本文選題：肝內(nèi)膽管結(jié)石 + 糖蛋白��； 參考：《山東大學(xué)》2015年博士論文

【摘要】：前言肝內(nèi)膽管結(jié)石是發(fā)生在左右肝管匯合部以上各分枝膽管內(nèi)的結(jié)石,在西方國(guó)家很少見,中國(guó)的肝內(nèi)膽管結(jié)石病人在所有的這類病人中占據(jù)著非常大的比例。肝內(nèi)膽管結(jié)石是一種發(fā)病率高、病情嚴(yán)重復(fù)雜、治療困難、容易復(fù)發(fā)的疾病。肝內(nèi)膽管結(jié)石的發(fā)生與環(huán)境因素、飲食結(jié)構(gòu)、感染、膽汁淤積、寄生蟲、遺傳等因素密切相關(guān)。結(jié)石形成的基礎(chǔ)是膽固醇在膽汁中呈飽和甚至過(guò)飽和狀態(tài)或者是非結(jié)合膽紅素在膽汁中相對(duì)增多,膽汁中的糖蛋白、金屬離子等均參與結(jié)石的形成并起著非常重要的作用。肝內(nèi)膽管結(jié)石可引起反復(fù)發(fā)作的膽管炎、敗血癥、門脈高壓、肝功能損害甚至衰竭等嚴(yán)重并發(fā)癥,還可導(dǎo)致肝癌,嚴(yán)重威脅了病人的健康和生命。但是,肝內(nèi)膽管結(jié)石不是惡性腫瘤,是一類良性疾病,應(yīng)該是可以防治的。第一部分膽汁糖蛋白含量測(cè)定及其意義目的通過(guò)測(cè)定膽汁中糖蛋白含量,對(duì)比肝內(nèi)膽管結(jié)石病人與肝外膽管結(jié)石病人膽汁中糖蛋白含量的不同,獲得更有說(shuō)服力的研究結(jié)果,探討肝內(nèi)膽管結(jié)石多發(fā)、復(fù)發(fā)的相關(guān)因素,為指導(dǎo)病人在生活工作中如何注意相關(guān)事項(xiàng)以預(yù)防其發(fā)生,指導(dǎo)醫(yī)生如何選擇恰當(dāng)?shù)闹委煼椒ㄒ匀〉酶玫寞熜峁┲匾罁?jù)。材料和方法1.病人資料：選擇2012年12月-2014年02月間因膽石癥入院的病人38例,肝內(nèi)膽管結(jié)石組病人17例,肝外膽管結(jié)石組病人21例,同期住院的非膽石癥病人18例為對(duì)照組,共56例。2.標(biāo)本采集：膽石癥病人膽汁標(biāo)本于術(shù)后(或EST后)3天通過(guò)T型引流管或鼻膽管取20ml,放置在無(wú)菌試管內(nèi)進(jìn)行密封保存,并放入冰箱內(nèi),設(shè)定溫度為零下20攝氏度。對(duì)非膽石癥病人均于術(shù)中細(xì)針穿刺膽囊取膽汁20ml,存放置在無(wú)菌試管內(nèi)進(jìn)行密封保存,并放入冰箱內(nèi),設(shè)定溫度為零下20攝氏度。3.方法：膽汁標(biāo)本解凍后,經(jīng)過(guò)離心、沉淀、除鹽等過(guò)程后,通過(guò)SDS-PAGE電泳跑出蛋白條帶,將分子量在200KD以下的蛋白條帶轉(zhuǎn)移至硝酸纖維素膜上,再以糖蛋白測(cè)定試劑盒,采用過(guò)碘酸一席夫液試劑染色法(PAS法)進(jìn)行糖蛋白定性試驗(yàn)。糖蛋白的定量按Lowry法,以血清白蛋白為標(biāo)準(zhǔn),計(jì)算分子量在200KD以下的糖蛋白含量值。4.