肝硬变患者合并胆结石的成因探讨

目的 探讨肝硬化状态下胆石发生的机理。方法 （１）采用四氯化碳灌胃的方法建立豚鼠的肝硬变模型,观察豚鼠的胆石形成情况,扫描电镜观察胆结石的细微结构,用薄层色谱扫描的方法定量测定胆汁酸的含量。（２）对７１６例肝硬变合并胆囊结石病人资料进行临床分析。结果 豚鼠中肝硬变组的胆石８３．３％,高于对照组的５．０％和慢性肝损害组的３７．５％,肝硬变组总结合胆汁酸作含量及Ｇ／Ｔ幽会均较对照组降低。临床资料显示肝     

外源性胰岛素对豚鼠胆汁酸代谢的影响及诱发胆结石形成的实验研究

作者通过给豚鼠注射外源性胰岛素，观察官对豚鼠的胆汁酸代谢、肝脏形态及胆石形成的影响。结果发现：①实验组（ｎ＝１２）７只豚鼠有胆石形成，成石率５８％，而对照组（ｎ＝１５）中仅１只有胆石形成，成石率６．７％，两组间有显著性差异（Ｐ＜０．０５）；②实验组豚鼠肝脏中央静脉周围有空泡变性及脂肪细胞沉积，对照组豚鼠则少见；③实验组豚鼠胆囊胆汁中牛磺鹅脱氧胆酸（ＴＣＤＣＡ）与甘氨鹅脱氧胆酸（ＧＣＤＣＡ）分别为０．５９７±０．３９ｍｇ／ｍｌ与２．４２１±１．５９ｍｇ／ｍｌ，而对照组分别为０．７５７±０．４３ｍｇ／ｍｌ与３．２６５±２．４７ｍｇ／ｍｌ，两组间也有显著性差异（Ｐ＜０．０１）。上述实验结果表明，外源性胰岛素可引起肝脏的空泡变性，进而使胆汁中结合胆汁酸含量降低，促进胆石形成。     

胆道狭窄致胆色素结石时胆汁酸成分的变化

目的 研究胆汁中胆汁酸的变化与胆色素结石形成的关系。方法 结扎豚鼠的胆总管造成狭窄，一周后测定胆汁中胆汁酸及其它成分并行病理研究。结果 狭窄组(S组)成石率达91．3%，均为胆色素结石（PS)，胆汁中总胆红素（TBr）、非结合胆红素（Br），钙离子(JCE）、糖蛋白(GP）均较对照组（C组）明显升高。总胆汁酸（TBA）也明显增高。S组胆汁中牛磺鹅脱氧胆酸(TCDCA）明显升高，而甘氨鹅脱氧胆酸（GCDCA）明显降低，G/T值显著下降。超微病理研究表明，S组肝细胞内线粒体明显肿胀，滑面内质网显著减少。结论 胆汁中G/T的下降与肝脏病变均有利于PS形成。     

绞股蓝预防豚鼠胆囊胆固醇结石形成

目的 探讨胆固醇结石的预防。方法 采用豚鼠为实验对象，随机分为三组，设置了空白组、对照组、预防组。结果 药物预防组较对照组成石率显著降低（P＜0．05），药物预防组胆汁中胆固醇含量较对照组显著降低（P＜0．05），胆汁酸含量较对照组显著升高（P＜0．05）。结论 绞股蓝能改善肝功能细胞，降低胆汁中胆固醇含量，提高胆汁酸含量，达到预防胆固醇结石形成的目的。     

应用绞股蓝预防豚鼠胆囊胆固醇结石形成的实验研究

目的 探讨胆固醇结石的预防。方法 采用豚鼠为实验对象,随机分为三组,设置了空白组、对照组、预防组。结果 药物预防组较对照组成石率显著降低(P<0.05),药物预防组胆汁中胆固醇含量较对照组显著降低(P<0.05),胆汁酸含量较对照组显著升高(P<0.05)。结论 绞股蓝能改善肝细胞功能,降低胆汁中胆固醇含量,提高胆汁酸含量,达到预防胆固醇结石形成。     

