Agarwal D K, Choudhuri G, Saraswat V A, Negi T S, Kapoor V K, Saxena R
Department of Gastroenterology and Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Gut. 1994 Jan;35(1):112-6. doi: 10.1136/gut.35.1.112.
The results of bile salt treatment in patients with radiolucent stones and a functioning gall bladder have been poor. In 42 of these patients awaiting cholecystectomy we determined the value of duodenal bile examination in predicting gall stone composition, and thus identifying those less likely to respond to bile salt therapy. Based on chemical analysis and scanning electron microscopy, 28 of 42 (67%) gall stones retrieved at surgery were potentially insoluble. Microscopic examination of duodenal bile correctly identified 21 (75%) of them: it predicted all four (100%) pigment stones, three of six (50%) calcium carbonate containing cholesterol stones, and 14 of 18 (78%) cholesterol stones with pigment shells. It was nearly as reliable as microscopic examination of bile aspirated directly from the gall bladder during surgery (21 (75%) v 23 (82%); p = NS). Furthermore, the presence of cholesterol crystals in duodenal bile was a more sensitive indicator than chemical detection of supersaturation (34 of 38 (89%) v 25 of 35 (71%); p < 0.05) for prediction of cholesterol gall stones. Microscopic examination of duodenal bile, if used as a screening test, could help to exclude potential non-responders and thereby improve considerably the results of oral bile salt treatment for gall stone dissolution.
对于透X线结石且胆囊功能正常的患者，胆盐治疗效果不佳。在42例等待胆囊切除术的此类患者中，我们确定了十二指肠胆汁检查在预测胆结石成分方面的价值，从而识别出那些对胆盐治疗反应较小的患者。基于化学分析和扫描电子显微镜检查，手术取出的42颗胆结石中有28颗（67%）可能不溶解。十二指肠胆汁的显微镜检查正确识别出其中21颗（75%）：它预测了所有4颗（100%）色素结石、6颗含碳酸钙胆固醇结石中的3颗（50%）以及18颗有色素壳的胆固醇结石中的14颗（78%）。其可靠性与手术期间直接从胆囊吸出的胆汁的显微镜检查相近（21颗（75%）对23颗（82%）；p = 无显著差异）。此外，十二指肠胆汁中胆固醇晶体的存在比化学检测过饱和状态更能敏感地预测胆固醇胆结石（38例中的34例（89%）对35例中的25例（71%）；p < 0.05）。如果将十二指肠胆汁的显微镜检查用作筛查试验，有助于排除可能无反应者，从而显著改善口服胆盐治疗胆结石溶解的效果。
