目的 探讨对Mirizzi综合征实施临床合理有效的手术方法。方法 自1990年1月至2003年12月期间，我院采用经肝放置胆道支撑引流管治疗Ⅱ、Ⅲ型Mirizzi综合征21例,胆道支撑引流管放置6个月以上，并行胆道造影检查。结果 所有患者恢复良好,胆道造影检查见胆道通畅后拔除支撑引流管，随访2～10年,无并发症发生。结论 经肝放置胆道支撑引流管治疗Ⅱ、Ⅲ型Mirizzi综合征,是保持胆道生理功能完整的有效方法。
Objective To explore the effects of bile from patients with cholecystolithiasis on the growth of human gallbladder carcinoma cells GBC-SD and the potential correlation between cholecystolithiasis and gallbladder carcinoma. Methods Cholecystolithiasis bile (CB) and normal bile (NB) specimens were used for this study. The proliferative effects of bile were measured by methabenzthiazuron (MTT) assay and cell cycle and apoptosis were analyzed by flow cytometry. Results CB can significantly promote the proliferation of GBC-SD cells, GBC-SD proliferative index increased significantly after treated with 1% CB for 48 h （P＜0.05）.The Sphase fraction of CB 〔（49.26±8.07）%〕 increased remarkably (P＜0.05) compared with that of NB 〔（25.54±6.57）%〕, and the CB percentage of G0/G1 phase 〔（40.59±9.12）%〕 decreased remarkably (P＜0.05) compared with NB 〔(60.64±13.42）〕%. Conclusion CB can promote the proliferation of human gallbladder carcinoma GBC-SD cells.
肝脏移植、心脏移植及肾脏移植等已广泛开展，大批受者长期存活。本文现就这组特殊人群在移植术后患胆道结石病的机理及其处理原则介绍如下。1器官移植受体胆石病的发生机理肝移植术后胆管结石与胆泥形成并引起胆道梗阻可随时发生。除了明确的结石外，胆泥形成胆管铸形并广泛分布于肝内胆管也有报道。胆管粘膜损害、胆管梗阻、移植肝的冷、热缺血、感染及胆固醇过饱和等都在胆管结石形成过程中发挥作用，但胆管梗阻可能是肝移植术后胆管结石形成的最重要因素［1］。胆管结石和胆泥形成的患者，绝大多数都伴有胆管狭窄，这个狭窄可以发生在胆管胆管吻合口和胆管空肠吻合口，也可发生在非吻合口处的胆管。胆管内异物如T型管或内支撑管也可作为结石形成的核心。除了这些引起胆汁淤积的物理学原因外，环孢素A（CsA）在胆石发生中也起了作用［2］： 它可抑制胆汁分泌，促进胆汁淤积，而FK506（普乐可复）似乎没有这方面的副作用。此外，肝移植受者胆汁中胆固醇呈过饱和状态，且T管引流及胆酸池的减少还加重这种状态。目前还不清楚胆道重建方式对胆道结石形成有没有影响。但从理论上讲，胆肠吻合会增加肠源性细菌进入胆道的机会，从而导致胆红素去结合化，并进一步形成色素石。但到底是胆管对端吻合还是胆肠吻合后更易形成结石，目前尚无详尽研究。
Objective To investigate the recurrence of hepatolithiasis and reoperation and their relation to the location of intrahepatic stone. MethodsTwo hundred and twentysix patients of hepatolithiasis operated upon in the period of 1990-1995 were retrospectively analysed.ResultsAmong those patients, there were 101 patients (44.7%) had previous operation for the gallstones diseases including cholecystectomy for gallbladder stones (n=21, 20.8%), choledocholithotomy (n=72, 71.3%),liver segmentectomy (n=6， 5.9%), and choledochojejunostomy (n=2, 2.0%). The operative mortality was 5.0% for the reoperation group and none for the first time operation for hepatolithiasis.Conclusion Although the liver resection is an ideal surgical method to eradicate the diseased lesion and to minimize the malignant changes especially in primary hepatolithiasis (type I, or IE)， choledochojejunostomy is only recommended for the secondary type (type IE or IE) where possible. In the management of hepatolithiasis, the complete information of biliary tract is needed for the choice of surgical methods.
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.
Thirty-six partial hepatectomies for patients with symptomatic intrahepatic stones is reported.Partial liver resection should be done when the liver containing strictrue(s),dilated ducts and stones.Meanwhile,additional procedures should be performed togather with partial hepatectomy,i,e,common duct exploration and drainage,cholangiotomy and cholangioplanty,and cholangeoenterostomy,according to the location of stones and ductal strictures.Postoperative long-term follow-up in this series showed that the results of 86.2% of patients were satiffactory.Partial hepatectomy can be considered as a better treatment of choice for the stones confined to one segment or lobe of liver or combined with multiple strictures of ducts.
