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肝硬化时胆囊壁增厚的机制及其临床意义 被引量:7

Mechanism and clinical significance of gall - bladder wall thickening in liver cirrhosis
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摘要 目的 研究肝硬化时胆囊壁增厚的机制并探讨其临床意义。方法 回顾性分析172例肝硬化患者,按胆囊壁增厚和正常分为两组,比较组间自由门脉压、门脉直径、食管静脉曲张、血浆总胆红素及白蛋白水平、腹水和凝血酶原时间的差别,并制作胆囊血管铸型标本和复习国内外文献。结果 70.8%(114/161)的患者胆囊壁增厚。与胆囊壁正常患者相比,胆囊壁增厚患者的自由门脉压明显增高(P<0.01),血浆白蛋白水平明显降低(P<0.05),凝血酶原时间显著延长(P<0.05),伴有腹水者显著增多(P<0.01),而门脉直径、食管静脉曲张、总胆红素水平在两组间差异无显著性(P>0.05)。分流术后胆囊壁厚度明显缩小(P<0.05),而断流术后无显著变化。胆囊血管铸型标本显示肝硬化胆囊壁增厚者胆囊静脉丰富、迂曲和扩张。结论 肝硬化时胆囊壁增厚的原因是多方面的,门脉高压可能是主要因素;胆囊壁增厚可能与肝硬化时胆囊继发炎症和结石有关,并可作为早期预报门脉高压和鉴别肝硬化和其他原因腹水的指标。 Objective To investigate the mechanism and clinical significance of gall - bladder wall thickening( GBWT) in liver cirrhosis. Methods After excluding patients with other diseases associated with GBWT, a retrospective study was conducted in 172 cases of liver cirrhosis in our hospital between 1993 and 2001. Free portal pressure(FPP) , portal vein diameter, serum levels of albumin and total bilirubin, prothrombin time and the presence of ascites and esophageal varices were compared between patients with GBWT and normal gall - bladder wall thickness. Cystic veins were observed in 10 gall bladder cast specimens perfused with hyper-chlororinyaceticether or emulsoid. Results 70.8%(114/161) of patients had GBWT. Compared with patients with normal gall- bladder walls, patients with GBWT had significantly higher FPP( P < 0.01) , lower serum albumin levels( P < 0.05) , a longer prothrombin time( P < 0.05) and higher percentage of ascites( P < 0.01) . There was no remarkable difference between two groups in the portal vein diameter, presence of oesophageal varices and serun level of total bilirubin. After shunt operations on cirrhotic in the portal vein diameter, presence of esophageal varices and serum level of total bilirubin. After shunt operations on cirrhotic patients with portal hy-pertension(PHT), GBWT was significantly decreased. In patients with disconnecting performances, however, GBWT had no notable change. Cast specimens results suggested the presence of gallbladder varices with tortuous appearance in patients with PHT. Conclusion The occurrence of GBWT observed in patients with cirrhosis may be multifactorial and PHT appeared to be the most important factor in causing GBWT. GBWT in cirrhotic patients may closely associate with the chronic cholecystitis, more likely results in cholelithiasis and can be used as a sign of HPT and a method to differentiate cirrhotic ascites from other ascites.
出处 《广东医学》 CAS CSCD 2002年第9期916-918,共3页 Guangdong Medical Journal
基金 本课题为广东省重点科技攻关项目(编号:99B06703G)
关键词 肝硬化 胆囊壁增厚 GBWT 病理 Liver cirrhosis Gall-bladder wall thickening
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参考文献2

  • 1李忠华..人体铸型标本的设计和制作[M],1992.
  • 2黄志强.黄志强胆道外科[M].济南:山东科学技术出版社,1999.813-814. 被引量:70

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