Makino I, Chijiiwa K, Higashijima H, Nakahara S, Kishinaka M, Kuroki S, Mibu R
Department of Surgery 1, Kyushu University Faculty of Medicine, Fukuoka, Japan.
Gut. 1994 Dec;35(12):1760-4. doi: 10.1136/gut.35.12.1760.
Changes in biliary lipid composition, pH, ionised calcium, total and unconjugated bilirubin, and cholesterol nucleation time of gall bladder bile samples were examined in six patients who had undergone subtotal or total colectomy between five months and seven years previously, and values were compared with those in control patients with no gall stones. The colectomy group mainly comprised patients with ulcerative colitis and familial adenomatosis coli, in whom only a short length of the terminal ileum (mean (SEM) 2.25 (0.57) cm) had been resected. The reconstruction procedures were ileoanal anastomosis in two patients, terminal ileostomy in two, ileorectal anastomosis in one, and J shaped ileal pouch-anal anastomosis in one patient. The distributions of age, sex, and relative body weight were similar in the two groups. The gall bladder bile was lithogenic in the post colectomy group--these patients had a significantly increased cholesterol saturation index (p < 0.01) and rapid cholesterol nucleation time (p < 0.05) compared with the control group. A significant increase in the molar percentage of cholesterol and a decrease in that of total bile acid associated with significantly decreased secondary bile acids (p < 0.05) were observed in the post colectomy group. Gall stones formed in two of six patients after colectomy were cholesterol stones containing more than 80% cholesterol by dry weight. Total and unconjugated bilirubin, pH, and ionised calcium values were similar in the two groups. The results indicate that after total or subtotal colectomy the composition of gall bladder bile increases the risk of cholesterol gall stone formation.
对6例在5个月至7年前接受过次全或全结肠切除术的患者胆囊胆汁样本的胆汁脂质成分、pH值、离子钙、总胆红素和非结合胆红素以及胆固醇成核时间的变化进行了检测，并将这些值与无胆结石的对照患者的值进行比较。结肠切除组主要包括溃疡性结肠炎和家族性腺瘤性息肉病患者，这些患者仅切除了一小段末端回肠（平均（标准误）2.25（0.57）cm）。重建手术包括2例回肠肛管吻合术、2例末端回肠造口术、1例回肠直肠吻合术和1例J形回肠贮袋肛管吻合术。两组患者的年龄、性别和相对体重分布相似。结肠切除术后组的胆囊胆汁具有致石性——与对照组相比，这些患者的胆固醇饱和指数显著升高（p<0.01），胆固醇成核时间加快（p<0.05）。结肠切除术后组观察到胆固醇的摩尔百分比显著增加，总胆汁酸的摩尔百分比降低，同时次级胆汁酸显著减少（p<0.05）。结肠切除术后6例患者中有2例形成的胆结石为胆固醇结石，干重含胆固醇超过80%。两组的总胆红素和非结合胆红素、pH值和离子钙值相似。结果表明，全结肠或次全结肠切除术后，胆囊胆汁的成分增加了胆固醇结石形成的风险。
