1985年 · 第05卷第01期

The experiences of operative cholangiography in 200 cases are reported. In 128 cases, operative cholangiography was performed by injecting contrast medium via the cystic duct after cholecystectomy, and in 72 cases a T-tube cholangiography was done at the end of choledochotomy. Residual or overlooked common ductal or intrahepatic ductal stones were discovered in 25 cases(12.5%) and stricture of the distal common duct, biliary carcinoma or abnormal anatomy were found in 9 cases (4.5%) . Of the 29 patients with a history of jaundice, only 4 cases were found to have bile ductal stones by operative cholangiography. Although operative cholangiography gave false negative result in 6 cases (3%) and false positive in 5 cases (2.5%) , its simplicity and safety still make it a worthwhile diagnostic procedure in biliary gurgery.

This paper reports the biopsy study in 8 cases with ultrastructure changes of gastric mucosa due to bile reflux. Their impairment included various damage of surface cells of mucosa. The mitochondria were swollen or vacuous. The cis-tern of endoplasmic reticulum expended and the free ribosome reduced. More microfilaments and annular bodies were found in the cistern in one case, and some specific crystal bodies with membrane could be seen in the cytoplasm in other case. Sometime the vacuole was found in nucleus. Junctional complex between epthelia remained intact. Some bac-teria were found in the intestinal metaplasia area and mucosal cytoplasm. A few of the parietal cells demonstrated wane, the TV system disappeared, and lysosome and autosome increased. There were few proteinoid and cholesterol crystals dispersed in lamina propria.

The rates of glucose and sodium absorption were greatly decreased in rats when acute injection and chronic ingestion of 35% alcohol were instituted into the small intestine. The oxygen consumption of the small intestine homogenate was also decreased. The lesions of the intestinal mucosal villi induced by acute or chronic alcoholism were variable in individual rat. Cytoprotection and mucosal harrier protective mechanism seemed to be present in the gastrointestinal tract. In mildly damaged cases, the lesions were reversible and regenerative process was rapid, however, chronic ingestion of alcohol should still be discouraged.

Based on gastric juice SIgA detection in 1064 cases and also experimental observation, the limit of anti-acid anti-peptic ability of SIgA was determined thus settled the controversies of past reports. Of all the 150 gastric juice samples studied from patients with gastric carcinoma, the detection rate of SIgA in 115 samples, whose pH valuc>4 was 87.93%;while in the remaining 35 samples, whose pH value<4, the detection rate was zero. However, by adjusting pH of the gastric juice intragastrically up to 5.0 or above, in all the 10 patients of the latter group SIgA was detected.

Since there existed an overlapping in the gastric juice SIgA contents between CAG and gastric cancer, the diagnostic significance of detecting SIgA in gastric juice was considered limited. But, if incorporated with pH value adjustment, it may have value in screening and early detection of gastric cancer among high risk population.

Intestinal lamina proprial lymphocytes were enumerated in 13 patients with Crohn's disease, 7 with ulcerative colitis and 9 control subjects with grossly normal bowel. The percentages and absolute numbers of B cells and complement receptor-bearing lymphocytes in the patients with ulcerative colitis did not differ significantly from the control group; in Crohn's disease, the percentages of these cells were significantly decreased but absolute numbers were normal. The percentages and absolute numbers of T cells identified by E rosettes (regular and stable) were normal in both Crohn's disease and ulcerative colitis. In both diseases, significantly increased percentages but normal absolute numbers of mature T cells were identified by monoclonal antibody staining with CKT3 reagent. There was an increase in the proportion of suppressor/cytotoxic T cells and a concomitant significant decrease of the helper to suppressor T-cell ratio (using either percentges of absolute numbers of cells) in tissues from patients with Crohn's disease, but not ulcerative colitis, when compared with the control group. These results suggest that the imbalances of T-cell subpopulations in the intestinal lamina propria may play a role in the immunopathology of Crohn's disease.

Bile specimens were collected weekly from 48 patients with biliary tract diseases, mainly gallstone, during operation and postoperatively. These specimens were tested both under pH 4.6 and 6.8 buffer systems. In 68.75% of cases, β-glucuronidase was predominantly of bacterial origin during operation, but on the second postoperative day, it turned to be visceral or tissue β-glucuronidase in 81.25% of cases. With the improvement of postoperative condition, tissue β-glucuronidase progressively decreased with a concomitant relative increase of bacterial β-glucuronidase. The results indicate the effect of surgery and tissue injury on biliary β-glucuronidase and the correlation of surgery with tissue β-glucuronidase is highly significant statistically. From this study, it is suggested that in heavy bacterial infection of the biliary tract, bacterial β-glucuronidase might be so overwhelming as to shroud the expected changes of tissue β-glucuroni-dase. The net effect on biliary β-glucuronidase will depend on the type of operation, extent of tissue injury and heaviness of bacterial infection and perhaps other factors.

Lithogenic index (LI) or percentage of unconjugated bilirubin (UCB%) was the monofactor discriminant score commonly used to reflect the lithogenic tendency of bile. It was found that these scores were not sufficiently reliable. We developed a new index, Z value, using Fisher's method to calculate the integrated score of LI and UCB%. The bile compositions of 78 cases were analysed, the discriminant accuracy was enhanced from 85% and 57% to 100%. The formula is Z = 0.96 (UCB%) +27.11 (LI) , and the critical value is Z. = 44.70. Z value above 44.70 indicates lithogenic bile. Prospective study of the lithogenic tendency in 20 cases revealed a good result.