胆囊隆起性病变一附54例报告

自１９８５年１月至１９９２年１０月，我科共收治经手术和病理证实的胆囊隆起性病变５４例，其中恶性病变１０例，良性病变４４例。我们根据临床不同的类型而选择不同的手术方式：①对于良性病变和局限于粘膜层的胆囊癌行胆囊单纯切除术；②对于未穿破浆膜层的胆囊癌宜行胆囊切除木及局部淋巴结清扫术；③对于穿破浆膜层或浸及肝脏的单个结节转移灶宜行胆囊切除术局部淋巴结清扫和肝部分切除；①对于不能切除的胆囊癌行剖腹探查，姑息性手术，肝动脉插管化疗等。本文讨论了Ｂ超检查作为首选辅助诊断的问题。     

Removal of large and small biliary duct stones

Large biliary stones of 2.0 cm size are difficult to extract with the catheter basket technique of Burhenne. A special four-wire snare basket was made and the T-tube tract was dilated to 26 French in order to extract large stones. A new technique of flushing and aspiration was used to extract small stones.     

Intervention for gallbladder disease

Intervention in the gallbladder includes therapy for both acute and chronic gallbladder disease. Although drainage for acute cholecystitis has been described by several investigators, the future seems to be in removal of calculi in symptomatic patients without acute cholecystitis. The technique for acute gallbladder drainage is described in detail using ultrasound guidance with or without fluoroscopy: for symptomatic gallstones, the clinical and technical aspects are described. We also discuss in detail the totally new concept for gallstone removal and the initial patient work using rotational contact lithotripsy with the Kensey-Nash device.     

hTERT和β-Catenin在胆囊癌细胞系中的表达及其与癌细胞增殖、侵袭关系研究

目的:检测hTERT和β-Catenin在人胆囊癌细胞系中的表达;初步探讨其与癌细胞增殖、侵袭关系。方法:采用端粒酶TRAP、半定量RT-PCR和Western印迹方法检测3种体外培养人胆囊癌细胞系端粒酶活性、hTERT基因和β-Catenin基因mRNA、蛋白质表达水平。四甲基偶氮唑盐(MTT)光吸收法检测琥珀酸脱氢酶(SDH)活性并做细胞增殖计数、运用Transwell小室和划线了解癌细胞侵袭与运动情况。结果:(1)TGBC1TKB、TGDC2TKB和GB-SD端粒酶活性OD值分别为0.183±0.001、0.257±0.002和0.260±0.002;β-Catenm基因mRNA值分别为44718±567、50279±545和50802±371;hTERT基因值分别为51287±1818、62346±733和63345±1154;后两组均高于第1组(P<0.05)。β-Catenm蛋白质值分别为35289±154、32636±345和32510±346;hTERT蛋白质值分别为34515±454、32562±571和32083±163。后两组均低于第1组(P<0.05),有显著差异。(2)TGBC1TKB、TGBC2TKB和GB-SD琥珀酸脱氢酶活性第5天OD值分别为1.324±0.792、1.573±0.(143和1.647±0.033;24h穿膜细胞数分别为60.667±3.512、113.333±5.508和124.667±6.506;24h过线细胞数分别为23.667±1.155、40.000±1.000和42.667±2.082。后两组均高于第1组(P<0.05),有显著差异。结论:端粒酶、hTERT和β-Catenin基因蛋白在人胆囊癌细胞系呈阳性表达;它们可提示胆囊癌细胞的生物学特性,可能影响胆囊癌细胞的增殖、运动和侵袭力。     

~(18)F-FDG PET显像诊断胆囊癌

目的：探讨^18F-FDG PET显像在胆囊癌诊断中的应用价值。方法：7例临床怀疑的胆囊癌患者均行^18F—FDG PET显像，对显像结果进行目测法及半定量分析，并与CT、手术、腹腔镜取病理等进行对比研究。结果：病理检查确诊4例胆囊癌，3例胆囊良性病变。^18F-FDG PET显像均正确定性。CT对6例作出正确定性。2例PET显像发现了CT未发现的转移灶3处，并对1例胆囊癌患者进行了正确疗效评价。结论：^18F-FDG PET显像对胆囊癌的诊断及临床分期具有较好的临床应用价值，并可准确地评价治疗效果。     

