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.     

术中胆囊与胆总管胆汁同步细菌培养对比研究

目的　了解胆石病病人胆道不同部位内胆汁的细菌学特点和药敏情况 ,指导术后抗生素应用。方法　 5 6例胆囊切除胆总管探查术病人同步作胆囊内胆汁和胆总管内胆汁细菌培养和药敏。结果　胆囊和胆总管内胆汁培养按双阳性率排列依次为急性化脓性胆管炎 (1 0 0 % )、胆源性胰腺炎 (5 7.1 % )、急性胆囊炎胆囊结石伴阻塞性黄疸 (5 0 % )、急性胆囊炎 (5 0 % )、慢性胆囊炎胆囊结石伴胆总管扩张 (35 .7% )。其中急性化脓性胆管炎、胆源性胰腺炎、急性胆囊炎胆囊结石伴阻塞性黄疸双阳性病例中各有 1例胆囊和胆总管内胆汁培养菌种不同。结论　胆石病病人不同部位胆汁内菌种大多数相同但存在差异 ,其药敏也有所不同。我们建议胆囊切除胆总管探查术 ,尤其在急性期并伴有黄疸病例中应同步培养胆囊和胆总管内胆汁 ,其对术后抗生素应用有指导作用     

The incidence of bacteria in gallbladder bile at acute and elective cholecystectomy

Aerobic and anaerobic bacterial cultivation was carried out on gallbladder bile collected from all patients operated on with cholecystectomy during a 10-month period. Acute cholecystectomy was performed on 34 patients because of acute cholecystitis. Elective cholecystectomy was performed on 177 patients because of non-acute gallbladder pathology. Bacteria were found in gallbladder bile in 16.4% of patients with non-acute cholecystopathy compared to 58.8% of patients with acute cholecystitis (p less than 0.001). An increased incidence of pathogenic bacteria was observed in the acute compared to the elective cholecystectomy material. The acute inflammatory process, its severity and the age of the patient seemed to be important factors which could be related to the increased occurrence of bacteria in the gallbladder bile. A higher incidence of postoperative morbidity and infectious complications was found in patients with pathogenic bacteria in gallbladder bile than in patients with no growth of bacteria or opportunistic bacteria in gallbladder bile.     

Gallbladder bile proteins in patients with gallstones and normal controls

The concentration of total protein and 17 different proteins in gallbladder bile of patients with gallstones and normal controls were analyzed. The result showed that the amount of total protein and 11 of 17 proteins was much higher in patients with cholesterol gallstones than that of normal controls. These proteins may be involved in the nucleation of cholesterol crystal in gallbladder bile of patients with cholesterol gallstones. The nucleation activity titre (NAT) of gallbladder bile of patients with gallstones and controls was determined. The NAT of gallbladder bile of patients with gallstones was 1/25-1/100 and that of controls was 1/100-1/6400. There was a statistically significant difference of NAT between patients with cholesterol gallstones and normal controls.     

治疗肝内胆管结石一定要切除胆囊吗

目的 探讨胆囊在肝内胆管结石手术治疗中的应用价值，并论证保留胆囊的可行性。方法 收集1994～2002年所有肝胆管结石病人的临床资料，总结既往胆囊切除的情况和原因；研究存在胆囊的肝胆管结石病人的胆囊功能状况。介绍一种应用完整胆囊解除肝门胆管狭窄的新术式——皮下通道型胆囊肝胆管成形术(STHG)，并总结其临床疗效。结果 8年间肝胆管结石病人共计247例，81例已切除胆囊，占32．8％，胆囊存在的肝胆管结石病人166例，其中胆囊形态功能正常者125例，占75．3％。其中有102例实施了STHG，不但保留了胆囊，而且使它发挥下列重要作用：①纠正肝门狭窄，改善肝内胆管的引流；②提高肝内胆管中胆汁酸浓度，从而防止该处色素结石复发；③保留了肝外胆管及Oddi括约肌的功能，防止肠胆反流；④为日后处理肝内结石复发提供一条便利通道。结论 肝胆管结石病人大多数胆囊功能正常。STHG应用正常完整的胆囊作为肝门胆管狭窄的修补材料，其术后近远期疗效好，值得推广应用。     

