| | | 胆总管结石的成因观察
| | 医学护理论文 作者：陈晓文，智发朝，曹东林，周思朗，陈勇伟,谢栋
【关键词】 胆总管
Experimental studies on causes of calculus formation in common bile duct
【Abstract】 AIM: To observe the roles of bacterial infections, gastrointestinal hormones and bile biochemical factors during calculus formation in the common bile duct. METHODS: In this study, 72 patients were divided into 2 groups: CBDS group (56 patients with common bile duct stone) and NCBDS group (16 patients with obstruction of common bile duct but without CBDS). Bile aspirated by ERCP from all the patients was cultured aerobically and the contents of TBA, Ca2+, P2+ and CHO in the bile were detected. Stones of 11 patients aspirated by ERCP were inspected for E.coli by PCR. The serum motilin (MTL) and the somatostatin (SS) were measured by radioimmunoassay in 52 patients. RESULTS: 53 patients (95%) of CBDS group and 8 patients (50%) of NCBDS group were positive in biliary germicultures. Infection rate in CBDS group was significantly higher than that in NCBDS group (P<0.05). Three (27%) of 11 patients who had a PCR examination had positive results. The serum motilin level of the patients in CBDS group was significantly lower compared with that of the patients in NCBDS group (202±151 vs 315±161) ng/L, while the serum somatostatin and bile Ca2+ level of CBDS group were significantly higher than those of NCBDS group ［(15±5 vs 12±3) ng/L, (1.4±0.9 vs 0.7±0.3) mmol/L, P<0.05］. TBA level of CBDS group was significantly lower than that of NCBDS group ［(12±6 vs 16±7) nmol/L, P<0.05］CONCLUSION: The changes of biochemical characteristics in the bile, the disorders of modulating action of gastrointestinal hormones and the bacterial infections may be the risk factors of common bile duct stones.
【Keywords】 common bile duct calculi；bacteria；motilin；somatostatin；bile；biochemistry
【摘要】 目的医学护理论文：探讨细菌感染、胃肠激素及胆汁生化在胆总管结石形成中的医学护理论文作用. 方法：实验分为胆总管结石(CBDS)组(n=56)、非结石胆总管梗阻(NCBDS)对照组(n=16). ① 内窥镜下逆行胰胆管造影术(ERCP)中抽取胆汁作需氧菌培养及进行总胆汁酸(TBA), Ca2+, P2+和胆固醇(CHO)测定. ② ERCP术中取结石用PCR法行结石大肠杆菌检测. ③采静脉血行胃动素及生长抑素检测. 结果：① CBDS组56例胆汁标本需氧菌培养中，有53例检出细菌(95%)，NCBDS组16例胆汁标本中，有8例检出细菌(50%)，两组细菌检出率比较有统计学意义（P<0.05）. 用PCR方法对11例CBDS患者结石进行大肠杆菌DNA片段检测，3例出现阳性(27%). ② CBDS组血浆胃动素水平较NCBDS组明显偏低(202±151 vs 315±161) ng/L，而生长抑素则明显升高(15±5 vs 12±3) ng/L，组间比较差异显著（P<0.05）. ③ CBDS组胆汁中Ca2+显著高于NCBDS组［(1.4±0.9 vs 0.7±0.3) mmol/L, P<0.05］,TBA则显著低于NCBDS组［(12±6 vs 16±7) nmol/L, P<0.05］. 结论：胆汁理化性质改变、胆道感染及胃肠激素紊乱在胆管结石形成中可能具有重要作用.
【关键词】 胆总管结石；细菌；胃动素；生长抑素；胆汁；生化
0引言
近年来，胆道细菌感染在棕色结石形成中的作用成为人们关注的焦点之一. Steward等［1］运用扫描电镜首次证实棕色结石中存在细菌，Tabata等［2］检测发现100%胆总管棕色结石中可检出细菌，提示细菌在胆总管结石(common bile duct stone, CBDS)形成中扮演重要作用；也有学者认为，胆结石形成可能与胆道动力异常和胆汁淤滞有关；近年来研究表明，改变胆汁酸组成和酸碱度可影响胆汁中胆红素及钙离子浓度，二者浓度过高，在胆汁中不能充分溶解，可促进胆汁核化和结石形成. 我们对胆总管结石患者菌群、激素水平及胆汁生化进行观察，以探讨其在胆总管结石形成中的作用.
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