Meier P B, Ansel H J, Shafer R B, Duane W C
Department of Medicine, Veterans Administration Medical Center, Minneapolis, Minnesota.
Gastroenterology. 1988 Dec;95(6):1595-600. doi: 10.1016/s0016-5085(88)80083-0.
After endoscopic retrograde sphincterotomy, patients with an intact gallbladder are at risk for developing symptoms or complications of gallbladder stones. Medical dissolution of such stones would be desirable, especially in elderly patients with an increased surgical risk. However, sphincterotomy alters emptying dynamics of the gallbladder and markedly reduces bile salt pool size, effects that may alter response to chenodeoxycholic acid or ursodeoxycholic acid treatment. Studying two groups of 5 patients with an intact gallbladder after endoscopic retrograde sphincterotomy, we found that 15 mg/kg.day of chenodeoxycholic acid increased the mean (+/- SEM) biliary percentage of chenodeoxycholic acid from 35.5% +/- 4.0% to 88.8% +/- 1.9% (p less than 0.01) and decreased the mean saturation index of gallbladder bile from 1.02 +/- 0.22 to 0.55 +/- 0.08 (p less than 0.05). Ursodeoxycholic acid (10 mg/kg.day) increased the mean biliary percentage of ursodeoxycholic acid from 5.6% +/- 1.5% to 44.7% +/- 5.8% (p less than 0.01) and decreased the mean saturation index of gallbladder bile from 1.04 +/- 0.25 to 0.57 +/- 0.03 (p less than 0.05). A long-term trial of bile acid treatment in sphincterotomy patients with stones in an intact gallbladder is needed.
内镜逆行括约肌切开术后，胆囊完好的患者有发生胆囊结石症状或并发症的风险。药物溶解此类结石是可取的，尤其是对于手术风险增加的老年患者。然而，括约肌切开术会改变胆囊的排空动力学，并显著减小胆汁盐池大小，这些影响可能会改变对鹅去氧胆酸或熊去氧胆酸治疗的反应。在研究两组内镜逆行括约肌切开术后胆囊完好的5例患者时，我们发现，每天15mg/kg的鹅去氧胆酸可使鹅去氧胆酸的平均（±标准误）胆汁百分比从35.5%±4.0%增至88.8%±1.9%（p<0.01），并使胆囊胆汁的平均饱和指数从1.02±0.22降至0.55±0.08（p<0.05）。熊去氧胆酸（每天10mg/kg）可使熊去氧胆酸的平均胆汁百分比从5.6%±1.5%增至44.7%±5.8%（p<0.01），并使胆囊胆汁的平均饱和指数从1.04±0.25降至0.57±0.03（p<0.05）。需要对胆囊完好且有结石的括约肌切开术患者进行胆汁酸治疗的长期试验。