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。     

Long-term results of treatment for pancreaticobiliary maljunction without bile duct dilatation

HYPOTHESIS: Resection of the gallbladder together with the dilated bile duct is the preferred treatment for pancreaticobiliary maljunction (PBM) with bile duct dilatation, whereas this treatment for PBM without bile duct dilatation is still controversial. DESIGN: Retrospective study of 196 patients from January 1979 to November 2004. SETTING: Two university hospitals. PATIENTS: One hundred ninety-six patients with PBM, 152 (78%) with and 44 (22%) without bile duct dilatation, formed the basis of this study. MAIN OUTCOME MEASURES: The effects of cholecystectomy on long-term results in the patients without bile duct dilatation. RESULTS: Significant differences were observed in patients without bile duct dilatation: patients were older, carcinoma of the gallbladder was more prevalent (19 patients [43.2%] without dilatation vs 9 patients [5.9%] with dilatation), and pancreatic cancer and pancreatitis were also more frequent. Most of their gallbladder carcinomas were found at stage IV (63%). The outcome was very poor in stage IV, whereas 5 patients in stage I and II lived for more than 5 years after surgery. Of the 44 patients without bile duct dilatation, 23 with carcinoma of the gallbladder or pancreas died and the other 2 were lost to follow-up. The remaining 19 patients were alive at the study's conclusion after cholecystectomy without bile duct resection. None of them had bile duct carcinoma at the time of surgery or during the mean follow-up period of 9 years after surgery. CONCLUSIONS: Prophylactic cholecystectomy without bile duct resection is the best treatment option for patients with PBM without bile duct dilatation. Possible association of gallbladder carcinoma should be kept in mind at the time of treatment of patients with PBM when the bile duct is not dilated.     

胆囊结石患者血清、胆汁与胆囊黏膜中纳米细菌的分布研究

目的　探讨纳米细菌在正常人群血清及胆囊结石患者血清、胆汁和胆囊黏膜中的分布情况。　方法　 ( 1)采用ELASA方法测定 338例正常人群和 76例胆囊结石患者血清中纳米细菌的感染情况 ;( 2 )对 5 7例胆囊结石和 18例非胆囊结石患者的胆囊胆汁进行纳米细菌培养 ,并采用免疫组化染色和透射电镜扫描进行鉴定 ;( 3)随机选取其中 40例胆囊结石患者胆囊黏膜进行免疫组化染色 ,观察相应胆汁和胆囊黏膜中纳米细菌分布的差异。　结果　 ( 1)正常人群和胆囊结石患者血清中纳米细菌感染率分别为 8 0 %和 31 6 % ,两者间差异有显著性 ( χ2 =2 9 90 ,P <0 0 5 ) ;( 2 ) 75例胆汁中有46例感染纳米细菌 ,阳性率为 6 1 3 % ,其中胆囊结石患者的胆汁纳米细菌的感染率为 6 1 4 % ,非胆囊结石患者的胆汁纳米细菌的感染率为 6 1 1% ,两者间并无统计学差异 ( χ2 =0 89,P >0 0 5 )。 ( 3) 14例胆囊结石患者胆囊黏膜感染纳米细菌 ,阳性率为 35 0 % ,其主要分布在黏膜或黏膜下层及钙化灶。　结论　正常人群血清中纳米细菌感染率为 8 0 % ,胆囊结石患者血清、胆汁和胆囊黏膜中存在着纳米细菌感染 ;胆囊壁的钙化或纤维化可能与纳米细菌感染有关。     