Regulation of pancreatic and gallbladder function by absorption of intrajejunal phenylalanine in man

Summary The effects of varying loads of intraduodenal phenylalanine on pancreatic and gallbladder function were investigated in 32 healthy volunteers using a triple lumen perfusion system. L-phenylalanine absorption rates in the proximal jejunum were measured simultaneously. Intraduodenal L-phenylalanine produced a dose related increase in pancreatic secretion reaching the maximum at the concentration of 100 mM. Bilirubin outputs too increased significantly but did not parallel enzyme secretion. In contrast to the effect of L-phenylalanine, D-phenylalanine 50 mM did not stimulate pancreatic enzyme secretion and gallbladder emptying. The absorption rates of L-phenylalanine increased with rising luminal concentrations. There was a significant correlation between pancreatic secretion and L-phenylalanine absorption rates. This relationship suggests that the release of cholecystokinin, a hormone stimulating pancreatic and biliary function is dependant of the absorption of nutrients like amino acids.This work was supported by a grant of the Deutsche Forschungsgemeinschaft HO 349/4We thank M.U. Folz for technical assistance and Mrs. G. Leineweber for secretarial help     

Capacitive and inductive low frequency impedances of Necturus gallbladder epithelium

The electrical impedance of Necturus gallbladder epithelium was analysed in the frequency range 0.24 Hz to 6,323 Hz. Under control conditions (NaCl-Ringer's on both sides), the impedance function yields a semicircle with depressed center. When serosal Na⁺ was replaced by K⁺, an inductive low frequency (LF) component appeared in the impedance locus. with KCl-Ringer on the mucosal side a second circular are was observed at frequencies below 1 Hz. The resistive parts of the capacitive and inductive LF components increased after application of TAP⁺ to the mucosal side. Both LF features were abolished after application of 5mM TEA⁺ to the mucosal medium as well as after acidification of the mucosal side. The LF components were depressed by addition of 5 mM Ba²⁺ to the mucosal solution. As TEA⁺ blocks apical K⁺ channels (Van Driessche and Gögelein 1978), it is concluded that the capacitive as well as the inductive LF components are related to transcellular K⁺ flow. With KCl-Ringer on the mucosal side, mucosa negative potentials increased the equivalent resistance and decreased the equivalent capacitance of the LF impedance. With serosal KCl-Ringer, negative potentials evoked a capacitive component which overlapped with the inductive component observed at open circuit conditions. Positive potentials, however, abolished the capacitive as well as the inductive LF component, elicited by mucosal or serosal KCl-Ringer, respectively. These results demonstrate that serosa to mucosa directed K⁺ flow causes an inductive LF feature and that mucosa negative potentials elicit a capacitive LF component.     

3H-ACh release from guinea pig gallbladder evoked by GABA through the bicuculline-sensitive GABA receptor

Summary We investigated the effect of GABA on the spontaneous efflux of ³H-acetylcholine (ACh) from the isolated guinea pig gallbladder loaded with ³H-choline. Application of GABA (10^–5 M) caused a significant increase in the fractional rate of tritium efflux. This GABA-evoked efflux of ACh was inhibited by the perfusion of tetrodotoxin (10^–6 M) and Ca-free medium. Nipecotic acid (10^–4 M) did not affect the GABA-evoked release of ACh, indicating that ACh was not released by the entry of GABA into cholinergic nerve terminals. Bicuculline (10^–6 M) and furosemide (10^–6 M), the chloride ion channel blocker, inhibited the GABA-evoked ACh release. The application of muscimol (10^–5 M), but not baclofen (10^–5 M) also produced an increase in the fractional rate of ACh release. Thus, the GABA receptors involved in the increase of ACh release are bicuculline-sensitive. The GABA-evoked release of ACh was not altered by the perfusion with hexamethonium (10^–5 M), thus indicating the presence of GABA receptors on the postganglionic cholinergic neurons.These findings suggest that bicuculline-sensitive GABA receptors probably coupled to a Cl^– ionophore are present on postganglionic cholinergic neurons and are involved in the increase of ACh release in guinea pig gallbladder.This paper is part of a dissertation submitted by N. Saito to Kobe University School of Medicine, for the requirement of Doctor of Philosophy     

