The authors invrstigated whenther samll dose of ursodeoxycholic acif treatment influences biliary concentration, nucleation time and gallbladder empting. 3 patients with cholesferd gallstones receired 400 mg ursodeoxychilic acid per prior to cholecystectomy. Treatment with small dose of ursodeoxycholic acid decreased the gallbladder chlesterol saturation index and prolonged the nucleation time ,bur had no effect on gallbladder empyting. We bilieve that snall dose of ursodeoxyxholic acis mat prevent the gallstone formation by decreasing xholecterol saturation index and lengthening the nucleation time.
【Abstract】ObjectiveTo investigate the anatomic feature and special clinical manifestations of variant right intrahepatic bile duct draining into left hepatic bile duct near the umbilical portion. MethodsVariant right intrahepatic bile ducts joining into left hepatic bile ducts near the umbilical portions were identified through cholangiograms in 52 patients, who were included in this study. Their history, clinical process and operations were reviewed. ResultsThere were total 38 cases of intrahepatic gallstone in this group. High incidence of intrahepatic calculi was found in variant right intrahepatic bile ducts （23/38 cases, 60.52%） and left hepatic ducts （33/38 cases, 86.84%）. Most of these cases were accompanied with dilatation and stricture of bile ducts in these area. The gallstones in the variant right intrahepatic bile ducts were not detected in 8 cases (8/23) and the rate of residual gallstone was as high as 86.95%(20/23). Injury of variant right intrahepatic bile duct took place when left hepatectomy was performed in one case. ConclusionGallstone is very likely to be formed in the variant right intrahepatic bile duct due to derangement of bile hydrokinetics and compression of blood vessel. Special attention should be paid to the diagnosis and operation of this abnormity.
Five thousands five hundreds and eighty two patients with cholelithasis in 46 hospitals were collected through questionnaire and analysed, of which 2 735 cases were gallstones (accounted for 48.99%),and 2 847 cases were intraand extrahepatobiliary tract stones (accounted for 51.00%). In the gallstone group, there were 487 cases (8.72%) complicated with choledocholithasis, 54 cases (1.97%) complicated with acute cholecystitis, 189 cases (6.91%) with acute cholangitis, and 215 cases (7.86%) with obstructive jaundice. In 2 847 cases with intra and extrahepatobiliary tract stones, 1 284 cases were found to be extrahepatic duct stones (23.00%), 668 cases were left intrahepatic duct stones (1.97%), 384 cases were right intrahepatic duct stones (6.88%), and 511 cases stone in both sides (9.15%); complications in this group were acute severe cholangitis 683 cases (23.99%), acute cholangitis 1 169 cases (41.06%), obstructive jaundice 431 cases (15.14%), and biliary cirrbosis 278 cases (9.76%). The operative procedure for patients with gallstones were cholecystectomy (2 697 cases), chelangioduodenostomy or cholangiojejunostomy (36 cases), and Oddi’s sphincteroplasty (7 cases); and for patients with intraand extrahepatobiliary tract stones were choledocholithotomy and T tubule drainage (2 275 cases), differecnt forms of choledochoenterostomy (534 cases), and Oddi’s sphincteroplasty (38 cases). The postoperative complicatioin rate in patients with gallstones was 1.13%, with intraand extrahepatobiiary tract stones was 14.47%, mortality of the latter was 1.62%. The authors consider that cholecystectomy should be performed in elderly patients (over 50 years) with or without symptoms, and proper choice of operative procedure for hepatobiliary tract stones is important.
In 100 patients with gallstone, blood glucose, insulin were measured and BT-PAMA test, amino acid consumption test were made. Result: 71 patients were found with symptoms of the gut disorders, 12 cases with hyperglycemia (among them, 6 cases had chronic hepatic disease), 14 with exocrine pancreatic insufficiency, 26 with induration of the head of pancrease. The authors consider that hyper glycemia is correlated with chronic hepatic disease and that the gallstone migration impaires the pancreatic structure and function might be one of the factors which induces the symptom of gut disorders in patients with gallstone.
