 10 patients not operated upon, two patients died of liver failure and the remaining eight patients are alive 8 months to 13 years after diagnosis (mean: 46 months) with no active biliary disease. It is concluded that: jaundice in this subpopulation most often reflects hepatocellular injury and rarely biliary tract obstruction, there appears to be a much lower incidence of acute cholecystitis and choledocholithiasis in cirrhotic patients with cholelithiasis than in the normal population, and patients with cirrhosis and asymptomatic cholelithiasis can be safely managed without operation.