담석증(膽石症)환자의 담관직경 내압(內壓) 및 성장(性狀)에 관한 연구

Abstract

[한글]

THE STUDY ON THE DIAMETER OF COMMON BILE DUCT, ITS PRESSURE AND COMPOSITION OF BILE

IN GAL STONE PATIENTS

Choi, Yorng Man

Department of Medical Science, Graduate School, Yonsei University

Ⅰ. Introduction

It has been recognized the incidence of common bile duct stones are more frequent

in Koreans more than Occidentals in the reported series. this fact reported and

emphasized by Dr. Ludlow from Severance hospital in 1930.

The present study is aimed to study the difference between gall bladder and

common bile duct and composition of bile.

The representative theories on the gall stone formation could be summarized as

follows

1) Stasis of bile flow

2) Infection of bile

3) Compositional change of bile

Nothing could be definitely stated in case of human patients.

Ⅱ. Materials and Methods

All subjects were admitted to Yonsei Medical Center and proved cases of gall

stones in the various biliary tract by operation from January, 1967 to the end of

August, 1969.

The diameter of common bile duct was measured in 112 cases. An additional 23

cases were studied on the pressure, diameter of common bile duct and bile

composition of gall bladder and common bile duct. 10 cases thise who was not

affected biliary tract dixease were selected as controls among those 25 cases. All

measurement of the common bile duct were made by compass on the immediate distal

common bile duct to main cystic duct. Bile sample collections for chemical analysis

were taken after measurement of pressure and diameter of common bile duct.

The pressure measurement of common bile duct was made by using water manometer

which was connected with 3-way stop cock, 22-gauge needle was used to minimize the

least leakage of bile after needle insertion. Bile studies were made for the

analysis of bilirubin, cholate and its specific gravity. Specific gravity was

measured using Electric balance under the room temperature(18-20 degree in

Centigrade).

Bilirubin measurement was made as follows.

0.2 ml. of bile was diluted up to 200 times with 0.1 N phosphate buffer solution,

pH 7.4 and it was read with spectrophotometer at 455 mu.

The measurement of cholate was made as follows.

0.2 ml. of bile was diluted up to 50 times with 0.1 N phosphate buffer solution,

pH 7.4 and 1.0ml. of the dilutes bile were mixed with 6.9ml. of 16N sulfuric acid

and 1.0 ml. of frufural solution. the mixed solution were heated for 13 minutes

with water bath(65℃) and then it was cooled down to room temperature. After

cooling, the solution was mixed with 5.0 ml. of glacial acetic acid solution and it

was read with spectrophotometer at 620 mu.

Ⅲ. Experimental results

(A) Observations on diameter of common bile duct were carried out into 4 groups.

The number of cases and its average values are as follows

Group No. Diameter(Cm)

-------------------------------------------------------------------------------

1. Control 10 1.0

2. Gall bladder stone alone 32 1.2

3. Gall bladder and C.B.D. stone 22 2.0

4. C.B.D. stone alone 48 2.4

-------------------------------------------------------------------------------

(B) Observations on the diameter, pressure of common bile duct and composition of

bile were made into 3 groups.

Group 1. .................Control

Group 2. .................Gall bladder stone patient

Group 3. .................Common bile duct stone patient

group no. diameter pressure specific gravity bilirubin cholate

C.B.D. C.B.D. G.B. C.B.D. G.B. C.B.D. G.B. C.B.D.

-------------------------------------------------------------------------------

1. 10 1.0 10.6 1.030 1.009 236.5 46.54 22.05 4.14

2. 7 1.2 12.4 1.035 1.010 141.6 32.09 15.6 4.17

3. 8 2.4 24.05 1.012 1.021 25.25 37.0 5.73 5.80

Ⅳ. Discussions

It is difficult to measure the diameter and pressure of common bile duct under

physiological conditions in human. Most of these measurements were made during

operation or after operation through the T-tube.

Numerous reports were made on the diameter of common bile duct in Occidentals and

the average value seems to be around 0.6-1.0 cm. there is none of these reports

among Koreans.

The present study reveals that its average values are 1.0 cm among control cases.

there exists some propotional relationship between diameter and pressure of common

bile duct in the present study. there are scattered report on the pressure of

common bile duct after biliary tract surgery in the Occidentals. But it is actually

difficult to compare these data to present study due to different conditions.

Bilirubin and cholate values showed quite characteristic change in gall stone and

common bile duct stone patients. The comparison data of bilirubin and cholate

values between gall bladder bile and common bile duct bile according to

experimental groups are follows.

group bilirubin cholate specific gravity

-------------------------------------------------------------------------------

1. 6 : 1 5 : 1 3 : 1

2. 3 : 1 4 : 1 3.5 : 1

3. 1 : 2 1 : 1 1 : 2

Specific gravity of bile in the control group are slightly lower than

Occidentals. This is considered to be low cholesterol and cholate value in the

bile. All these data has suggested that the concentrating ability of bile has

markedly diminished in case of choledocholithiasis. There also noted compensating

dilatation of common bile duct in case of choledocholithiasis.

Ⅴ. Conclusions

1. The diameter of common bile duct was measured in 112 biliary tract diseases

patients. 10 cases of non-biliary tract disease were used as control. The diameter

of common bile duct, specific gravity and composition of bile were measured in 15

cases of cholelithiasis and choledocholithiasis.

