经皮胆镜胆囊碎石取石术（附684例报告）

１９９１年１０月至１９９３年４月，作者采用经皮胆镜碎石取石术治疗胆囊结石６８４例，手术成功率为９６．２９％，结石残留率２．３４％，治愈率９７．６６％，无术后并发症及死亡者。术后１３６例随访６～２４月（平均１６月），其中９例（６．６１％）结石复发。本法近期效果明显，优于其他各种非手术疗法，并具有创伤小，痛苦少、康复快的特点，既一次能清除较多的胆囊结石，又保留了功能良好的胆囊，是一种有效、经济、值得推广的内镜新技术。     

高效液相色谱法测定速效牛黄丸中胆红素的含量

本文报道了高效液相色谱法测定速效牛黄丸中胆红素含量的方法。采用进口ODS(美国)色谱柱,氯仿-甲醇(9∶1)为流动相,在450nm波长处检测,线性范围0.02～0.08mg/ml,平均回收率为99.9%,精密度以CV表示为2.7%,方法简便,准确。     

鹅去氧胆酸噁唑啉乙酰化合物的合成

鹅去氧胆酸用于治疗胆石症,能抑制胆固醇和胆酸在肝脏的合成,增加胆固醇在胆汁中的溶解度。但是它易被肠道细菌7-脱羟酶作用生成石胆酸,引起对肝脏的毒性,而且用药剂量较大、疗程较长。根据Cohen和Mosbach等报道,胆酸(口恶)唑啉衍生物可抑制7-脱羟     

Recurrent small bowel obstruction after laparoscopic surgery for gallstone ileus

Gallstone ileus is an uncommon cause of small bowel obstruction. A patient presenting with gallstone ileus was managed in our department by laparoscopic enterolithotomy. Postoperatively, the patient developed recurrent small bowel obstruction due to the presence of a second gallstone. It is therefore important to exclude the possibility of multiple gallstones at the initial operation.     

ELISA法检测胆汁200kD糖蛋白

目的：建立检测胆汁蛋白的ELISA方法，初步应用临床，开辟胆石症研究的新途径。方法：利用已提纯的具有强力促成核活性的200kD糖蛋白，免疫家兔获得特异性抗体，首次建立了该糖蛋白ELISA测定方法，并测定了15例患者．结果：胆石症患者血清中该糖蛋白的含量明显高于对照组。结论：该糖蛋白的ELISA检测法具有一定的临床价值。     

Gallstones in Gallbladder Diseases

The correlation between gallbladder stones (gallstones) and various gallbladder diseases was examined. The incidence of gallstones was 47.1% in cases of nonneoplastic epithelial polyp, 48.0% in adenoma, and 59.1% in adenocarcinoma. There was no relation between the incidence of gallstones and sex. The incidence of gallstones in cancer cases showed no difference among histological gradings. Non neoplastic epithelial polyps, adenomas and carcinomas were divided into metaplastic type and non metaplastic type based on the presence or absence of metaplastic changes. Comparison of the incidence of gallstones showed that cases of metaplastic type polyp and adenoma had a higher incidence of gallstones than non metaplastic type polyp and adenoma. In the cases of cancer, no differences were observed in the incidence of gallstones between metaplastic type and non metaplastic type carcinomas. However, comparison among early carcinomas showed that metaplastic type carcinoma had a significantly higher incidence of gallstones than the non metaplastic type. These results suggest that gallstones may play an important role in the histogenesis of gallbladder diseases of the metaplastic type. Acta Pathol Jpn 39: 582 585, 1989.     

腹腔镜胆囊切除术预防肝外胆管横断性损伤的体会

目的研究腹腔镜胆囊切除术（LC）预防肝外胆管横断性损伤的可行办法。方法：①先解剖胆囊壶腹，应用胆囊壶胆与胆囊管交界部的重要解剖标志来确认胆囊管是防止将肝外胆管误认为胆囊管造成横断性损伤的关键性措施；②紧靠胆囊壁钝性分开Calot三角，侧面观察肝总管、胆总管，靠胆囊壁切断胆囊动脉和纤维组织，解剖出Calot三角，是防止处理Calot三角时造成肝总管或低位汇合的左、右肝管横断性损伤的重要方法。结果：缺乏经验或未遵循此原则本组发生横断肝外胆管4例（0.1％）。结论：LC先解剖胆囊壶腹，分出胆羹壶腹与胆囊省交界部来确认胆囊管是无可争议的技术性原则，紧靠胆囊壁钝性分出Calot三角是预防横断肝外胆管的有效方法。     

纤维胆道镜胆囊取石术治疗胆囊结石

１９９２年５月至１９９４年１月，作者采用经皮小切口纤维镜胆囊取石术４６例，手术成功率１００％，治愈率１００％，无结石残留，无手术并发症及死亡者。４６例随访３个月Ｂ超证实胆囊正常，本法一次取净胆囊结石，一期缝合不放引流，术后平均住院日５．６天，是保留功能正常胆囊创小，痛苦少，恢复快，值得推广的内窥间新技术。     

各类不同成分胆囊结石声象图的分型探讨

本文通过对42例胆囊结石病人术前超声检查的声象图,与术后取出的结石(成分、外形、剖面)进行分析对照,从中得出直径大于1cm的大结石及直径小于1cm的小结石其不同成分的结石声象图的特征。经过此项研究的结果,可为临床提供胆囊结石的成分类型,对胆囊结石患者即可采取不同的治疗方法,从而避免了过去对胆囊结石治疗上的盲目性,可以提高治疗的效果。     

Non-surgical options for the management of gallstone disease: an overview

Summary The modalities for the non-surgical treatment of gallstones include oral dissolution by bile salts, local dissolution by methyl-tert-butyl-ether (MTBE), extracorporeal shockwave lithotripsy (ESWL) and percutaneous gallstone clearance. The results of oral bile salt therapy for cholesterol stones have been disappointing, and the only indication for this treatment is after ESWL. The high efficacy initially reported for MTBE has not been confirmed by subsequent experience in other centres: this therapy is toxic and best confined to specialized centres. ESWL, though effective in noncalcified stones, has limited overall applicability (approx. 15%) and is frequently followed by recurrence despite maintenance therapy with oral bile salts. Percutaneous gallstone clearance (radiologic or laparoscopic) has been superseded by laparoscopic cholecystectomy. This offers definitive treatment in a single session and has significant advantages over open cholecystectomy in terms of short hospital stay and accelerated recovery with early return to work or full activity. Destruction of the gallbladder by sclerosant agents (chemical cholecystectomy) requires further experimental evaluation before its introduction to clinical practice.