双氯灭痛对豚鼠表皮角质形成细胞/黑素细胞比值及前列腺素E2含量影响的实验观察

目的 研究双氯灭痛对豚鼠皮肤前列腺素E2含量变化及自体全厚皮片表皮内角质形成细胞／黑色素细胞(KC／MC)比值与色素沉着的影响。方法 借助放射免疫分析方法动态观察皮片内前列腺素E2(PGE2)含量的变化及双氯灭痛的影响；借助组织学及组织化学方法观察皮片表皮内KC／MC比值变化。结果 在手术对照组，移植早期PGE2含量升高伴随着KC／MC比值的升高；而实验后期KC与MC的比值(KMR)减小。在双氯灭痛组，早期PGE不升反降，KMR减小；相应的实验后期KMR增大，皮片色泽较浅。结论 在移植早期应用双氯灭痛可以减轻炎症反应对表皮黑色素单位的损伤，减弱其增殖反应，从而降低KMR，减轻皮片色素沉着的程度。     

胆固醇性胆石症患者胆汁及血清中胆汁酸含量的初步观察

胆汁酸代谢紊乱是形成胆结石的重要原因。当胆汁中胆汁酸的相对含量下降，胆固酸／胆汁酸＞1：11时，胆汁胆固醇即呈过饱和状态，形成“致石胆汁”（Lith。geni。Bile）［fi。血清胆汁酸含量是反映机体胆汁酸代谢的重要指标。为此我们对胆石患者及非胆石患者的血清胆酸含量及胆汁类脂含量进行了比较。1材料和方法1．1病例选择及分组本研究选择胆固醇结石患者及非胆石患者各30例。年龄在30～60岁之间，均为上海市区女性居民，饮食习惯类同；无其他胃肠道疾病及糖尿病、甲亢等代谢性疾病，一年以内未服用降脂药、激素类药物（如避孕药，皮质…     

胆汁酸与胆色素结石的关系(文献综述)

胆汁酸的代谢和生化特性胆汁酸是胆汁的主要成分,占胆汁总固体量的50～70%,其化学结构是环戊烷多氢菲为核心的24碳羧酸胆烷系.胆汁酸仅在肝脏合成,通过肽键与甘氨酸或牛磺酸结合成甘氨胆酸(G)或牛磺胆酸(T),末端离子化,正常人胆汁中G/T比值约为3,可能是因为肝内甘氨酸多于牛磺酸.人服用牛磺酸后G/T比值下降,相反,若以强硷性阴离子交换树脂阻断肠肝循环以促进肝内胆汁酸合成时,由于牛磺酸相对不足,G/T比值明显升高.在胆汁中,胆汁酸一部分以自由酸的形式存在,另一部分则以其钠盐或钾盐的形式存在,称为胆汁酸盐(简称胆盐).细菌能水解胆盐,产生胆汁酸和甘氨酸或牛磺酸.     

肝硬变的胆汁代谢和胆石(文献综述)

肝硬变并发胆石的发生率Bouchier 于1968年从理论上对胆石的形成做了分析以后,认为肝胆汁的成份紊乱是胆石形成的基础。随后他对4,895例尸解资料进行了回顾,发现586例(12%)有胆石,235例(4.8%)为肝硬变。在肝硬变者中,69例(29.4%)同时存在胆石,对比无肝硬变者,     

炎性细胞因子对大鼠肝细胞胆汁酸分泌的影响

目的探讨炎性细胞因子对肝脏胆汁酸分泌机制的影响.方法利用体外原代培养大鼠肝细胞、枯否细胞(Kupffer cell,KC)的方法和反向高效液相色谱(RP-HPLC)技术,观察部分炎性细胞因子(IL-I、IL6、TNFa)以及被内毒素(LPS)活化的KC上清液对肝细胞胆汁酸分泌的影响.结果(1)炎性细胞因子和活化的KC上清液刺激后,肝细胞培养上清液中GCDCA、GCA和TGA三种结合胆汁酸含量均较对照组明显降低(P＜0.01);(2)实验组(GCA±GDCA)/TGA(G/T)的比值较对照组G/T的比值明显升高(P＜0.05).结论炎性细胞因子可以改变大鼠肝细胞胆汁酸的分泌机制,导致胆汁酸分泌含量的减低,并引起胆汁酸比例的变化.     