外伤性胆道损伤的处理

目的 探讨外伤性胆道损伤的处理方法.方法 回顾性分析2009年7月至2014年5月华中科技大学同济医学院附属同济医院收治的26例外伤性胆道损伤患者的临床资料.26例患者均有外伤史.根据损伤控制原则,行剖腹探查术明确诊断后,根据术中探查情况,采用Mattox损伤分型标准对患者进行分型.在抗休克治疗的同时,根据损伤部位和程度,选择胆囊切除术、胆管修补术、胆管对端吻合术、胆肠吻合术和肝方叶切除＋肝门部胆管整形＋肝肠吻合术等手术方式.合并其他脏器的损伤者均行相应的手术治疗.术后辅以抗炎、补液等对症支持治疗.记录患者院内死亡情况.出院患者定期门诊或电话随访,随访时间截至2014年10月.结果 26例患者行剖腹探查术,术中发现胆囊损伤15例、胆总管损伤5例、肝总管损伤3例、左肝管损伤2例、右肝管损伤1例;合并肝破裂11例、脾破裂1例、肾破裂5例、小肠破裂4例.Mattox损伤分型：Ⅰ型11例,Ⅱ型4例,Ⅲ型0例,Ⅳ型8例,Ⅴ型3例.15例胆囊损伤患者中,5例Ⅰ型胆囊挫伤较轻者未行胆囊切除术,6例Ⅰ型胆囊挫伤较重者和4例Ⅱ型患者行胆囊切除术;11例肝胆管损伤患者中,5例Ⅳ型较轻者行胆管修补＋T管引流术,3例Ⅳ型较重者根据损伤部位采用不同手术方案（1例行胆管对端吻合术＋T管引流术、1例行胆肠吻合术、1例行肝方叶切除＋肝门部胆管整形＋肝肠吻合术）,3例Ⅴ型患者均行胆肠吻合术.合并其他脏器损伤的患者均行相应的手术治疗：11例联合肝破裂修补术或肝段切除术,1例联合脾切除术,5例联合肾切除术,4例联合小肠部分切除＋端端吻合术.26例患者中,术后1例因失血性休克经抢救无效于住院期间死亡;3例出现胆汁漏,1例出现伤口感染,经对症支持治疗后痊愈.25例患者治愈出院.25例患者获得随访,随访时间为术后1、3、6、12个月,无一例患者发生迟发性胆?     

Primary "brown pigment" bile duct stones

Bile duct stones from 42 patients were morphologically and chemically analysed. The calculi from 27 patients had important primary bile duct stone (PBDS) features, consisting of a general ovoid shape and fragile structure, with alternating light and dark brown pigmented layers on cross-section. Chemically these stones contained low levels of cholesterol, with high levels of bilirubin and calcium. Subsequent infrared spectroscopy analysis showed that calcium bilirubinate and calcium palmitate were the only calcium salts present. Calcium palmitate was prominent in the light brown layers. A morphological and chemical comparison with gallbladder stones showed that bile duct "stasis stones" were similar in morphological and chemical composition to the brown pigment gallbladder calculi. However, they were distinct from most gallbladder stones, indicating that primary bile duct calculi have an aetiology that is different to 90% of gallbladder calculi. Primary bile duct calculi were observed to occur with or without the presence of a gallbladder, and more interestingly, in the bile duct of two patients with cholesterol gallbladder stones. Bile duct bile of patients with primary choledocholithiasis were always moderately to profusely infected and with abundant calcium bilirubinate precipitation. Moreover, this study has shown that PBDS chemical analyses profiles were consistent and correlated well with their defined morphology. Consequently, PBDS may be accurately identified at the time of operation by morphology. An important aetiological factor would appear to be infection, which would seem to promote bile duct bile stasis and eventual stone growth.     

Triglyceride and cholesterol content in bile, blood, and gallbladder wall

Cholesterol gallstone disease is frequent in Chile compared with other countries, as is cholesterolosis of the gallbladder. The purpose of this study was to determine any differences in bile composition and cholesterol content in the gallbladder wall and serum of patients compared with findings in patients with gallstones and control subjects. In control subjects, cholesterol content of the gallbladder wall was determined in autopsy material. Patients with cholesterolosis had bile composition similar to that of patients with gallstones, with supersaturation of cholesterol in the bile. Also, these patients had increased levels of cholesterol in the gallbladder wall but normal serum cholesterol levels. These findings suggest that altered bile composition occurs in patients with cholesterolosis and gallstones.     

