Calabuig R, Castilla M, Pi F, Domingo J, Ramos L, Sierra E
Department of Surgery, Hospital de Viladecans, Institut Català de la Salut, Barcelona, Spain.
Rev Esp Enferm Dig. 1996 Nov;88(11):770-9.
To test the hypotheses that: 1) postprandial gallbladder emptying might be abnormal in patients with acalculous biliary colic; and 2) that hymecromone, a drug that increases bile flow and relaxes biliary muscle might improve symptoms.
Twenty-four women were studied. Twelve patients presented recurrent biliary type of pain in the absence of gallstones, and persistence of contrast in the gallbladder, 24 hours after an oral cholecystogram, suggesting cholesterolosis. Twelve healthy volunteers used as controls had no symptoms and the gallbladder was not visible the day after an oral cholecystogram. Gallbladder emptying induced by an oral meal was studied with ultrasound in both groups before and after the administration of hymecromone.
Gallbladder volumes were similar in both groups (23 +/- 10 ml vs. 31 +/- 11 ml; NS). Gallbladder emptying in the control group was simple exponential (R2 = 0.948 +/- 0.059) with a rate of 32 +/- 16 minutes. Gallbladder emptying was bimodal in patients. Gallbladder volume increased to 120% in the first 10 minutes, to empty exponentially thereafter (R2 = 0.964 +/- 0.040. Rate: 29 +/- 22 minutes). This resulted in a marked reduction in gallbladder volume emptied at 40 minutes when compared to controls (30% +/- 27% vs. 54% +/- 14%; p = 0.012). Pretreatment of controls with hymecromone induced an emptying pattern similar to that of patients. In patients, emptying after hymecromone did not change but symptoms were improved.
An abnormal emptying pattern of the gallbladder was identified in patients with acalculous biliary colic, and hymecromone was partly effective to reduce pain, despite a minor effect on gallbladder emptying pattern.
验证以下假设：1）无结石性胆绞痛患者的餐后胆囊排空可能异常；2）增加胆汁流量并松弛胆道肌肉的药物羟甲香豆素可能改善症状。
对24名女性进行研究。12名患者在无胆结石的情况下出现复发性胆绞痛类型疼痛，口服胆囊造影24小时后胆囊内造影剂持续存在，提示存在胆固醇沉着症。12名健康志愿者作为对照，无症状，口服胆囊造影后第二天胆囊不可见。两组在服用羟甲香豆素前后均通过超声研究口服餐食引起的胆囊排空情况。
两组胆囊体积相似（23±10毫升对31±11毫升；无显著性差异）。对照组胆囊排空呈简单指数形式（R2 = 0.948±0.059），排空率为32±16分钟。患者的胆囊排空呈双峰模式。胆囊体积在最初10分钟内增加到120%，此后呈指数形式排空（R2 = 0.964±0.040。排空率：29±22分钟）。与对照组相比，这导致40分钟时胆囊排空体积显著减少（30%±27%对54%±14%；p = 0.012）。用羟甲香豆素预处理对照组会诱导出与患者相似的排空模式。在患者中，服用羟甲香豆素后排空情况未改变，但症状得到改善。
在无结石性胆绞痛患者中发现胆囊排空模式异常，尽管羟甲香豆素对胆囊排空模式影响较小，但对减轻疼痛有部分效果。