Bile acid pattern of gallbladder and hepatic bile in patients with and without cholesterol gallstones.

Bile acid composition of hepatic and gallbladder bile was examined in a group of 18 patients with uncomplicated cholelithiasis and a control group consisting of 13 patients with healed duodenal ulcers. Bile specimens were taken during laparotomy. Molar concentrations of the different bile acids in hepatic and gallbladder bile were determined. The ratios between the molar concentrations of the different bile acids were calculated. In order to compare these molar ratios in hepatic and gallbladder bile the quotients between identical molar ratios of hepatic and gallbladder bile were calculated in each subject. Bile acid concentration of the gallbladder bile was found to be lower in the gallstone patients. Trihydroxy or dihydroxy bile acid molar ratio was lower in the gallstone group. Hepatic to gallbladder relative trihydroxy to dihydroxy and cholate to deoxycholate bile acid ratios were elevated in the gallstone patients. This might indicate that an increased formation of deoxycholate is the main cause for the decreased trihydroxy to dihydroxy bile acid molar ratio observed in the gallbladder bile of patients with cholesterol gallstones.     

胆囊结石患者肝细胞胆汁酸分泌的变化

目的: 研究胆汁酸代谢异常与胆囊结石形成的关系.方法: 利用反相高效液相色谱(RP-HPLC)技术和体外原代培养肝细胞的方法,观察肝脏分泌机制与胆囊结石患者胆汁酸的成份变化及亲水-疏水平衡之间的关系.结果: 胆囊结石患者的甘氨鹅脱氧胆酸(GCDCA)和甘氨胆酸(GCA)的比例均较非结石组明显降低(P<0.05),而甘氨脱氧胆酸(GDCA)的比例明显上升(P<0.01).胆囊结石患者的胆汁及肝细胞培养上清液中胆汁酸HI值均较非结石患者显著上升.结论: 胆囊结石患者肝细胞胆汁酸分泌处于病理状态,胆汁中结合CDCA和结合CA比例下降,而结合DCA比例上升很可能为肝脏分泌胆汁机制受损所致,而胆汁中亲水-疏水平衡被打破是肝脏分泌机制紊乱的一个重要表现.     

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。     

Risk of developing cholelithiasis after vagotomy

Summary As the vagotomy coupled with pyloroplasty is becoming increasingly popular in recent years as operation of choice for gastric and duodenal ulcer, it becomes important to determine whether or not gallstone incidence increases after vagotomy. Dog gallbladder bile can hold additional cholesterol than is normally present. It is this additional cholesterol holding capacity of bile which is responsible for the dissolution of human gallstones inserted in dog gallbladder. Therefore dissolution of human gallstones in dog gallbladder can in turn be used to indicate the extent of cholesterol unsaturation in dog gallbladder bile. In the present communication human gallstone inserted in dog gallbladder is found to become less soluble after vagotomy and change of bile composition after vagotomy seems to indicate that higher incidence of gallstone can be expected. Possible factors responsible for the change of bile composition after vagotomy is discussed.     

Hepatocarcinoma, gallstone disease and gallbladder carcinoma: a case report of a rare incidental association

We report a rare case of a patient operated on with a diagnosis of hepatic tumour and gallstone disease, which postoperatively was found to be a hepatocellular carcinoma associated with a gallbladder carcinoma. Spiral CT at admission showed only a hepatic mass in the 4th segment, compatible with hepatocellular carcinoma and gallbladder lithiasis. Cholecystectomy was performed followed by a wedge resection of the 4th segment of the liver. The histopathological examination revealed a well-differentiated hepatocellular carcinoma and, surprisingly, an adenocarcinoma of the gallbladder confined to the mucosa. The association of a hepatocellular carcinoma and gallbladder adenocarcinoma is extremely rare. This association, together with an analysis of the literature showing the increased incidence of gallstones in cirrhotic patients and the consequent greater surgical risk when undergoing subsequent cholecystectomy after liver resection, would suggest that cholecystectomy should be performed routinely during liver resection for hepatocellular carcinoma or cirrhosis, even for minor resections and when there are no evident signs of gallbladder disease.     