胆囊黏膜ABCA1的表达和胆囊胆固醇息肉发病关系的研究

目的：研究ABCA1在胆囊黏膜的表达及其表达与胆囊胆固醇息肉发病的关系。方法：收集因胆囊疾患而行腹腔镜胆囊切除术病人的胆石、胆汁、胆囊黏膜及胆囊壁全层组织共计42例,其中胆囊胆固醇息肉15例,胆囊胆固醇结石15例,对照组12例（胆囊腺瘤5例,非胆固醇胆囊结石7例）。分别测定胆石胆固醇含量、胆汁胆固醇、胆汁酸、磷脂的浓度;实时PCR定量检测胆囊黏膜ABCA1、LXRα、RXRα的mRNA表达：胆囊壁全层组织做病理切片;免疫组化显示ABCAl蛋白在胆囊黏膜的表达．结果：胆固醇息肉组胆汁胆固醇饱和指数为1．0±0．2,较对照组胆固醇饱和指数0．6±0．3明显增高,其差别有统计学显著性（P〈0．01）。免疫组化显示ABCA1在胆囊黏膜上皮细胞有明显表达。息肉组、结石组和对照组胆囊黏膜ABCAI、LXRa、RXRα mRNA相对表达量比较,各组之间差异无统计学意义。结论：胆囊黏膜ABCA1的表达可能并不是导致胆囊胆固醇息肉发病的重要原因。     

顺逆结合胆囊切除在腹腔镜胆囊切除术中的应用

目的 :探讨顺逆结合胆囊切除在腹腔镜胆囊切除术 (LC)中的应用价值。方法 :对 6 0 0例结石性胆囊炎、胆囊息肉患者 ,采用顺逆结合法行LC手术。结果 :6 0 0例患者术后均顺利康复 ,无胆管损伤等并发症发生。术中将胆囊完全游离后发现 ,把 8例的胆总管误认为胆囊管夹闭 ,2例各有一与肝总管平行的副肝管汇入钛夹远端的胆囊管 ,11例在钛夹近端的胆囊管内有结石嵌顿 ,而术前B超未提示胆囊管内有结石嵌顿 ;均及时取除钛夹后 ,重新夹闭胆囊管的近端和远端 ,再切除胆囊。结论 :在LC手术中 ,采用顺逆结合法切除胆囊 ,可有效地减少胆管损伤、胆囊管残余结石等并发症的发生     

Elective cholecystectomy with intraperitoneal drain. A bacteriological evaluation

The occurrence of bacteria in 108 patients operated on with elective cholecystectomy was investigated in specimens from preoperative skin, gallbladder bile, drain wound secretion and drainage fluid. Growth of bacteria in gallbladder bile was found in 13% and in drainage fluid in 46% of the patients. The occurrence of bacteria in drainage fluid was not correlated with the operative time or the experience of the surgeon. The presence of pathogenic bacteria in the drainage fluid in our investigation was related to increased amounts of drainage fluid and to increased incidence of infectious complications (manifest or suspected intra-abdominal abscess and wound infection). Growth of bacteria analogous to those found in drainage fluid was observed in gallbladder bile (5% of the patients), in preoperative skin culture (12%) and in drain wound secretion (14%). Most of the bacteria in the drainage fluid seemed to come from an exogenic source. However, in 35% of the patients with bacteria in the gallbladder bile analogous bacteria were demonstrated in the drainage fluid. Since an increased occurrence of bacteria in gallbladder bile has been found in patients with acute cholecystitis and in patients more than 60 years of age the use of intraperitoneal drain from a bacteriological point of view could thus be limited to these groups of patients.     

