A study of bile kinetics and flow pattern of human gallbladder in vivo

Based on the principle of fluid mechanics a mathematical model of the oval gallbladder'smoving boundaries was obtained by CT,radio contrast radiography and B mode echography.Weadopted for the first time in this field,the finite element method to calculate the transient flow fieldwithin the human gallbladder in vivo and successfully made out the distribution of bile flow withinthe cyst,known as Newtonian fluid and axisymmetric flow.Thus we completed the poineering ofthe bile flow study within the gallbladder,and confirmed the way of the cholelithogenesis withinthe cyst.Theoretically the vortex flow is proved to be the mechanical factor in the formation ofgallbladder stone and several conclusions were drawn from this study:(1)near the axis of thecontacting gallbladder exists an accelerated bile out-flow column;(2)near the central cross-section ofthe flow field there exist two opposed vortex areas,the one which near the axis rotatescounterwise and flows faster;(3)a gross similarity exists between the law of attenuation of bile flowvelocity and the gallbladder contraction;(4)chololithogenesis within the cyst is related to the vortex inthe flow field.     

胆石病胆囊切除与血清免疫球蛋白

通过对５０例胆石病患者胆囊切除术前、后免疫球蛋白的观察，发现胆囊切除术前血清中ＩｇＧ、ＩｇＡ、ＩｇＭ均有不同程度的增高，尤以ＩｇＧ和ＩｇＡ为突出，而胆囊切除术后，血清ＩｇＧ和ＩｇＡ均有较大幅度下降，比较术前术后ＩｇＧ和ＩｇＡ的改变，有显著差异（Ｐ＜０．０１）。从而提示免疫球蛋白可能不参与胆石的形成，而胆石的存在做为一种刺激因子使机体产生更多的免疫球蛋白，当去除病因，消除刺激后，血清免疫球蛋白有不同程度的下降。     

腹腔镜胆囊切除术的适应征探讨

本文报告我院1991年9月至1992年1月,应用电视腹腔镜切除胆囊202例经验,重点对手术适应征进行探讨,掌握好LC手术的适应征,以便使这一新技术进一步发展。     

Cholelithiasis in Jamaican patients with homozygous sickle cell disease

The prevalence of cholelithiasis in Jamaican adults with SS disease was studied by plain abdominal radiograph in 206 patients and by oral cholecystogram in 126 (61%) of these patients. Gallstones were found in 57 (28%) of patients, were more common in females than males, and increased with age and hemolytic rate. The majority of gallstones were visible on the plain abdominal radiograph, only 17% of patients with gallstones having only radiolucent stones. Nonfunctioning oral cholecystograms were common (10%) in agreement with observations by previous workers. Gallstones were noted in the common bile duct in 2 patients. In general there was no clear relationship between the presence of cholelithiasis and clinical symptomatology. Complications, such as pancreatitis and malignant change in the gall bladder, recognized to be associated with cholelithiasis in the general population, have not been clearly related to cholelithiasis in SS disease. More information is needed before a logical policy can be evolved for surgical intervention in cholelithiasis in SS disease.     

Comparison of the effect of diclofenac with hyoscine-N-butylbromide in the symptomatic treatment of acute biliary colic

BACKGROUND: Although non-steroidal anti-inflammatory drugs (NSAID) and spasmolytics have been used to relieve biliary colic, the role of these drugs in the natural history of biliary colic has not been clarified. The objective of the present study is to compare the efficacy of intramuscular diclofenac with intramuscular hyoscine in the treatment of pain of acute biliary colic, and to study their role in the natural history of biliary colic and in the prevention of cholelithiasis-related complications. METHODS: Seventy-two consecutive patients with biliary colic were enrolled in this prospective, randomized, double-blind study. They received either a single 75 mg intramuscular dose of diclofenac (n = 36) or similarly administered 20 mg of hyoscine (n = 36). Pain severity was recorded on a visual analogue scale 30 min, 1 h, 2 h and 4 h after injection of the drug. Patients were then followed closely for the next 72 h for persistence or relapse of pain, or development of acute cholecystitis, or drug related complications. RESULTS: Diclofenac provided much more rapid relief of pain than hyoscine, as shown by significantly lesser pain scores after injection of the drug. 91.7% of patients on diclofenac were completely relieved of pain at 4 h as compared to 69.4% with hyoscine (P = 0.037). Progression to acute cholecystitis was seen in only 16.66% of patients on diclofenac as compared to 52.77% on hyoscine (P = 0.003). CONCLUSIONS: In patients with biliary colic, diclofenac gives much faster and more effective pain relief in a significantly larger number of patients as compared with hyoscine. Most remarkably, diclofenac can prevent progression of biliary colic to acute cholecystitis in a significant number of patients.     