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??Study on the relationship between gallbladder cholesterol polyps and the pathogenesis of gallstones JIAO Da-hai*, HAN Tian-quan, JIANG Zhao-yan, et al. *Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China Corresponding author: WANG Ming-liang, Email: mingliangwang@hotmail.com Abstract Objective To study on the relationship between gallbladder cholesterol polyps and the pathogenesis of gallstone. Methods gallbladder stone, bile and part of gallbladder full-thickness tissue were collected from 62 patients who underwent laparoscopic cholecystectomy from April 2008 to september 2008 in our center, including 31 patients with gallbladder cholesterol polyps, 18 patients with cholesterol gallstones and 13 patients in control??6 patients with gallbladder adenoma and 7 patients with non-cholesterol gallstone ). sonography was applied to measure the gallbladder three diameter before and 1 hour after breakfast to evaluate the contracted function of gallbladder. The contents of cholesterol in gallstone and cholesterol, bile acid and phospholipid in bile were measured, and the full-thickness tissue of the gallbladder wall was done the pathological examination. Results Emptying Rate of Gallbladder in the patients with cholesterol polyps was(47.3±18.6) %, it was significantly decreased comparing with those that in the healthy people(71.7±8.1)%, P??0.01, but there ware no differences between the patients in group of cholesterol polyps and in group of gallstones??47.6±23.7??%. Cholesterol saturation index was higher in the patients with cholesterol polyps comparing with those that in control group(1.0±0.2 vs 0.6±0.3, P??0.01), but there ware no differences between the patients in group of cholesterol polyps and in group of gallstones (1.0±0.2 vs1.0±0.2, P??0.05). Gallstones and cholesterol polyps coexistence in 13 patients among 31 patients who with the gallbladder cholesterol polyps, and the incidence of gallstone is 41.9%. Conclusion the existence of gallbladder cholesterol polyps may lead to the formation of gallbladder stone.     

Laparoscopic cholecystectomy in 226 cirrhotic patients. Experience of a single center in Taiwan

Background: Since 1987, laparoscopic cholecystectomy (LC) has been widely used as the favored treatment for gallbladder lesions. However, cirrhosis and portal hypertension have been considered relative or absolute contraindications to LC. This study aimed to assess the safety of LC in cirrhotic patients. Method: The medical records of 226 cirrhotic patients with gallbladder lesions who had undergone LC from 1991 to 2000 were reviewed, including demographics, severity of cirrhosis, laboratory data, operative morbidity, operative mortality, and hospital stay. Furthermore, the clinical features and outcomes of 4030 patients with gallbladder lesions without cirrhosis that had undergone LC were also summarized for comparison. Results: Of 4256 patients with gallbladder lesions that had undergone LC, 226 (5.6%) had cirrhotic livers. The cirrhotic group patients clearly exhibited the trends of older age, worse liver function, higher blood loss, and higher mortality compared to the noncirrhotic group patients. Conclusions: This study presents the clinical features and outcomes of 226 cirrhotic patients who underwent LC. LC, once considered contraindicated in patients with cirrhosis, is a feasible procedure for most Child's A and B patients with cholecystolithiasis. Minor morbidity, an acceptable conversion rate, and shorter hospital stay can be achieved by applying LC to treat cirrhotic patients. However, appropriate preoperative preparations and meticulous operative techniques are required to reduce blood loss during laparoscopy and even mortality.     

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.     

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.     

肝硬化并胆囊结石的病理改变与发病机制

肝硬化为常见的肝脏慢性疾病,其合并胆囊结石的发病率明显升高。肝硬化的病理变化主要体现在门静脉高压及肝功能减退两方面,进一步导致局部及全身的多种生理变化,并在胆囊结石的发病过程中起促进作用。笔者就肝硬化并胆囊结石的病理改变与发病机制进行综述。