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使用丙酸乙酯成功实现胆固醇性胆囊结石的局部溶解。

Successful topical dissolution of cholesterol gallbladder stones using ethyl propionate.

作者信息

Hofmann A F, Amelsberg A, Esch O, Schteingart C D, Lyche K, Jinich H, Vansonnenberg E, D'Agostino H B

机构信息

Department of Medicine, University of California San Diego 92093-0813, USA.

出版信息

Dig Dis Sci. 1997 Jun;42(6):1274-82. doi: 10.1023/a:1018818527187.

Abstract

Topical dissolution of cholesterol gallbladder stones using methyl tert-butyl ether (MTBE) is useful in symptomatic patients judged too ill for surgery. Previous studies showed that ethyl propionate (EP), a C5 ester, dissolves cholesterol gallstones rapidly in vitro, but differs from MTBE in being eliminated so rapidly by the liver that blood levels remain undetectable. Our aim was to test EP as a topical dissolution agent for cholesterol gallbladder stones. Five high-risk patients underwent topical dissolution of gallbladder stones by EP. In three patients, the solvent was instilled via a cholecystostomy tube placed previously to treat acute cholecystitis; in two patients, a percutaneous transhepatic catheter was placed in the gallbladder electively. Gallstone dissolution was assessed by chromatography, by gravimetry, and by catheter cholecystography. Total dissolution of gallstones was obtained in four patients after 6-10 hr of lavage; in the fifth patient, partial gallstone dissolution facilitated basketing of the stones. In two patients, cholesterol dissolution was measured and averaged 30 mg/min. Side effects were limited to one episode of transient hypotension and pain at the infusion site; no patient developed somnolence or nausea. Gallstone elimination was associated with relief of symptoms. EP is an acceptable alternative to MTBE for topical dissolution of cholesterol gallbladder stones in high-risk patients. The lower volatility and rapid hepatic extraction of EP suggest that it may be preferable to MTBE in this investigational procedure.

摘要

使用甲基叔丁基醚(MTBE)对胆固醇性胆囊结石进行局部溶解,对那些被判定病情过重而无法进行手术的有症状患者是有用的。先前的研究表明,丙酸乙酯(EP),一种C5酯,在体外能迅速溶解胆固醇结石,但与MTBE不同的是,它被肝脏迅速清除,以至于血液中无法检测到其水平。我们的目的是测试EP作为胆固醇性胆囊结石的局部溶解剂。五名高危患者接受了EP对胆囊结石的局部溶解治疗。在三名患者中,通过先前放置的用于治疗急性胆囊炎的胆囊造瘘管注入溶剂;在两名患者中,选择性地经皮经肝将导管置入胆囊。通过色谱法、重量法和导管胆囊造影术评估胆结石的溶解情况。四名患者在冲洗6 - 10小时后胆结石完全溶解;在第五名患者中,胆结石部分溶解便于将结石套取出来。在两名患者中测量了胆固醇溶解情况,平均为30毫克/分钟。副作用仅限于一次短暂性低血压发作和输液部位疼痛;没有患者出现嗜睡或恶心。胆结石清除与症状缓解相关。对于高危患者胆固醇性胆囊结石的局部溶解,EP是MTBE的一种可接受的替代方法。EP较低的挥发性和肝脏的快速提取表明,在这个研究过程中它可能比MTBE更可取。

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