丝裂霉素诱导人胆囊癌GBC-SD细胞凋亡的研究

目的:研究丝裂霉素对胆囊癌细胞凋亡的影响。方法:在体外培养的胆囊癌细胞中加入不同浓度的丝裂霉素,应用光镜、电镜、DNA凝胶电泳及流式细胞仪检测胆囊癌细胞凋亡的形态学特征、生化学特征、细胞凋亡百分率及细胞周期的变化。结果:在丝裂霉素作用下,凋亡的胆囊癌细胞出现膜小泡、凋亡小体等特征性改变;DNA电泳呈现典型的“梯状”条带;流式细胞仪测定,出现典型的凋亡峰,其凋亡百分率随着药物浓度的提高而明显升高,分别与对照组比较,差别有统计学意义(P<0.05);同时,S期细胞含量下降,而G_2/M期细胞含量上升。结论:丝裂霉素可诱导胆囊癌细胞发生凋亡,并可使胆囊癌细胞生长受阻于G_2/M期,这可能是其杀伤肿瘤的一种重要机制。     

胃癌手术不同消化道重建方式对患者术后胆囊收缩功能的影响

目的 探讨胃癌手术不同消化道重建方式对患者术后胆囊收缩功能影响.方法 选择2010年8月至2014年8月在我院接受胃癌根治术的患者60例作为研究对象.依据胃切除术后消化道重建方式的不同分成A组(n=23)及B组(n=37).A组给予毕Ⅰ式重建,B组给予调节型双通道重建,随访1年,比较两组患者手术前后的胆囊容积、胆囊收缩功能、血清胆囊收缩素(CCK)水平以及两组的随访症状.结果 A组患者术后3 d、7 d、1个月、6个月及12个月的胆囊容积分别为(20.89±3.12) ml、(21.23±8.10) ml、(23.64±7.88) ml、(24.94±5.32) ml、(27.84±8.81) ml,均较术前(17.15±8.24) ml及B组术后同时期的(17.20±7.94) ml、(17.19±7.22) ml、(17.18±7.99) ml、(17.19±8.54) ml、(17.20 ± 8.20) ml明显增大,差异均有统计学意义(P<0.05);术后A组患者各时期的胆囊排空率分别为13.04%、17.39%、13.04%、17.39%、21.74%,均较B组同时期的37.84%、43.24%、40.54%、43.24%、48.65%均明显下降,差异均有统计学意义(P<0.05);术后A组患者各时期的血清CCK水平分别为(5.32 ± 0.84) pmol/L、(5.35 ± 0.76) pmol/L、(5.36 ± 0.82) pmol/L、(5.38 ± 0.77) pmol/L、(5.36 ± 0.79) pmol/L,均较B组同时期的(4.45 ± 0.39) pmol/L、(4.50 ± 0.62) pmol/L、(4.48±0.41) pmol/L、(4.47±0.84) pmol/L、(4.51±0.33) pmol/L明显上升,差异均有统计学意义(P<0.05);A组患者随访症状中的消化道症状及胆囊结石发生率分别为43.48%、34.78%,均较B组的2.70%、0%高,差异均有统计学意义(P<0.05).结论 胃癌手术中实施调节型双通道的消化道重建方式有利于患者术后胆囊收缩功能的恢复,可提升其生存质量,值得推荐.