Cohort study of surgical bypass to the gallbladder or bile duct for the palliation of jaundice due to pancreatic cancer

OBJECTIVE: To compare patterns in mortality and the use of subsequent biliary drainage interventions (surgical, endoscopic, and percutaneous) associated with the different types of biliary bypass. SUMMARY BACKGROUND DATA: Surgical palliation of obstructive jaundice due to pancreatic cancer is often accomplished with an intestinal bypass to either the gallbladder or the bile duct. It is not known whether a gallbladder bypass, which is a simpler operation and more amenable to laparoscopic surgery, performs as well as a bypass to the bile duct. METHODS: The authors conducted a retrospective cohort study of 1,919 patients 65 years of age or older who had a surgical biliary bypass for pancreatic cancer diagnosed between 1991 and 1996 using Medicare claims data and the Surveillance, Epidemiology and End Results (SEER) database. RESULTS: At 1, 2, and 5 years, 7.5%, 17.4%, and 26.0% of 945 patients initially treated with a gallbladder bypass had additional biliary interventions, as compared with 2.9%, 11.0%, and 13.3% of 974 patients initially treated with a bile duct bypass. Patients who initially had a gallbladder bypass were 4.4 times as likely to have additional biliary surgery and 2.9 times as likely to have any subsequent biliary intervention as were patients who initially had a bile duct bypass. Median survival was longer following bile duct bypass. The adjusted hazard ratio for death associated with gallbladder bypass was 1.2. CONCLUSIONS: Compared to patients whose initial biliary bypass was to the bile duct, the risk of having one or more additional surgical, endoscopic, or percutaneous biliary drainage procedures is substantially greater in patients whose initial bypass was to the gallbladder.     

Oddi括约肌与胆管色素结石形成关系的探讨

目的探讨Oddi括约肌结构及功能异常与胆管色素结石形成之间的关系。方法胆道术后留有T型管的患者123例,使用放射性核素^99mTc—DTPA判断是否存在肠胆反流,以此将患者分为反流组及非反流组,检测空腹血胃动素、胃泌素水平,随机选取53例使用胆道镜测压。采用钡餐透视观察胆管色素结石、非胃肠胆道疾病、胆囊息肉、胆囊胆固醇结石患者的十二指肠降段憩室发生率;十二指肠镜观察原发性胆管色素结石、胆管结石合并胆囊结石、继发于胆囊结石的胆管结石、胆管末端和乳头部炎症狭窄、胆管末端癌和乳头癌、胆囊切除术后综合征患者的十二指肠憩室内（旁）乳头的发生率。结果123例行胆道取石T型管引流术后的患者中有44例检测到十二指肠胆道反流（35．8％）,反流组Oddi括约肌基础压（SOBP）、收缩波幅（SOCA）、胆总管压（CBDP）显著低于对照组（P〈0．01）。反流组血胃动素、胃泌素水平明显低于无反流组及对照组（P〈0．01）。血胃动素与SOBP、血胃泌素与SOBP及CBDP呈正相关。钡餐摄影显示胆总管色素结石患者十二指肠降段憩室发生率达36．62％,明显高于其他3组（P〈0．05）。胆管胆色素结石患者十二指肠憩室内（旁）乳头的发生率明显高于继发于胆囊结石的胆管结石组、胆管末端和乳头部炎症狭窄组及胆管末端癌和乳头癌组（P〈0．05）。结论胆管色素结石患者存在明显的肠胆反流和胆系感染,Oddi括约肌结构与功能状态与胆管色素结石形成密切相关,其解剖及功能异常是胆管色素结石形成的重要原因。     

重视腹腔镜胆囊切除术中胆道隐性疾病的发现与处理

目的：总结1452例腹腔镜胆囊切除术（LC）中早期胆囊癌,胆总管结石等隐性胆道疾病易被忽略的发生原因及治疗措施。方法：有要用回顾性病例总结的方法,对胆囊结石,胆囊腺肌症,胆囊腺瘤导致癌变,胆总管结石易被术者忽略的原因进行分析。结果：1269例胆结石患者中2例癌变,179例息肉中3例癌变,癌变率达0．3％,105例胆总管直径＞0．8cm者,术中造影28例有胆管结石,发生率为26．6％,结论：？LC前临床医师应对胆囊巨大结石,胆囊壁增厚及有宽蒂息肉者高层重视,以免对癌肿误诊,对术前胆总管＞0．8cm者,术中[造影检查是必需的,以免漏诊胆总管结石。     

