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.
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.
Objective To probe into disorder of plasma lipids and apolipoproteins in patients with gallstone,and their position and function in formation of gallstone. MethodsConcentration of plasma lipids and apolipoproteins in 94 healthy subjects and 161 patients with gallstones was investigated. ResultsThe gallstone group had a higher serum mean concentration of TG,Apo CⅡ,Apo CⅢ, and had a lower serum mean concentration of TC，HDLc，HDL2c，HDL3c and LDLc as compared with the control group (P＜0.01 or P＜0.05). Conclusion Higher serum mean concentration of TG，Apo CⅡ，Apo CⅢ, and lower serum mean concentration of TC, HDLc, HDL2c, HDL3c and LDLc, are characteristic of lipids metabolism and important cause of formation of gallstone.
ObjectiveTo evaluate the feasibility of clipless laparoscopic cholecystectomy (LC) to patients with calculous cholecystitis in acute inflammation stage. Methods The clinical data of 169 patients with calculous cholecystitis in acute inflammation stage who underwent clipless LC from December 2008 to July 2010 were analyzed. ResultsAll patients were successfully operated by LC except one case who suffered from gallbladder perforation and a conversion to open surgery was performed. The operation time ranged from 25-70 min (mean 38 min). The blood loss ranged from 10-200 ml (mean 22 ml). Peritoneal drainage was done in 38 patients, and the drainage time ranged from 1-6 d (mean 1.8 d). The time to out-of-bed activity was at 2 h after operation and the hospitalization time was 3-7 d (mean 3.5 d). There was no complication such as bile duct injury, hemorrhage, billiary leakage, and intra-abdominal infection. ConclusionWith improvement of operator’s experiences and skills, the clipless LC becomes feasible and safe for patients with calculous cholecystitis in acute inflammation stage.
Ten dogs weighed 8.5～16.4kg were selected to determine the safe dose of methyl tert-butyle ether (MTBE) for dissolving gallstones in vivo and its toxic and side effects. A couple of human gallstones type Ⅰ and type Ⅳ were put into each dog’s gallbladder connecting outside with a silicon gel tube from which MTBE was administered at intervals with random doses. The vital signs were observed during the course of operations. Moreover liver and renal functions were tested before and after operations. Results: ①All gallstones type Ⅰ and Ⅳ in animal models were dissolved quickly, however, MTBE showed somewhat toxicity in inhibiting CNS, so that the dose of MTBE should be controlled precisely. ②No abnormal change of liver and renal functions of dogs were found before and after operations. ③Choloecyst pathological sections of gallbladder suggested that no evident of damage and inflammation of gallbladder was of found. Hemopexis with reversible histological change was observed in hepatic sinusoid and centeral vein short time after administation of MTBE.
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.
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.
The conectration of cholecystokinin infasting serum was determined by radioimmunoessay in 30 patients with gastric antrum cancer before and after radical sbutotal gastrectomy.It was 119.6±142.2pmol/L before the operation and 78.5±149.2pmol/L after the operation,which was significantly lower than that before the operation,P=0.022. The result suggests that the reduction of cholecytokinin secretion after gastrectomy was one of the important causes in the bile stasis,the disturbance of gallbladder emptying funcion and the formation of gallstone.
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.
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.