胆总管结石成因观察.docVIP

胆总管结石成因观察 　 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 (Plt;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, Plt;0.05］. TBA level of CBDS group was significantly lower than that of NCBDS group ［(12±6 vs 16±7) nmol/L, Plt;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：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