To study the mechanism of cholesterol gallstone formation, rabbit models were induced by feeding with high cholesterol diet. Bile acids were tested with bi-wavelengh thin layer scan and low density lipoprotein receptor activity of hepatocytes binding to 125I-LDL were tested with radio immunoassay in different feeding phases as 1,2,3 and 4-week groups, as well as the control group. The results showed that cholesterol gallstones in 2,3 and 4-week groups were induced in respectively. The contents of glucocholic acid (GCA) in bile were decreased significantly (vs control group, Ｐ＜0.05). The Bmax values of LDL receptor of hepatocytes binding to 125I-LDL were decreased significantly (Ｐ＜0.05). Kd values of those gradually increased (Ｐ＜0.05). These suggest that the decreased activity of LDL receptor of hepatocytes would reduce the synthesis of GCA, thus resulting in the formation of cholesterol gallstones.
Objective To introduce the current status of clinical research on endoscopic cholecystolithotomy with reservation of gallbladder. Methods Literatures related to the basis, advantage, indication, contraindication, operative method and current controversy were reviewed and summarized. Results The objective evidences were afforded by postoperative complications of cholecystectomy for endoscopic cholecystolithotomy with reservation of gallbladder. The progress of endoscopic technique made it possible for reservation of gallbladder. The controversy in endoscopic cholecystolithotomy with reservation of gallbladder was focused on the choice of indications and operative procedure. Incorrect patient selection and undue pursuit of cholecystolithotomy with reservation of gallbladder would be completely opposite to the treatment of gallstone. Conclusion It is feasible for endoscopic cholecystolithotomy with reservation of gallbladder to remove completely stone and reserve gallbladder function, but further investigation and long-term follow up are required to delineate gallstone recurrence after operation.
Objective To study the relation between the pathogenesis of gallstone and blood lipid and protein.Methods Then indexes of blood lipid and protein in 204 cases of gallstone patients were measured and analysed by statistical software SPSS. Results There was a significant difference between the gallstone group and control in the value of proalbumin, total cholesterol, high density lipoprotein and carrier protein B (Ｐ＜0.01), the value of total protein, triglyceride, low density lipoprotein cholesterol, very low density lipoprotein cholesterol and carrier protein A1 were higher than those in the control (Ｐ＜0.05). Conclusion The indexes mentioned above may play an important role in the gallstone formation.
Using radioimmunoassay (RIA) and immunohistochemical LASB technique, the level of serum estradiol (E2), testosterone (T), progesterone (P), estrogen receptors (ER) and progesterone receptors (PR) in 30 male patients with gallstones were detected. The results showed that the level of serum P, E2/T and PR was higher. This suggests that the metabolic disorder of gonadal hormones play an important role in gallstone formation.
To study bacterial changes of bile, to detect relationship between formation of core of gallstones and bacterial infection. Floras of bacteria in bile were studied in patients with gallstones by using aerobic, anaerobic and Lforms (X, Y,L) culturing system.Results: Bacterial growth positive was found in 88 of 98 patients in which single bacterial growth accounted for 54 cases, multiple growth 34 including type X 83, type L 23 and type Y 5. The results show that some alteration of bacteria flora exists during biliary infection and S. Liguefaoiens and E. Coli are the most frequent bacteria present. Formation of the core of gallstone might be related with bacterial infection.
To investigate the origin and releasing relation of motilin (MTL), vasoactive intestinal peptide (VIP) and somatostatin (SS) in guinea pig bile as well as its effects during gallstone formation. Guinea pig were divided into three groups: control group (50 animals), on normal diet; lithogenic group (70 animals), fed with lowprotein low fat; and recovering group (50 animals), fed with lowprotein low fat and recovering normal food after the experiment of gallstone formation. MTL, VIP and SS in the bile gallbladder tissue and portal vein plasma of the normal control group were measured with radioimmunoassay. Meanwhile the changes of the gut peptides in the bile and the bile components from different groups were also compared. Results: In control group the levels of MTL, VIP and SS in the bile were higher than those in the plasma, but, obviously lower than those in the tissues, the concentration relationship between in the bile and in the tissue was a positive correlation. In contrast to the control group, MTL concentration decreased but VIP and SS increased in the bile of the lithogenic group, the physicochemical nature of the bile also became lithogenic. In the recovering group the bile also became lithogenic, but, the concentration of those peptides and the nature of the bile all got normal. Conclusion: MTL, VIP and SS in guinea pig bile originate mainly form the gallbladder wall tissues. Food components affect the levels of the gut peptides in bile, which promote the bile lithogenic changes and gallstone formation.