Four hundred and twenty six laparoscopic cholecystectomy(LC)were peformed on patients with acute and subacute cholecystitis,including ①emergency LC(59 patients),②selected LC(215 patients following administration of antibiotic and antispasmotic drugs for 10-15days),and ③selected LC(152 patients with mild biliary colic without any medication).Operative findings were ①congestion and edema of the gallbladder(208cases,11 of them were achieved laparocystectomy),②impaction of stones in the cystic infundibulum or duct with hydrops of gallbladder(142 cases,14 of them were achieved by laparocystectomy),and ③gangrene or empyema of gallbladder(76 patients,20 of them were achieved by laparocystectomy).LC was done successfully on 377 cases,conversion to open surgery was 45 cases (10.6%),severe complication occured on 4 patients for LC(reoperation,0.9%).The quthors believe that LC for patients with acute and subacute cholecystitis issafe and suitable,but LC cannot replace the classical laparocystectomy.
Eighty two cases of acute gallstone pancreatitis on early operation are reported and the significance of the clinical picture and pathology are analysed. The data showed that gallstone was found in 85.5%, among the cases of them mulliple gallstone was 71.1%, dilated cystic duct was 26.4%, common bile duct stone 36.8%, distal bile ductal stricture was found in 9.3%, and anomalous conjunction of biliary and pancreatic duct was 20.1%. Sixteen cases with serious pancreatitis were determined on operation, but death rate was 3.7% only. The authors claim that early operation may be of value in patients of acute gallstone pancreatitis with or without jaundice espesially in bile duct obstruction.
Ｃｈｏｌｅｄｏｃｈｏｊｅｊｕｎａｌ ｓｈｕｎｔ ｗａｓ ｐｅｒｆｏｒｍｅｄ ｉｎ ｒａｂｂｉｔｓ ｂｙ ｉｎｓｅｒｔｉｎｇ ｔｕｂｅｓ ｏｆ ｄｉｆｆｅｒｅｎｔ ｃａｌｉｂｒｅ ｉｎｔｏ ｔｈｅ ｈｅｐａｔｉｃ ｄｕｃｔ ａｎｄ ｐｒｏｘｉｍａｌ ｊｅｊｕｎｕｍ ｓｅｐａｒａｔｅｌｙ ｗｉｔｈ ｌｉｇａｔｉｏｎ ｏｆ ｃｏｍｍｏｎ ｂｉｌｅ ｄｕｃｔ ａｎｄ ｃｏｎｎｅｃｔｉｎｇ ｔｗｏ ｔｕｂｅｓ ｕｎｄｅｒ ｔｈｅ ｓｋｉｎ ｏｆ ａｂｄｏｍｉｎａｌ ｗａｌｌ ｆｏｒ ｓｕｂｓｅｑｕｅｎｔ ｃｏｌｌｅｃｔｉｏｎｓ ｏｆ ｂｉｌｅ ｔｏ ｄｅｔｅｃｔ ｔｈｅ ｉｍｍｕｎｅ ｃｏｍｐｌｅｘ．Ｔｈｅ ｃｏｎｓｅｃｕｔｉｖｅ ｏｂｓｅｒｖａｔｉｏｎ ｄｅｍｏｎｓｔｒａｔｅｄ ａ ｒｅｇｕｌａｒｉｔｙ ｏｆ ｉｍｍｕｎｅ ｃｏｍｐｌｅｘ ｉｎ ｂｉｌｅ ｉｎｃｒｅａｓｉｎｇ ｆｒｏｍ ｔｈｅ ｌｏｗｅｒ ｔｏ ｔｈｅ ｈｉｇｈｅｒ ｌｅｖｅｌ ｉｎ ｔｈｅ ｐｒｏｃｅｓｓ ｏｆ ｆｏｒｍａｔｉｏｎ ｏｆ ｐｉｇｍｅｎｔａｌ ｓｔｏｎｅ．
Objective To evaluate the effectiveness and safety of Chinese medicine treatment of cholelithiasis. Methods We searched electronic databases including MEDLINE (1966 to Feb. 2009), EMbase (1974 to Feb. 2009), The Cochrane Library (Issue 4, 2008), Chinese Biomedical Literature Database (CBM, 1978 to Feb. 2009), CJFD (CNKI, 1994 to Feb. 2009), the Chinese Scientific and Technical Journals database (VIP, 1989 to Feb. 2009), and a database of Chinese biomedical journals (CMCC, 1994 to Feb. 2009). At the same time, we searched references of the included studies. Metaanalysis was performed using RevMan 5 if there was no significant heterogeneity. We described the date which could not be combined. Results A total of 18 randomized controlled trials involving 2 276 patients were included. According to measurement indicators and interventions, subgroup analysis was performed. Efficacy was reported in 10 studies, which showed that part of proprietary Chinese medicines had a higher efficiency for cholelithiasis. Gallbladder emptying index and the trend of bile into the stone were compared in 5 studies, suggesting that the bile of proprietary Chinese medicines reduced the stone index, which eased the bile tendency to rock. Three studies reported the rate of cholecystokinin. Metaanalysis results suggested that the difference was significant. Two studies reported adverse drug reactions (ADRs), such as epigastric discomfort and diarrhea. Most ADRs were slight, and could be self relieved. Conclusion Results suggest that Chinese medicines produce effects on clinical symptoms of cholelithiasis, gallbladder function and reduce the trend of bile into stones. However, the therapeutic effects for long-term are rarely reported. The conclusion needs further verification due to low methodological quality and apparent heterogeneity.