9例结石性肠梗阻的诊断与治疗

目的 探讨结石性肠梗阻的诊断及治疗。方法 比较腹部平片和B超的术前诊断率。随访患者以了解不同手术方法的得失。结果 腹部平片术前诊断率为22％,辅以B超则上升为66％。4例Ⅰ期手术和3例Ⅱ期手术患者无死亡。无胆管炎发作。结论 仅靠腹部平片易漏诊,辅以B超则能提高术前诊断率。争取回期手术切除胆囊、闭合胆肠瘘,如有困难,则动员患者6-8周后Ⅱ期手术。     

肝胆管结石术后疗效观察

按本文提出的病型分类方法对121例肝胆管结石进行术后随访,结果表明:肝内、上部、下部胆管狭窄型及胆管无狭窄型分别以肝叶切除、肝门部狭窄胆管切除或整形胆肠吻合、胆总管空肠吻合或Oddi括约肌成形、胆总管切开取石术为基本术式,术后疗效较好。多数病例术后残余结石长期存在,肝功能恢复与残余结石有直接关系。     

胃癌术后胆囊结石形成的研究进展

胃癌是消化道的常见肿瘤，手术切除仍是其主要治疗手段。胃癌术后除了常见的并发症外，患者胆囊结石的发病率明显升高，部分需要二次手术，其结石原因涉及神经、体液等多方面因素，本文就胃癌手术对胆囊结石形成的研究进展作一综述。     

AN EPIDEMIOLOGICAL SURVEY OF CHOLELITHIASIS IN SHANGHAI

Objective To obtain a general overview of gallstone disease in Shanghai. Methods 3415citizens aged >20 in the community of Shanghai were randomly selected to undergo a clinical epidemiological study and an ultrasound examination to screen for cholelithiasis. Results Overall prevalence rate of gallstones was 6.5% (8.6% in women and 5.1% in men). Among the 3415 persons investigated, 65 had already undergone cholecystectomy. The percentage of asymptomatic gallstone was 70 .5% . Prevalence of gallstone diseases (gallstones plus cholecystectomy) increased with age significantly. Conclusion Compared to the research in Shanghai ten years ago, especially for the persons older than 50 years, the gallstone disease has become more frequent. The proportion of asymptomatic gallstones and the awareness is increasing.     

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.     

Apolipoprotein B-100 gene Xba I polymorphism and cholesterol gallstone disease

The apolipoprotein (apo) B gene Xba I polymorphism is associated with alterations in serum lipids. Disturbances in serum lipids may be a risk factor for cholesterol gallstone disease. However, the relation between the Xba I polymorphism and cholesterol gallstones is unknown. This study was aimed at characterizing the polymorphism of the apo B gene Xba I in patients with gallbladder stones and the association of Xba I polymorphism with serum lipids. Xba I genotypes were measured by PCR-RFLP, and serum lipids assayed in 190 patients with gallbladder stones and 441 control subjects. The frequency of the X+/- genotype (20.63 vs. 7.94%) and X+ allele (10.79 vs. 3.97%) was significantly higher in the patient group than in the control group. Patients with the X+/- genotype had a significantly higher concentration of total cholesterol, low-density lipoprotein (LDL)-cholesterol, and apo B in serum than patients with the X-/- genotype. The X+ allele of the apo B gene is characterized by a higher cholesterol concentration and a higher LDL-cholesterol concentration in serum, and it may be a marker for increased risk of cholesterol gallstone disease.     

京尼平苷对地鼠胆固醇结石形成的影响

目的观察京尼平苷预防给药对地鼠胆固醇结石形成的影响.方法用高脂肪高蛋白致石饲料造成地鼠胆固醇结石模型,阳性对照药物熊去氧胆酸80mg/kg和京尼平苷50,100mg/kgig,每天预防给药,给药30d后作胆囊内容物涂片检查观察地鼠的成石率,检测胆汁脂类成分计算胆汁成石指数.结果模型组的成石率为100%,成石指数(LI)大于1;京尼平苷50和100mg/kg组的成石率分别为40%(P＜0.05)和25%(P＜0.01),LI均小于1,熊去氧胆酸组的成石率与LI与京尼平苷100mg/kg组相近.结论京尼平苷对地鼠胆固醇结石的形成可能具有抑制作用.     

对保胆取石历史和现状再认知

近年来,尽管腹腔镜胆囊切除术已成为治疗胆囊结石的主流术式,内镜保胆取石手术在某些医院仍颇为流行。从历史和实践来看,内镜保胆取石并未体现外科技术的突破,反而可能违背了胆囊结石的医疗原则。行保胆取石的病人选择及操作的合理性均存疑问,诸多临床研究的规范性、科学性欠妥,且术后长期随访数据匮乏,相关医生对继发胆囊癌变的问题普遍认识不足,更有一些医生及媒体对其进行夸大甚至错误的宣传。作为一项理念和技术均不成熟的外科操作,该术式目前尚不能作为胆囊结石治疗的规范手段,需医患双方谨慎选择。     

缺铁与胆囊结石形成关系的研究

本文检测了 110例 (男 32 ,女 78)胆囊结石病人的血清铁水平 ,低于正常值者 31例 ,占 2 8 2 % ;其中女性 2 5例 ,占80 6 % ,男性仅 6例 ,占 19 4%。铁在肝脏的酶代射过程中扮演着重要角色 ,因此 ,缺铁可能改变胆固醇的代谢 ,增强胆囊结石的形成。     

金石散胶囊溶解胆石的临床研究

自１９８７年迄今,用金石散（４－６胶囊／次,２－３次／天）治疗胆结石患者１７７例,３月为一疗程,共２－４疗程。治疗前后均经Ｂ超检查以判断疗效。结果显示：１．服药一月,９０％病人的发热、腹胀、疼痛等临床症状消失。２、６２例胆囊结石经服药平均８．１８＋７．１４月后,３例结石完全消失（４．８４％）,３７例结石减少变小,总有效率６４．５２％;而临床类型型相似的另外２３例,用ＵＤＣＡ治疗作为对照组,总有效率