2. There noted remarkable diminition of concentrating ability of bile in gall

bladder in cases of choledocholithiasis than cholelithiasis.

3. Some of these findings are considered to be very helful for differential

diagnosis of biliary tract disease pre-operatively or intra-operatively and by the

same taken.

It would be much help for surgical judgement.

[영문]

Ⅰ. Introduction

It has been recognized the incidence of common bile duct stones are more frequent in Koreans more than Occidentals in the reported series. this fact reported and emphasized by Dr. Ludlow from Severance hospital in 1930.

The present study is aimed to study the difference between gall bladder and common bile duct and composition of bile.

The representative theories on the gall stone formation could be summarized as follows

1) Stasis of bile flow

2) Infection of bile

3) Compositional change of bile

Nothing could be definitely stated in case of human patients.

Ⅱ. Materials and Methods

All subjects were admitted to Yonsei Medical Center and proved cases of gall stones in the various biliary tract by operation from January, 1967 to the end of August, 1969.

The diameter of common bile duct was measured in 112 cases. An additional 23 cases were studied on the pressure, diameter of common bile duct and bile composition of gall bladder and common bile duct. 10 cases thise who was not affected biliary tract dixease were selected as controls among those 25 cases. All

measurement of the common bile duct were made by compass on the immediate distal common bile duct to main cystic duct. Bile sample collections for chemical analysis were taken after measurement of pressure and diameter of common bile duct.

The pressure measurement of common bile duct was made by using water manometer which was connected with 3-way stop cock, 22-gauge needle was used to minimize the least leakage of bile after needle insertion. Bile studies were made for the analysis of bilirubin, cholate and its specific gravity. Specific gravity was

measured using Electric balance under the room temperature(18-20 degree in Centigrade).

Bilirubin measurement was made as follows.

0.2 ml. of bile was diluted up to 200 times with 0.1 N phosphate buffer solution, pH 7.4 and it was read with spectrophotometer at 455 mu.

The measurement of cholate was made as follows.

0.2 ml. of bile was diluted up to 50 times with 0.1 N phosphate buffer solution, pH 7.4 and 1.0ml. of the dilutes bile were mixed with 6.9ml. of 16N sulfuric acid and 1.0 ml. of frufural solution. the mixed solution were heated for 13 minutes with water bath(65℃) and then it was cooled down to room temperature. After cooling, the solution was mixed with 5.0 ml. of glacial acetic acid solution and it was read with spectrophotometer at 620 mu.

Ⅲ. Experimental results

(A) Observations on diameter of common bile duct were carried out into 4 groups.

The number of cases and its average values are as follows

Group No. Diameter(Cm)

-------------------------------------------------------------------------------

1. Control 10 1.0

2. Gall bladder stone alone 32 1.2

3. Gall bladder and C.B.D. stone 22 2.0

4. C.B.D. stone alone 48 2.4

-------------------------------------------------------------------------------

(B) Observations on the diameter, pressure of common bile duct and composition of

bile were made into 3 groups.

Group 1. .................Control

Group 2. .................Gall bladder stone patient

Group 3. .................Common bile duct stone patient

group no. diameter pressure specific gravity bilirubin cholate

C.B.D. C.B.D. G.B. C.B.D. G.B. C.B.D. G.B. C.B.D.

-------------------------------------------------------------------------------

1. 10 1.0 10.6 1.030 1.009 236.5 46.54 22.05 4.14

2. 7 1.2 12.4 1.035 1.010 141.6 32.09 15.6 4.17

3. 8 2.4 24.05 1.012 1.021 25.25 37.0 5.73 5.80

Ⅳ. Discussions

It is difficult to measure the diameter and pressure of common bile duct under physiological conditions in human. Most of these measurements were made during operation or after operation through the T-tube.

Numerous reports were made on the diameter of common bile duct in Occidentals and the average value seems to be around 0.6-1.0 cm. there is none of these reports among Koreans.

The present study reveals that its average values are 1.0 cm among control cases.

there exists some propotional relationship between diameter and pressure of common bile duct in the present study. there are scattered report on the pressure of common bile duct after biliary tract surgery in the Occidentals. But it is actually

difficult to compare these data to present study due to different conditions.

Bilirubin and cholate values showed quite characteristic change in gall stone and common bile duct stone patients. The comparison data of bilirubin and cholate values between gall bladder bile and common bile duct bile according to experimental groups are follows.

group bilirubin cholate specific gravity

-------------------------------------------------------------------------------

1. 6 : 1 5 : 1 3 : 1

2. 3 : 1 4 : 1 3.5 : 1

3. 1 : 2 1 : 1 1 : 2

Specific gravity of bile in the control group are slightly lower than Occidentals. This is considered to be low cholesterol and cholate value in the bile. All these data has suggested that the concentrating ability of bile has markedly diminished in case of choledocholithiasis. There also noted compensating dilatation of common bile duct in case of choledocholithiasis.

Ⅴ. Conclusions

1. The diameter of common bile duct was measured in 112 biliary tract diseases patients. 10 cases of non-biliary tract disease were used as control. The diameter of common bile duct, specific gravity and composition of bile were measured in 15 cases of cholelithiasis and choledocholithiasis.

2. There noted remarkable diminition of concentrating ability of bile in gall bladder in cases of choledocholithiasis than cholelithiasis.

3. Some of these findings are considered to be very helful for differential diagnosis of biliary tract disease pre-operatively or intra-operatively and by the same taken.

It would be much help for surgical judgement.