Portincasa P, Di Ciaula A, Vendemiale G, Palmieri V, Moschetta A, Vanberge-Henegouwen G P, Palasciano G
University Medical School, Bari, Italy; Hospital of Bisceglie, Italy; University Hospital Utrecht, The Netherlands.
Eur J Clin Invest. 2000 Apr;30(4):317-24. doi: 10.1046/j.1365-2362.2000.00639.x.
Little is known about gallbladder motility in patients with black pigment stones when compared to cholesterol gallstone patients, or about their relationship to biliary composition, crystallization and stone characteristics.
Fasting and postprandial gallbladder volumes were studied by ultrasonography in 49 gallstone patients with pigment (n = 14) or cholesterol (n = 35) stones and 30 healthy controls. After cholecystectomy stone composition, gallbladder wall inflammation, cholesterol saturation index and appearance of platelike cholesterol crystals in bile were evaluated in gallstone patients.
Fasting gallbladder volume was significantly (P < 0.05) increased in cholesterol stone patients (31.7 +/- 1.9 mL) but not in pigment stone patients (21.9 +/- 3.1 mL), compared to controls (21.0 +/- 1.5 mL). Postprandial emptying was delayed in patients (half-emptying time: 31 +/- 2 min, 35 +/- 3 min, 24 +/- 2 min in cholesterol stone patients, pigment stone patients and controls, respectively, P < 0.05) and incomplete (residual volume: 43.2 +/- 2.7%, 40.0 +/- 4.3%, 15.8 +/- 1.6% min in cholesterol stone patients, pigment stone patients and controls, respectively, P < 0.05). The inflammation of the gallbladder wall was mild or absent in all cases. Biliary cholesterol saturation index was 152.3 +/- 8.5% and 92.9 +/- 4.8% in patients with cholesterol and pigment stones, respectively (P < 0.01). Whereas cholesterol crystals never appeared during 21 days in biles from patients with pigment stones, crystal observation time in patients with cholesterol gallstone was 5 days (median) and was significantly shorter in patients with multiple (4 days) than in patients with solitary (12 days) cholesterol stones (P = 0.0019).
Patients with black pigment stones who do not have excess cholesterol and do not grow cholesterol crystals in bile have decreased gallbladder emptying, although to a lesser extent than patients with cholesterol stones. Thus, gallbladder stasis is likely to put a subset of subjects at risk for the formation of pigment gallstones, and pathogenic mechanisms need to be further investigated.
与胆固醇结石患者相比，关于黑色色素结石患者胆囊运动功能的了解较少，关于其与胆汁成分、结晶及结石特征的关系也知之甚少。
通过超声检查研究了49例有色素结石（n = 14）或胆固醇结石（n = 35）的胆结石患者及30例健康对照者空腹及餐后的胆囊容积。胆囊切除术后，对胆结石患者的结石成分、胆囊壁炎症、胆固醇饱和指数及胆汁中板状胆固醇结晶的出现情况进行了评估。
与对照组（21.0±1.5 mL）相比，胆固醇结石患者的空腹胆囊容积显著增加（P < 0.05）（31.7±1.9 mL），而色素结石患者的空腹胆囊容积未增加（21.9±3.1 mL）。患者的餐后排空延迟（排空一半时间：胆固醇结石患者、色素结石患者及对照组分别为31±2分钟、35±3分钟及24±2分钟，P < 0.05）且不完全（残余容积：胆固醇结石患者、色素结石患者及对照组分别为43.2±2.7%、40.0±4.3%及15.8±1.6%，P < 0.05）。所有病例中胆囊壁炎症均为轻度或无炎症。胆固醇结石患者及色素结石患者的胆汁胆固醇饱和指数分别为152.3±8.5%及92.9±4.8%（P < 0.01）。色素结石患者的胆汁在21天内从未出现胆固醇结晶，而胆固醇结石患者的结晶观察时间为5天（中位数），多发性胆固醇结石患者（4天）的结晶观察时间显著短于单发性胆固醇结石患者（12天）（P = 0.0019）。
没有过多胆固醇且胆汁中不生长胆固醇结晶的黑色色素结石患者胆囊排空减少，尽管程度低于胆固醇结石患者。因此，胆囊淤滞可能使一部分人有形成色素胆结石的风险，其致病机制需要进一步研究。
