1982年 · 第02卷第01期

Cholagogic dry syrup is composed of 15 medicinal herbs and sugar. (1) 84 patients with cholecystolithiasis were treated with this syrup for ½ year, resulted in disappearance of stones and reduction of stone size in 10 each. (2) The drug was also given to 60 patients having T-tube drainage after biliary surgery for stones. By bile analysis at intervals it was found that the lithogenic index and unconjugated bilirubin contents of bile were gradually reverted toward normal values. (3) 22 guinea pigs were fed with low protein lithogenic diet for 2 mo, during sacrifice, gall bladder pigment stones were found in 91%. Another 22 guinea pigs were fed with cholagogic dry syrup in addition, only 10% were found to have stones. The differences in percentages of unconjugated bilirubin and lithogenic indices of the biles of the two groups were also significant. We conclude that cholagogic dry syrup is effective in dissolution and prevention of gallstone.

Fifty cases of carcinoma of the bile ducts were admitted during the period of January 1970 to March 1980. Most patients had progressive jaundice, itching, anorexia, hepatomegaly and marked elevation of serum bilirubin and alkaline phosphatase. The gallbladder was usually not palpable. Diagnosis was established by exploration in 48 cases, and by percutaneous transhepatic cholangiography in the remaining 2. 31 cases had their carcinoma sites near the confluence of the right and left hepatic duct. In only 2 cases tumors were resectable and they survived 9 mo postoperatively. In 36 cases, palliative biliary drainage was performed, they lived in average 5.6 mo postoperatively. The remaining 12 received exploration survived 5 mo only. The pathology, diagnosis and treatment of carcinoma of the bile duct were briefly discussed.

Twenty patients of various GI diseases complicated with acute massive hemorrhage were treated with argon laser photocoagulation. The emergency endoscopic findings of the cases were: 9 duodenal ulcer; 2 gastric ulcer; 2 combined gastric and duodenal ulcers; 3 erosions at gastroenteric anastomosis; 2 acute ulceration of gastroenteric anastomosis; and 2 gastric carcinoma. Blood volume was restored by rapid transfusion, and gastric lavage was performed with normal saline before emergency endoscopy. The maximum power output of the argon laser used was 7.8 w (usually being stabilized at 6.2 w). The argon laser beams were focused on the proximal end of a quartz lightguide (400 μm in diameter, 300 cm in length, with an output angle of 23^•.) through the adjustment of a 5-axis micropositioner. The transmission rate of the quartz lightguide was 90% or greater. After aiming at the bleeding lesion, laser photocoagulation was carried out at a distance of 1-3 cm for 5- or 15-sec duration and was repeated 2 or 3 times when necessary. The endoscope was withdrawn when no more bleeding was observed. All but two of the patients had the bleeding controlled promptly. No side effect or relapse was found in this group of patients.

Quantities of IgG and IgA in gastric juice were investigated by Agar Simple Diffusion Method in 260 cases, of which 47 cases were gastric cancer patients, 182 cases with benign gastric diseases (including gastric ulcer, duodenal ulcer superficial gastritis and atrophic gastritis etc.) and 31 healthy individuals as controls. IgG content above 200 μg/ml was considered as positive, and that below 200 μg/ml as negative. IgA content above 50 μg/ml was considered as positive, and that below 50 μg/ml as negative. The positive rates of IgG and IgA in gastric cancer cases were 93.6% and 87% respectively, whereas that in the cases with benign gastric diseases were 3.8% and 5.5% respectively. The authors consider that the mechanism of the elevation of IgG in gastric juice of gastric cancer patients is probably due to the antitumor antibody response, and for that of IgA, due to the large amount of gastric secretion caused by stimulation of the tumor antigen acting on the gastric mucosa.

Four hundred eighty cases of pathologically proved schistosomiasis from 1950 to 1979 were analysed, of which 134 were found in 935 resected rectal specimens, 44 in 766 sigmoidal, 70 in 1,506 other colonic, 15 in 466 ileal, 285 in 18,139 appendical, 7 in 2,522 duodenal and 15 in 6,584 gastric specimens. None of the 486 jejunal specimens was positive for schistosomiasis. The associated or complicated conditions encountered were: carcinoma (63 cases), polyps (35), perforation (33), stenosis (24), ulcer (23), granuloma (22), obstruction (13), fistula (10), and intussusception (2). The gastrointestinal schistosomiasis cases showed higher incidence of carcinoma than non-schistosomiasis except the appendical schistosomiasis, while the latter had higher incidence of gangrene or perforation than those without.

The authors presented a case of Whipple's disease (Intestinal lipodystrophy) which is supposed to be the first case discovered in China. The biopsy of colon mucosa revealed PAS-stain-positive macrophages and electron microscopy demonstrated bacilliform bacteria. A discussion of the case was given together with a review of the literatures.

