糖尿病患者胆囊排空障碍的原因探讨  

The cause of impairment of gallbladder emptyingin patients with gallstone and diabetes mellitus

作　　者：丁雄[1] 刘长安[1] 陆昌友[1] 许舸[2] 马英[3] 谭光智[3] 冷志[3] 

机构地区：[1]重庆医科大学第二临床学院肝胆外科,重庆400010 [2]重庆医科大学基础医学院电镜室,重庆400016 [3]重庆医科大学第二临床学院病理科,重庆400010

出　　处：《重庆医科大学学报》2004年第6期795-797,共3页Journal of Chongqing Medical University

摘　　要：目的 :从胆囊动脉角度探讨糖尿病患者胆囊排空功能障碍的原因。方法 :单纯胆囊结石患者和胆囊结石伴糖尿病患者各 30例 ,术前用B超测定胆囊排空功能 ,术后对病理切片做PAS染色 ,用北航CM - 2 0 0 0B型生物医学图象分析系统对胆囊动脉做管腔图像分析和体视学图像分析。结果 :糖尿病伴胆囊结石组空腹和餐后胆囊体积明显增加 ,胆囊排空指数下降。糖尿病伴胆囊结石组胆囊动脉血管壁面积与血管断面积的比值 (0 .81± 0 .0 9)明显大于单纯胆囊结石组 (0 .5 8± 0 .15 ) (P <0 .0 1) ,其平均光密度 (0 .4 1± 0 .0 7)也明显大于单纯胆囊结石组 (0 .30± 0 .12 ) (P <0 .0 1) ,血管大小 (周径 )对该比值无明显相关性 (P >0 .0 5 )。结论 :糖尿病患者胆囊收缩排空功能明显减退。PAS阳性物质在胆囊动脉壁沉积 ,导致血管腔明显狭窄 ,可能是影响胆囊排空功能的重要原因。Objective:To investigate the abnormity of arterioles in gallbladder and its relation with gallbladder hypomotility in patients with gallstone and diabetes mellitus.Methods:30 patients with simple gallstone and 30 patients with gallstone accompanied with diabetes mellitus were analyzed.Their gallbladder emptying function was measured with B ultrasound before operation.After operation,the arterioles of gallbladder rinsed with PAS reagent in photos were analyzed in tubular area and stereo system with BEIHANG CM-2000B biological and medical photo system.Results:The gallbladder volumes of fasting(V 0),two hours after eating(V 2) increased (59.3±0.6 vs 37.9±5.4,44.7±6.6 vs 14.3±4.9 respectively),whilethe ejective volume of bile(EV) and the ejective rate of gallbladder two hours after eating[GBEF 2 (%)] decreased in patients with diabetes mellitus(14.5±7.1 vs 23.4±9.3,24.9±12.7 vs 61.5±8.5,respectively).In patients with gallstone and diabetes mellitus,the area ratio of arterioles wall to whole arterioles in cross section was significantly higher than in the patients with simple gallstone(0.81 ±0.09 vs 0.58±0.15, P <0.01),and their average sound density was also higher than the latter(0.41±0.07 vs 0.30±0.12, P <0.01).The size of arterioles(diameter) had no significant relation to the area ratio( P >0.05).Conclusion:The emptying function is significantly impaired in patients with gallstone and diabetes mellitus.The sedimentation of PAS positive material in the wall of arterioles lead to the stenosis of arterioles,and it is probably the cause for gallbladder hypomotility.

关 键 词：胆囊结石 糖尿病 动脉 胆囊运动 

分 类 号：R575.62[医药卫生—消化系统] R587.1[医药卫生—内科学]