幽门螺杆菌与胆囊疾病关系的M eta分析

目的：系统评价幽门螺杆菌与胆囊恶性疾病、胆结石、胆囊炎的关系。方法计算机检索EM base、Pubmed、中国科技期刊全文数据库（VIP）和中国生物医学文献数据库（CBM ）收集有关幽门螺杆菌与胆囊恶性疾病、胆结石、胆囊炎关系的文献,检索时限均为从建库至2015年5月。由2名研究者根据纳入和排除标准独立筛选文献,提取资料,并在评价纳入研究的方法学质量后,采用Stata 11．0软件进行Meta分析。结果纳入24篇文献,Meta分析结果显示：胆囊恶性疾病患者的幽门螺杆菌检出率高于对照组,差异有统计学意义（OR＝5．31,95％ C I：2．34～12．05,P＝0．000）;胆结石患者的幽门螺杆菌检出率高于对照组（OR＝1．84,95％ C I：1．13～2．98,P＝0．014）;胆囊炎患者的幽门螺杆菌检出率高于对照组（OR＝9．92,95％ C I：4．04～24．39, P＝0．000）。结论幽门螺杆菌是胆囊恶性疾病,胆结石,胆囊炎发生的危险因素。     

腹腔镜下经胆囊管的胆总管探查取石术治疗肝外胆道结石

目的探讨腹腔镜下经胆囊管的胆总管探查取石术治疗肝外胆道结石的临床应用效果。方法应用该方法治疗胆囊结石合并胆总管结石26例，总结其临床资料。结果经胆囊管途径取石成功率为24／26，1例因胆囊管变异，1例导丝插入胆总管未成功，中转为胆总管切开术。术中扩张时无胆管撕裂，术后无腹腔出血、胆漏发生，无围手术期死亡。术后住院时间4-8d.结论对于胆囊结石合并继发性肝外胆管结石的病例，在采用腹腔镜下1次手术的方式治疗时，应首先考虑经胆囊管途径，以争取更小创伤以便更快地恢复。     

个体化护理干预在胆石症合并肝硬化择期手术患者中的应用价值

目的 探讨个体化护理干预在胆石症合并肝硬化患者中的应用价值.方法 100例胆石症合并肝硬化患者,随机分为观察组和对照组,各50例.所有患者完善各项检查后制定手术方案,择期手术,对照组在此基础上给予一般护理,观察组在对照组基础上给予个体化护理干预.结果 2组治疗和护理干预前SCL-90评分,除强迫、恐怖和偏执外,其他评分均高于国内常模(P＜0.01);干预后,观察组除强迫、恐怖和偏执外,其他各项评分均显著下降(P＜0.01),对照组患者的躯体化、抑郁、焦虑和精神病性评分显著下降,但仍高于常模(P＜0.01);组间比较,除强迫、恐怖和偏执外,观察组其他各项评分均低于对照组(P＜0.01).观察组的护理满意度和疾病知晓程度评分均高于对照组(P＜0.01).结论 个体化护理干预可有效改善胆石症合并肝硬化患者的负性情绪,提高其对自身病情的了解程度,促进病情恢复.     

Hemochromatosis associated with cholelithiasis as a cause of hydrops fetalis and stillbirth: Prenatal diagnosis

Prenatal diagnosis of neonatal hemochromatosis (NH) is usually raised in front of fetal hepatomegaly and heterogeneous liver architecture. We describe a novel sonographic feature that may be associated with NH. Ultrasound demonstrated reticulonodular liver and distended gallbladder with multiple gallstones in a hydropic fetus. These abnormalities were confirmed to be consistent with NH after correlation with autopsy findings. This case report highlights the value of cholelithiasis in clinical suspicion of NH and the importance to consider this sonographic feature when the liver has abnormal texture.     

金石穿胶囊对致石豚鼠胆汁主要成分的影响

目的 :研究金石穿对致石豚鼠胆汁中几种主要化学成分的影响 ,以确定其防治胆石症的疗效。方法 :随机将 6 0只实验豚鼠分为正常组、模型对照组、胆石通组、金石穿组 ,用致石饲料诱发豚鼠胆囊结石模型 ,喂养一段时间后处死豚鼠 ,取胆汁 ,测定其胆汁中胆红素 (Bi L)、胆固醇 (Cho)、钙离子 (Ca2 )的含量。结果 :金石穿组胆汁中Cho、Bi L、Ca2 浓度均降低。结论 :金石穿能有效降低致石豚鼠成石率 ,具有明显的防治胆石症的作用     

乳头括约肌切开术联合腹腔镜胆囊切除术治疗胆囊并胆管结石的临床观察

[目的]探讨乳头括约肌切开术（EST）联合腹腔镜胆囊切除术（LC）治疗胆囊及胆总管结石的应用价值。[方法1226例胆囊结石合并胆管结石患者随机分为观察组和对照组,观察组行EST联用LC,对照组行开腹胆管探查T管引流。观察两组治疗后并发症、住院时间、恢复情况等。[结果]观察组住院时间及排气时间短,术后镇痛次数少,与对照组比较有显著性差异（P〈0．05）。观察组并发症发生率为7．89％,与对照组（7．14％）比较差异无统计学意义（P〉0．05）。[结论]EST联合LC利用内镜、腹腔镜的优势,充分体现微创治疗的特点,优于传统开腹手术。     

ABCB4 mutations underlie hormonal cholestasis but not pediatric idiopathic gallstones