Sixteen schistosomiasis patients complicated with cirrhosis of liver and ascites refractory to repeated conventional diuretics were treated with high doses of microgranule spironolactone (120-240 mg per day). 13 patients became free from ascites within 2-4 weeks, and 2 patients within 7 weeks. Another case with large amount of ascitic fluid and pleural effusion showed little improvement until furosemide and mannitol infusions were supplemented. The mean values of sodium excretion after diuretic treatment were 10-60 times the values before treatment, and in 2 patients even reached 100 times. No complications were observed except in 2 cases of hyperkalemia associated with renal function impairment 2 cases had history of hepatic coma previously tolerated the treatment well.

One hundred thirty six cases of stricture of the hepatic duct at the porta hepatis were treated surgically from 1963 to Oct. 1980, which constituted about 10% of the total biliary tract operations carried out in our hospital. The lesions could be divided into 3 clinicopathological patterns: simple type; complicated with intrahepatic stones; and complicated type, frequently having multiple strictures and/or serious damage of liver parenchyma. Operative procedures were planned accordingly, they were hepatectomy, high hepatic duct jejunostomy, and combined operations. There was one operative death (0.77%). 107 cases were followed up for an average of 4.5 years, with satisfactory results in 84.3%. Good results might also be obtained in those complicated cases after a thorough operation. Six of the seven cases complicated with liver cirrhosis and portal hypertension obtained satisfactory results by staged operations.

Five hundred thirteen gallstone cases were reviewed. Among them 3.3% had gallbladder stones, 93.4% common duct stones, 1.9% intrahepatic stones, and 1.4% stones both in the gallbladder and the bile duct. The patients were treated first with Chinese herbal decoctions combined with acupuncture. 76.6% of the patients thus treated expelled gallstones without surgical intervention. The "gallstone expelling decoction" has antibacterial, analgesic and antispasmodic effects and needling in points Ri-Yue and Qi-Men results in relaxation of sphincter of Oddi. A huge common duct stone measured 4.2 × 3.9 × 3.9 cm was expelled through the sphincter of Oddi into the intestine and caused gallstone ileus. When surgical operation was indicated, an end-to-end choledochojejunostomy in Roux-en-Y pattern was performed. In the later years we added artificial intussusception to the short arm which was anastomosed with common bile duct for reflux prevention, and also the two short arms of "Y" were sutured together for a ength of 8-10 cm to facilitate downward passing of chyme. The technique has been proved to be satisfactory.

The effect of acidified Ston Expelling Decoction (SED) on the amount of dog's hepatic bile flow was evaluated in 11 anesthetized dogs. Each dog was infused with SED or acidified SED or fortified Acid-SED into its duodenal lumen. The latter two were made by adding 0.3 and 0.6 ml of 10 N HCl into 30 ml SED respectively. Secretin was injected intravenously and the effect of secretin combined with SED on bile flow was observed. The results were as follows: (1) Choleretic action of acidified SED is more powerful than that of the nonacidified and obviously less than that of the fortified Acid-SED. (2) SED combined with exogenous secretin may also augment choleretic action. The study implies that acidified SED may induce the release of endogenous secretin by duodenal mucosa, and therefore enhance the therapeutic efficiency of the nonoperative general attack therapy for intra- and extra-hepatic cholelithiasis.

Fifty eight female guinea pigs were divided into control group (22 animals), on normal diet; observed group (22), fed with lithogenic diet; and prevention group (18), lithogenic diet plus compound Chinese medicine for 2 months. After sacrifice, stones were found in none of the control group, 91% of the observed group and only 7% of the prevention group (p<0.01). The unconjugated bilirubin in the bile of the 3 groups were 45.9 ± 7.7%, 11.2 ± 6.5% and 6.33 ± 4.4% of the total bilirubin respectively (P<0.01); the β-glucuronidase in bile were 9.27 ± 3.5, 3.77 ± 1.7 and 1.59 ± 0.7μg/ml (p<0.05); and serum cholesterol were 292.5 ± 118, 120.0 ± 31.0, 98.8 ± 22.0 mg % (p<0.05) respectively. The prophylactic effect of the compound Chinese medicine is considered to be the result of regulating the dynamic balance of the components of bile contents as well as metabolism of cholesterol, blilirubin and β-glucuronidase.

China-made endoscopic argon laser photocoagulation set was applied to 8 heparinized mongrel dogs for the study on the actively bleeding gastric lesions. Argon laser with a maximum power output of 5 w was used. The beams were transmitted through a flexible quartz fibre (400 μm in diameter) lying within a 2 mm `Teflon' catheter for dispersing the blood from the bleeding lesions. Photocoagulation was carried out with a power of 2-3.5 w (at the fiber tip) for 3-20 sec. Hemostasis was achieved in all the dogs after laser irradiation while in those of the controls the bleeding did not stop. The range of effectiveness of the laser photocoagulation was limited in the local area and its depth involved was limited down to the submucosa. No complications such as perforation were observed.