肝硬变合并胆结石成因的探讨

目的 探讨肝硬变状态下胆石发生的机理。方法 （1）采用四氯化碳藻胃的方法建立豚鼠的肝硬变模型，观察豚鼠的胆石形成情况，扫描电镜观察胆结石的细微结构，用薄层色谱扫描的方法定量测定胆汁酸的含量。（2）对716例肝硬变合并胆囊结石病人资料进行临床分析。结果 豚鼠中肝硬变组的胆石发生率为83.3％,高于对照组的5.0%和慢性肝损害组的37.5%，肝硬变组总结合胆汁酸含量及G／T比值均较对照组降低。临床资料显示肝硬变病人胆石发生率为15.1%，肝硬变代偿期胆石发生率为9.7%，失代偿期胆石发生率为15.7%。胆石以胆囊内为多，占98.2%。结论 肝硬变病人胆石发生率升高，且随肝功能的降低，成石率升高，肝硬变状态下胆石发生率升高与胆汁中结合胆汁酸含量下降，G／T比值下降有关。

THE MECHANISM OF GALLSTONE FOR-MATION IN LIVER CIRRHOSIS

objective cirrhosis. Methods 1. cirrhotic model was established in guinea pigs through perfusing stomach with CCL4, 12 weeks later, we observed the gallstone formation, under scanning electromicroscope, we observed the microstructure of gallstone, under transmision electromicroscope, we observed the ultrastructure of gallbladder and liver, then we measured the conjugated bile acid of gallbladder through thin - layer chromatography. 2. analysed 716 cases of liver cirrhosis and studied the gallstone formation. Results The animal experiment showed that the gallstone formation rate is 83. 3% in cirrhotic group, higher than in contrast group (5.0%) and in chronic liver damaged group (37.5%), the level of conjugated bile acid of gallbladder and G/T ratio decrease in cirrhotic group, clinical data showed that the incidence of cirrhotic patients is 15.1%, gallstone fomation rate is 9.7% in the compensated cirrhotic group, while it is 15.7% in the decompensated cirrhotic group, the gallstone mainly exists in gallbladder. Conclusion There is a higher incidence of gallstone in liver cirrhosis, and the incidence increases with the decreasing of liver function, the higher incidence is related to the decreasing of conjuated bile acid and G/T ratio.