AIM:To investigate the contribution of ABCB4 mutations to pediatric idiopathic gallstone disease and the potential of hormonal contraceptives to prompt clinical manifestations of multidrug resistance protein 3 deficiency.METHODS:Mutational analysis of ABCB4,screening for copy number variations by multiplex ligation-dependent probe amplification,genotyping for low expression allele c.1331T>C of ABCB11 and genotyping for variation c.55G>C in ABCG8 previously associated with cholesterol gallstones in adults was performed in 35 pediatric subjects with idiopathic gallstones who fulfilled the clinical criteria for low phospholipid-associated cholelithiasis syndrome(LPAC,OMIM#600803)and in 5young females with suspected LPAC and their families(5 probands,15 additional family members).The probands came to medical attention for contraceptiveassociated intrahepatic cholestasis.RESULTS:A possibly pathogenic variant of ABCB4was found only in one of the 35 pediatric subjects with idiopathic cholesterol gallstones whereas 15 members of the studied 5 LPAC kindreds were confirmed and another one was highly suspected to carry predictably pathogenic mutations in ABCB4.Among these 16,however,none developed gallstones in childhood.In 5index patients,all young females carrying at least one pathogenic mutation in one allele of ABCB4,manifestation of LPAC as intrahepatic cholestasis with elevated serum activity of gamma-glutamyltransferase was induced by hormonal contraceptives.Variants ABCB11c.1331T>C and ABCG8 c.55G>C were not significantly overrepresented in the 35 examined patients with suspect LPAC.CONCLUSION:Clinical criteria for LPAC syndrome caused by mutations in ABCB4 cannot be applied topediatric patients with idiopathic gallstones.Sexual immaturity even prevents manifestation of LPAC.     

An Animal Model of Black Pigment Gallstones Caused by Nanobacteria

Black pigment gallstones are often founded in gallbladder, but their pathogenesis is unclear. The present study was undertaken to study the role of nanobacteria in pigment gallstone formation in Japanese white rabbits. Nanobacteria were successfully cultured from 3 of 7 cholecystolithiasis patients gallbladder (without acute cholecystitis) bile samples and affirmed by Hoechst 33258 staining and specific immunostaining using monoclonal antibody. Nanobacteria were injected into rabbits’ gallbladder. After 2 weeks follow-up, the incidence of black pigment gallstones in rabbits was significantly greater in nanobacteria-injected group (8/10) than that in DMEM-injected group (2/10) and that in hydroxyapatite-injected group (2/10). This study indicates that nanobacteria exists in gallbladder bile of cholelithiasis patients and causes the formation of black pigment gallstones in rabbits. For the first time, we successfully established an animal model of black pigment gallstones caused by nanobacteria. This will be helpful in further delineating the pathogenesis of black pigment gallstones. Supposted by Shantou University Medical College.     

Gallstone recurrence after direct contact dissolution with methyltert-butyl ether

To determine the rate and characteristics of gallstone recurrence after direct contact dissolution with methyltert-butyl ether, 60 consecutive patients were followed for up to 4.5 years (median 2.2 years) after complete disappearance of all stone residues and debris and cessation of adjuvant bile acid therapy. Initial gallstones had been multiple in all but four patients. Twenty-eight of the 60 patients developed recurrent gallstones. The cumulative risk of gallstone recurrence (actuarial analysis) was 23±6%, 34±7%, 55±8%, and 70±9% at one, two, three, and four years, respectively. The recurrent stones were usually multiple and small (6±4 mm). Gallstone recurrence was associated with recurrent biliary pain in two patients, one of whom developed acute cholecystitis. Recurrent stones were cleared completely by bile acid medication with or without shock-wave lithotripsy in 61±15% of patients at one year (actuarial analysis). In conclusion, gallstone recurrence after successful contact dissolution of multiple stones with methyltert-butyl ether has to be expected in a high percentage of patients. Most patients, however, remain free of biliary pain during long-term follow-up.     

Gallbladder stone recurrence after medical treatment do gallstones recur true to type?

Medical treatments that dissolve or remove gallbladder stones but leave the gallbladder in situ have the disadvantage of gallstone recurrence. Little is known about the composition of recurrent stones or whether they recur true to type. In 21 patients with recurrent stones detected 5–74 months (mean ±sem, 26±4 months) after being rendered stone-free with dissolution therapy (N=15) or percutaneous cholecystolithotomy (N=6), we compared pretreatment and postrecurrence gallstone number, maximum gallstone attenuation scores measured by computed tomography (CT) and, in 13, the dissolvability of the recurrent stones with oral bile acids ± extracorporeal shock-wave lithotripsy. Before treatment, five patients had solitary and 16 had multiple stones but on recurrence, the gallstones differed in number from the primary stones in 10 of the 21 patients. As a result of patient selection, before dissolution, the primary stones were all radiolucent with maximum CT scores of <100 Hounsfield units (HU) (mean 45, range 10–84 HU). On recurrence, the stones were again CT-lucent in 13 of the 15 patients but were CT-dense in the remaining two (118 and 176 HU). Initially, all six patients treated by percutaneous cholecystolithotomy had radio-opaque stones, with a mean CT score of 459 (range 100–969) HU. However, on recurrence, only one had calcified stones (HU 140); the remaining five had CT-lucent stones (16–98 HU,P<0.05). Of the 13 patients whose recurrent, plain x-ray-lucent and CT-lucent stones were treated with oral bile acids ± lithotripsy, 12 (92%) showed evidence of gallstone dissolution. We conclude that gallbladder stones do not recur true to type in up to two thirds of patients. However, irrespective of original gallstone composition, recurrent stones are usually radio- and CT-lucent, presumed cholesterol-rich, and therefore potentially dissolvable with oral bile acids.