Portincasa P, Di Ciaula A, Baldassarre G, Palmieri V, Gentile A, Cimmino A, Palasciano G
Institute of Clinica Medica I, University of Bari Medical School, Italy.
J Hepatol. 1994 Sep;21(3):430-40. doi: 10.1016/s0168-8278(05)80324-1.
Gallbladder motility was studied by ultrasound in 100 healthy adult volunteers and 150 gallstone patients, in a subgroup of whom gallstone burden, type and number, gallbladder histology and tensiometric responses of gallbladder strips to cholecystokinin octapeptide were evaluated. Patients were divided into contractors (n = 108) and hypocontractors (n = 42), according to their gallbladder motility pattern in vivo. Contractors showed slower gallbladder emptying and increased fasting and postprandial residual volumes, although the ejected amount of bile was greater than that of controls (20.2 +/- SEM 1.1 vs 16.0 +/- 0.7 ml; p < 0.001). In contrast, hypocontractors exhibited slower and less complete gallbladder emptying than controls with a reduction in the absolute amount of ejected bile. Although gallbladder wall inflammation was mild and comparable in specimens from both groups of patients, the thickness of the muscular layer was greater in hypocontractors than in contractors (1073 +/- 76 vs 745 +/- 75 microns, p < 0.01) and related inversely to postprandial ejected volume (r = -0.42; p < 0.03; n = 32) but positively to gallstone volume (r = 0.40; p < 0.03; n = 32). Compared to contractors, gall-bladder muscle strips of hypocontractors exhibited a decrease in frequency and amplitude of spontaneous contraction and in maximal stress and receptor sensitivity to cholecystokinin octapeptide (0.1 nM-1 microM). Postprandial gallbladder evaculation was unaffected by stone number, and by the presence or absence of stone calcification. Gallstone volume was larger in hypocontractors (19.4 +/- 3.0 ml vs 9.6 +/- 0.9 ml, p < 0.001) than contractors. The comparison of in vitro contractility patterns between cholesterol, mixed and pigment stone patients showed a more severe defect in patients with cholesterol and mixed stones than in those with pigment calculi. In conclusion, in gallstone patients: (i) gallbladder motor dysfunction manifests mainly with increased fasting and postprandial residual volumes in contractors and with markedly increased postprandial residual volumes and decreased gallbladder emptying in hypocontractors; (ii) gallbladder kinetics seem to be influenced by stone volume and cholesterol content of calculi but not stone number, calcification or mild chronic cholecystitis; (iii) a form of hypertrophic leiomyopathy is observed in gallstone patients with the most impaired gallbladder motor function.
通过超声对100名健康成年志愿者和150名胆结石患者的胆囊运动功能进行了研究，对其中一个亚组的患者评估了胆结石的负荷、类型和数量、胆囊组织学以及胆囊条带对八肽胆囊收缩素的张力测定反应。根据患者体内胆囊运动模式，将患者分为收缩功能增强组（n = 108）和收缩功能减弱组（n = 42）。收缩功能增强组患者的胆囊排空较慢，空腹和餐后残余容积增加，尽管胆汁排出量大于对照组（20.2±标准误1.1 vs 16.0±0.7 ml；p<0.001）。相比之下，收缩功能减弱组患者的胆囊排空比对照组更慢且更不完全，胆汁排出的绝对量减少。尽管两组患者标本中的胆囊壁炎症均较轻且相当，但收缩功能减弱组患者的肌层厚度大于收缩功能增强组（1073±76 vs 745±75微米，p<0.01），且与餐后排出量呈负相关（r = -0.42；p<0.03；n = 32），但与胆结石体积呈正相关（r = 0.40；p<0.03；n = 32）。与收缩功能增强组相比，收缩功能减弱组患者的胆囊肌条自发收缩的频率和幅度、最大应力以及对八肽胆囊收缩素（0.1 nM - 1 microM）的受体敏感性均降低。餐后胆囊排空不受结石数量以及结石有无钙化的影响。收缩功能减弱组患者的胆结石体积大于收缩功能增强组（19.4±3.0 ml vs 9.6±0.9 ml，p<0.001）。胆固醇结石、混合性结石和色素性结石患者体外收缩模式的比较显示，胆固醇结石和混合性结石患者的功能缺陷比色素性结石患者更严重。总之，在胆结石患者中：（i）胆囊运动功能障碍在收缩功能增强组主要表现为空腹和餐后残余容积增加，在收缩功能减弱组主要表现为餐后残余容积显著增加和胆囊排空减少；（ii）胆囊动力学似乎受结石体积和结石胆固醇含量的影响，但不受结石数量、钙化或轻度慢性胆囊炎的影响；（iii）在胆囊运动功能受损最严重的胆结石患者中观察到一种肥厚性平滑肌瘤病的形式。
