肝胆疾患胆囊动力学研究及其临床意义

The Motility Study and Clinical Significance of Hepatocystic Disease

目的与方法：利用Ｂ型超声检查１４例慢性胆囊炎。１２例胆囊结石、１３例肝硬化病人的胆囊充盈和排空功能，旨在阐明其胆囊动力学变化及其可能的机制和临床意义，结果：与正常对照比较，胆囊炎和胆囊结石患者空腹胆囊容积无变化；胆囊最大排空指数（ＧＢＥＦｍａｘ）明显下降（Ｐ均＜０.０５）；胆囊炎与胆囊结石间ＧＢＥＦ－ｍａｘf无显著性差异。肝硬化组病人空腹胆囊体积比对照组健康者明显扩大（Ｐ＜ ０．０１），而 ＧＢＥＦｍａｘ无差异。肝硬化组病人胆囊最大收缩指数远大于其它二个病例组。结论：１．为慢性非结石性胆囊炎诊断、肝病胆囊与炎性胆囊鉴别诊断提供了客观依据。２．慢性胆囊炎。胆囊结石病人的ＧＢＥＦｍａｘ＜４０％可作为手术切除胆囊的良好指征。３肝硬化患者宜给予适量利胆药物治疗，有助于防止胆囊过度充盈，减少胆汁在胆囊内淤滞。

This study investigated the function of gallbladder filling and emptying in 14 patients with chronic acalculous cholecystitis (CAC). 12 cholelithiasis and 13 liver cirrhosis using ultrasound scaning, in order to study the dynamic changes of gaubladder in these diseases, its machanism and clinical significance. Results: Of CAC patients and cholelithiasis patients, there were no changes of fasting gallbadder volume compared with that of the control group, but the gallbladder maximal ejec- tion fraction (GBEFmax) obviously decressed (P < 0.05) while the difference of GBEFmax between CAC patients and gallstone pa- tients was not significant. In liver cirrhosis group the fasting gallbladder volume was much larger than that in the control group (P < 0.01 ), there were also no significant difference. The GBEFmax of the cirrhosis group was bigger than that of other two groups.Con- clusion: 1 .This result provide a objective base for the diagnosis of CAC and the different diagnosis of hepatic gallbladder and inflam- matic gallbladder. 2. The GBEFmax of CAC and gallstone patients < 40% can be a reliable indicator for cholecystectomy. 3. It is help- ful for cirrhosis patient to eat frequently but less every time or to be given proper cholagogics to prevent overfilling of the gallbladder and bile stasis.