基层医院高龄胆囊结石患者治疗的探析

目的：探讨基层医院高龄胆囊结石患者的外科治疗特点。方法：回顾性分析152例65岁以上高龄老年胆囊结石患者手术治疗的临床资料。结果：152例中100例（66%）合并其他疾病,152例病人均经手术治疗,术式以胆囊切除、胆道探查为主,胆囊切开取石＋胆囊造瘘3例,共治愈124例（82%）。结论：掌握手术适应症和手术时机,积极处理并存病,是减少老年胆道病人术后并发症,降低病死率的关键。     

Carcinoma of the extrahepatic bile ducts

Thirty-seven patients with carcinoma of the extrahepatic bile ducts (EHBD), diagnosed over 14 years from 1974 to 1987, were studied retrospectively. The most common presenting complaint was jaundice, followed by abdominal pain, nausea and vomiting, and weight loss. The majority of EHBD carcinomas were located at the middle third of the bile duct (43.2%), followed by upper third bile duct (37.8%), and lower third bile duct (18.9%). The resectability of the surgically managed group was 44.4%. The most common histologic type was adenocarcinoma. The 30-day postoperative mortality was 30.6%. The mean overall survival of the patients with EHBD carcinoma was 11.2 months. Patients with distal third tumors had the best prognosis with a mean overall survival of 16.0 months. The mean overall survival of patients with upper-third and middle-third tumors were 10.9 months and 9.4 months. A high index of suspicion of the disease as well as earlier, aggressive surgery may improve patient survival.     

党中勤教授治疗胆石症的经验

党中勤教授认为胆石症的病位虽在肝胆,却与五脏六腑的功能失调有关,尤与脾胃功能失调至为密切;其病机关键在于肝胆疏泄失职;病因缘于情志失调、饮食不节、感受外邪、虫积及地理水土和体质等综合因素;导师认为通胆利腑是治疗本病的大法,但并非单纯泻下通腑、利胆排石才是通利,强调通胆利腑之要旨在于:针对病因病机和病理表现,采取疏肝理气化痰祛瘀,佐以健脾和胃、利胆清热等法,使结石渐消缓散、胆道畅通。     

胆石症与非胆石症患者之胆汁及胆石微量元素分析

用发射光谱法测定五种胆汁及两种胆石中的微量元素。结果表明,154份标本中均含有钙、镁、铝、铁、铜、锌、铅、银、锰、锡等元素,其中非胆石症胆汁中的铁、铝、锡元素的含量明显低于胆石症胆汁中含量;而非胆石症胆汁中钙、镁、铜、银、锰、锌、铅的含量明显高于胆石症胆汁中的含量。     

胆石利通片联合茴三硫治疗胆石症的临床研究

目的 探讨胆石利通片联合茴三硫治疗胆石症的临床疗效。方法 选取2020年5月—2023年5月聊城市第二人民医院收治的128例胆石症患者，按随机数字表法分为对照组（64例）和治疗组（64例）。对照组口服茴三硫片，1片/次，3次/d。治疗组在对照组的治疗基础上口服胆石利通片，6片/次，3次/d。两组治疗30 d。观察两组患者临床疗效，比较治疗前后两组患者症状缓解时间，胆囊壁厚度、胆囊容积、生活质量及血清白细胞介素-6（IL-6）、核转录因子-κB（NF-κB）、肿瘤坏死因子-α（TNF-α）和瘦素（LEP）水平。结果 治疗后，治疗组总有效率为98.44%，明显高于对照组（84.37%，P＜0.05）。治疗后，治疗组恶心呕吐、腹胀、腹泻、右上腹疼痛等缓解时间均明显短于对照组（P＜0.05）。治疗后，两组患者胆囊壁厚度、胆囊容积明显降低，而生活质量评分明显升高（P＜0.05），且治疗组的胆囊壁厚度、胆囊容积均明显低于对照组，生活质量评分明显高于对照组（P＜0.05）。治疗后，两组患者血清炎性因子IL-6、NF-κB、TNF-α、LEP水平明显降低（P＜0.05），且治疗组明显低于对照组（P＜0.05）。结论 茴三硫与胆石利通片协同治疗效果确切，能有效缓解临床症状，改善胆囊功能状态。