Altered Bile Composition in the Gallbladder and Common Bile Duct of Patients with Anomalous Pancreaticobiliary Ductal Junction

The high incidence of biliary tract carcinoma in patients with anomalous pancreaticobiliary ductal junction (APBDJ) has been well documented. Elevation of the secondary and free bile acid (FBA) concentrations is considered a risk factor for biliary carcinogenesis in these patients. Bile from the gallbladder and common bile duct in 12 patients with APBDJ was analyzed and compared with gallbladder bile from 19 patients with gastric cancer and a normal hepatobiliary tract. The concentrations of secondary bile acids were significantly lower in the APBDJ group than in the control group, and FBA concentrations were not detected in the gallbladder in either group. The lysolecithin (LL) in the phospholipid, which is produced from lecithin by activated phospholipase A₂ in refluxing pancreatic juice, was significantly elevated in the APBDJ group. Elevation of the LL concentration in the bile is one of the factors for the development of biliary tract carcinoma in patients with APBDJ.     

瘦素对血脂及胆汁成分的调节在胆囊胆固醇结石形成中的作用

目的:分析胆囊胆固醇结石患者瘦素与血脂及胆囊内胆汁成分的关系,探讨瘦素在胆囊胆固醇结石形成中的作用。方法:选择胆囊胆固醇结石接受腹腔镜胆囊切除术的患者30例(结石组)与同期因胆囊息肉行腹腔镜胆囊切除术的患者22例(息肉组),检测患者血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、瘦素、胆囊胆汁中的TC与总胆汁酸(TBA)水平,以及胆囊壁组织瘦素受体mRNA水平。结果:与息肉组比较,结石组血清TC、TG、LDL、瘦素水平以及胆囊内胆汁TC/TBA含量比率与胆囊组织瘦素受体mRNA水平均明显升高,而血清HDL明显降低(均P0.05)。结石组的血清瘦素水平与血清TG、TC及胆汁TC均呈正相关(r=0.633,P=0.002;r=0.224,P=0.025;r=0.384,P=0.000),与HDL和TBA呈负相关(r=-0.205,P=0.014;r=-0.548,P=0.024)呈负相关,而息肉组血清瘦素与以上指标间均无关(均P0.05)。结论:瘦素参与了胆囊胆固醇结石的形成,瘦素及其受体水平的升高可能与胆囊胆固醇结石患者胆固醇代谢异常、胆囊胆汁成分失调密切相关。     

肝硬化胆囊结石患者的胆囊胆汁和结石成分分析

目的: 通过测定肝硬化患者胆囊胆汁和结石成分,分析胆囊结石的类型及其与胆汁成分改变的关系. 方法: 将研究对象分四组,即非胆囊结石对照组(A组,13例)、单纯胆囊结石组(B组,16例)、肝硬化组(C组,5例)和肝硬化胆囊结石组(D组,7例).测定A组13例、B组15例、C组5例和D组7例的胆囊胆汁成分.对B组16例、D组6例行结石成分分析,用肉眼和实体显微镜观察结石的表面及剖面,并按1984年傅培彬等人提出的结石分类法分类,结石成分用化学方法分析. 结果: ①两组肝硬化的胆汁中未结合胆红素(UCB)含量明显升高,胆汁酸(TBA)含量明显降低,与对照组比较差异有显著性意义(P<0.05).结石中的66.7%为黑结石.单纯胆囊结石组胆汁中胆固醇(TC)含量明显升高,胆汁酸含量明显降低,与对照组比较差异有显著性意义(P<0.05).结石中的87.5%为胆固醇型结石.②两组肝硬化(C和D组)的血清TB和UCB均显著高于A和B两组(P<0.05).而血清TBA在B、C和D组中却明显低于A组(P<0.05).血TC在C和D两组低于A和B两组(P<0.05). 结论: 肝硬化患者好发胆囊胆色素结石,且以黑色结石多见,这与肝硬化时肝脏代谢胆红素和胆固醇障碍胆汁中UCB升高、TBA降低有关.