統(tǒng)計(jì)學(xué)處理：分別計(jì)算各組病人的膽汁糖蛋白含量,所得數(shù)據(jù)用X±S表示,以SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理。采用獨(dú)立樣本實(shí)驗(yàn)的均值比較,方差齊則取對(duì)應(yīng)方差齊的P值,方差不齊則取對(duì)應(yīng)方差不齊的P值,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.關(guān)于膽汁糖蛋白含量：肝內(nèi)膽管結(jié)石組病人高于肝外膽管結(jié)石組病人,肝外膽管結(jié)石組病人高于對(duì)照組病人。2.關(guān)于均值比較統(tǒng)計(jì)學(xué)處理：肝內(nèi)膽管結(jié)石組病人與肝外膽管結(jié)石組病人兩組數(shù)據(jù)間的差異具有顯著性；肝內(nèi)膽管結(jié)石組病人、肝外膽管結(jié)石組病人分別與對(duì)照組病人數(shù)據(jù)比較的差異均具有顯著性。討論1.研究肝內(nèi)膽管結(jié)石發(fā)病機(jī)制的重要性：肝內(nèi)膽管結(jié)石因其治療困難及并發(fā)癥嚴(yán)重可能會(huì)導(dǎo)致病人死亡,但是它不是惡性腫瘤,而是一類良性疾病,應(yīng)該是可以預(yù)防和治愈的。因此,探索其病因及發(fā)病規(guī)律,為指導(dǎo)病人在生活工作中如何注意相關(guān)事項(xiàng)以及指導(dǎo)醫(yī)生如何選擇恰當(dāng)?shù)闹委煼椒ㄌ峁┮罁?jù)就顯得非常重要。2.糖蛋白在肝內(nèi)膽管結(jié)石形成中的作用機(jī)制：研究發(fā)現(xiàn)糖蛋白的凝聚作用是膽石形成的主要因素。許多實(shí)驗(yàn)結(jié)果表明：一定分子量范圍內(nèi)的糖蛋白在膽石形成過(guò)程中起促進(jìn)作用。糖蛋白或糖蛋白膽色素復(fù)合物可以作為核心,使膽固醇結(jié)晶或膽色素鈣鹽不斷沉積而形成結(jié)石。糖蛋白分子之間互相交聯(lián)在膽管粘膜表面形成膠體網(wǎng)狀結(jié)構(gòu)中,微泡的運(yùn)動(dòng)受到限制,微泡脫水融合,形成膽固醇結(jié)晶。糖蛋白形成的凝膠體粘性很高,膽色素分子及鈣離子被粘附在凝膠體中,相互結(jié)合形成膽色素鈣復(fù)合物。在糖蛋白凝膠體中,膽固醇結(jié)晶或膽色素鈣鹽在糖蛋白復(fù)合物或糖蛋白膽色素復(fù)合物周圍不斷沉積、粘附、結(jié)合而形成結(jié)石。3.糖蛋白的相關(guān)研究：很多學(xué)者通過(guò)各自的研究一致認(rèn)為,糖蛋白在膽石形成過(guò)程中起著重要的作用。4本研究的特點(diǎn)：我們以肝內(nèi)膽管結(jié)石病人為研究對(duì)象,直接用膽汁為標(biāo)本測(cè)定糖蛋白含量,從深層次探討與肝內(nèi)膽管結(jié)石形成及復(fù)發(fā)相關(guān)的因素。采用SDS-PAGE電泳分離后PAS法染色,測(cè)定膽汁糖蛋白含量,這種方法是目前比較先進(jìn)的測(cè)定糖蛋白的方法,經(jīng)濟(jì),可靠,數(shù)據(jù)容易得出。促進(jìn)膽管結(jié)石形成的糖蛋白分子量都在200KD左右以下。