• 作者： 陳儉鏗; 羅光瑞; 姜安娜
• 作者服務機構： 榮民總醫院; 國立陽明醫學院
• 中文摘要： 肝內結石係東方民族常見疾病之一，以日本、香港及我國之臨床報告最多，以往臨床診斷非常困難，經若干改進，目前診斷上已無甚問題。惟病因至今不明，亦無詳細研究報告，如能對膽汁內之成分做化學分析，或許可以進一步了解此項疾病之病理因素。 研究方法係收集色素性結石存在於膽囊及總膽管（膽結石組）與肝管及總膽管（肝內結石組）之病患的膽汁。這些病患均是經剖腹手術及“T”管引流者。收集標本時，儘量採取病患“T”管引流液內已無血塊殘留，並且病息已無發燒之情況時，以減低影響膽酸分析結果之有關因素。膽汁經化學方法前處理後，注入氣體分析儀(Gas chromatography)，以測定不同膽酸之量。 目前已分析了39個檢體，其中膽結石組佔17例，其膽酸之定量結果如下（單位均為 g /ml)：Lithocholic acid (LC) 134.9 155.2, Deoxycholic acid (DC) 158.0 92.9, Chenodeoxy-cholic acid (CDC) 1093.6 983.7, Cholic acid (C) 2285.1 1664.1；而肝內結石組有22例，其膽酸之定量值如下：LC 117.4 91.9, DC 105.1 75.9, CDC 767.3 569.3, C 1383.0 997.0。比較二組之結果顯示肝內結石病患之第一次膽酸：C與CDC比膽囊結石組病患顯著降低，而另外二種主要膽酸成分 (LC 及 DC) 之平均值在肝管結石組病患亦比膽囊結石組病患低，但由於個人差異很大，使得統計結果不具顯著意義。
• 英文摘要： The incidence of intrahepatic pigmentedstone formation in Asian countries such asJapan, Hong Kong and Taiwan is very high.Although clinical diagnosis is not a difficultproblem, little is known about the chemicalcomposition and the etiology of these pigmentedstones. Comparative study of the chemicalcomposition of bile acids in bile juice of pati-ents with gallbladder and intrahepatic stonesmay be helpful for the pathological mechanismsin stone formation. This report presents a comparative study ofbile acid composition among 39 Chinese patientswith gall- and intra-hepatic stones. Bile wascollected from the patients receiving "T" tubedrainage after operation. If the patients devel-oped fever or if blood clot was found in bile,the sample was not processed for study. A quan-titative microanalytical method was used toanalyze individual bile acids. The procedureinvolves solvent extraction followed by gaschromatographic (GLC) analysis. The bile acid content (in g/ml) in thegroup of gallbladder stones was: Lithocholicacid (LC) 134.9 155.2, Deoxycholic acid (DC)158.0 92.9, Chenodeoxycholic acid (CDC)1093.6 983.7，Cholic acid (C) 2285．1 1664.1.In the group of intrahepatic stones, the resultswere: LC 117.4 91.9, DC 105.1 75.9, CDC767.3 569.3, C 1383.0 997.0. These resultsshow a different bile acid contents between thetwo groups. The mean LC and DC levels inthe intrahepatic group were lower than in thegall stone group. Due to the large individualvariations, these differences did not reach thelevel of statistical significance. On the otherhand, the primary bile acid levels (C and CDC)were significantly lower in the intrahepaticstone group.
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