肝硬化伴或不伴胆结石胆囊排空的比较

Comparison of gallbladder emptying in liver cirrhosis patients with or without gallbladder stones

目的观察肝硬化患者伴或不伴有胆囊结石时胆囊的排空功能，以探讨胆囊的排空是否与胆囊结石的形成有关。方法24位肝硬化并胆囊结石患者纳入研究，作为试验组，ChildA、B、C级各8例；另24例不伴胆囊结石的肝硬化患者为对照组，每级均有8位患者。利用超声波检查测量空腹胆囊体积，后嘱受试者摄入脂餐计箅胆囊体积，估测胆囊最小体积、胆囊排空分数。统计分析使用Students’t检验和Pearson’S相关性分析。结果对照组中空腹胆囊体积和胆囊最小体积均增大，但胆囊排空分数并无明显变化。试验组中，与Child A级比较，Child C级胆囊排空分数显著降低，并且也比对照组中Child C级的胆囊排空分数显著下降。结论肝硬化患者的胆囊收缩功能明显下降，胆囊的运动减弱则与肝脏病变的严重程度呈平等趋势，胆囊的运动减弱是肝硬化晚期患者胆囊结石形成的主要原因，胆囊结石的数量和大小及胆囊壁的厚度与胆囊排空并无明显的相关性。

Objective To observe liver cirrhosis patients with or without gallbladder stones gallbladder emptying function in order to investigate whether gallbladder emptying in gallstone formation. Methods The study group comprised 24 patients with liver cirrhosis and gallstones, 8 in.each Child class. The controls were represented by 24 cirrhotic patients with- out gallstones, 8 in each Child class. Fasting gallbladder volume was calculated by ultrasound. Gallbladder emptying was evaluated for 90 min after ingestion of a fatty mealassessing minimal residual volume, gallbladder ejection fraction, at 15 - min intervals. Statistical analysis was performed using the Students＇ t test and Pearson＇s correlation coefficient. Results In controls, gallbladder fasting and residual volumes increased with the severity of cirrhosis, but gallbladder emptying did not change significantly. In cirrhotics with gallstones, gallbladder emptying decreased in Child Ccompared with Child A class patients, and compared to Child C controls. Conclusion Gallbladder contractility is impaired in patients with liver cirrhosis and gallstones. Hypomotility is proportional to the severity of liver disease. Gallbladder hypomotility might contribute to the increased gallstone formation in patients with advanced cirrhosis. The number or size of gallstones, as well＇ as the thickness of the gallbladder wall, did not correlate with gallbladder emptying parameters.