T管胆汁胆固醇结晶性状与胆石复发的关系

The Relations Between the Quality of Cholesterol Crystals of Bile from T-tube and Cholelithiasis Recurring

目的探讨胆管结石术后T管中胆汁胆固醇结晶的性状与胆石复发的可能关系。方法收集60例胆管结石T管引流术后第2～10d胆汁标本，其中首次发现胆总管结石者42侧，再发者18例；另8例非胆石症置T管者作为对照。通过测定胆汁中胆固醇、磷脂和胆盐的含量，计算胆固醇饱和指数（CSI）;偏振光显微镜下观察胆汁中胆固醇结晶成核时间（NTm），以及模拟胆汁胆固醇结晶成核时间（NTc），并计算NTm／NTc比值；同时计数术后第10d胆汁中胆固醇结晶数，计算结晶分数。结果复发结石组NTm／NTc为0．26，具有高度的成石活性。与初发结石组间存在显著性差异（P〈0．05）；而对照组T管胆汁NTm／NTc则超过1．4，成石活性低。结论NTm／NTc的比值〈0．3时应高度怀疑胆石复发的可能性。

Objective To explore the possible relationship between the quality of cholesterol crystals of bile from T-tube after cholelithotomy and the gallstone-recidivism. Methods 60 patients who had undergone the surgical removing of calculus in bile ducts and T-tube drainage were set, among which 42 were newly diagnosed and 18 were recurrent cases. Another 8 patients who do not suffered from calculus but T-tubes were also placed in their common bile duct, used as controls. The bile samples were reopectedly collected from T-tubes （q. d. ）in 2th to 10th day. Calculate the cholesterol saturation index （CSI） through measuring the quantity of cholesterol, phospholipid and bile salt in bile; observe the time needed by the nucleation of the cholesterol in bile （NTm） under a polarized microscope and simulate the nucleation time （NTc） of bile , then to calculate the ratio of NTm/NTc. Meanwhile, the number of cholesterol crystal and the partial of crystallization were also calculate. Results The NTm/ NTc of the recurrence group are 0.26, which indicated the calculus formation activity in recurrence group are much higher and the difference between the two groups are of significance（P〈0.05）; while the NTm/NTc in control group is less than 1.4, which meant a lower activity in gallstone formation. Conclusion the recurrence of gallstone are highly suspicious when the ratio of NTm/NTc 〈0.3.