結(jié)論本研究結(jié)果表明膽汁糖蛋白含量與膽管結(jié)石的形成相關(guān),而膽汁糖蛋白含量與肝內(nèi)膽結(jié)石的形成關(guān)系更為密切,測(cè)定膽汁糖蛋白含量對(duì)肝內(nèi)膽管結(jié)石病人具有重要的意義。第二部分膽汁鈣離子含量測(cè)定及意義目的本研究通過(guò)測(cè)定膽汁鈣離子含量,對(duì)比肝內(nèi)膽管結(jié)石病人與肝外膽管結(jié)石病人膽汁鈣離子含量的不同,獲得更有說(shuō)服力的研究結(jié)果,探討肝內(nèi)膽管結(jié)石多發(fā)、復(fù)發(fā)的相關(guān)因素,為指導(dǎo)病人在生活工作中如何注意相關(guān)事項(xiàng)以預(yù)防其發(fā)生,指導(dǎo)醫(yī)生如何選擇恰當(dāng)?shù)闹委煼椒ㄒ匀〉酶玫寞熜峁┲匾罁?jù)。材料和方法1.病人資料及標(biāo)本采集同第一部分。2.方法：膽汁標(biāo)本凍融后,在酸性鉻藍(lán)K緩沖溶液中加入膽汁標(biāo)本,膽汁中的鈣與酸性鉻藍(lán)K間形成一種絡(luò)合物,此絡(luò)合物的最大吸收波長(zhǎng)為496 n m,用分光光度法在波長(zhǎng)496 n m處測(cè)量酸性鉻藍(lán)K溶液吸光度減少值,能測(cè)定的鈣離子含量范圍為0～60mol/L。3.統(tǒng)計(jì)學(xué)處理：分別計(jì)算各組病人的膽汁鈣離子含量,所得數(shù)據(jù)用X±S表示,以SPSS17.0軟件行統(tǒng)計(jì)學(xué)處理。采用獨(dú)立樣本實(shí)驗(yàn)的均值比較,方差齊則取對(duì)應(yīng)方差齊的P值,方差不齊則取對(duì)應(yīng)方差不齊的P值,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.關(guān)于膽汁鈣離子含量：肝內(nèi)膽管結(jié)石組病人高于肝外膽管結(jié)石組病人,肝外膽管結(jié)石組病人高于對(duì)照組病人。2.關(guān)于均值比較統(tǒng)計(jì)學(xué)處理：肝內(nèi)膽管結(jié)石組病人與肝外膽管結(jié)石組病人兩組數(shù)據(jù)間的差異具有顯著性；肝內(nèi)膽管結(jié)石組病人、肝外膽管結(jié)石組病人分別與對(duì)照組病人數(shù)據(jù)比較的差異均具有顯著性。討論1肝內(nèi)膽管結(jié)石的特點(diǎn)：肝內(nèi)膽管結(jié)石在我國(guó)的發(fā)病率比較高,其發(fā)生與環(huán)境、飲食、感染等許多因素有關(guān),其形成涉及到游離膽紅素所占比例增高；結(jié)石核心的形成；糖蛋白的凝聚作用以及金屬離子的參與等。主要是膽色素結(jié)石,常伴有膽汁淤積及膽道感染。臨床特點(diǎn)為間歇性、反復(fù)性發(fā)作。其治療比較困難,療效不夠滿意。2病因機(jī)制的特殊性：肝內(nèi)膽管結(jié)石主要成分是膽色素和鈣。由于膽道感染等原因?qū)е履懼杏坞x膽紅素所占的比例增高,可與膽汁中的鈣結(jié)合,形成不溶性的膽紅素鈣而析出,進(jìn)而形成肝內(nèi)膽管結(jié)石3鈣離子在肝內(nèi)膽管結(jié)石形成中的作用機(jī)制研究：游離膽紅素和其他物質(zhì)與金屬離子集結(jié)是肝內(nèi)膽管結(jié)石形成的一個(gè)主要過(guò)程,并且鈣離子是所有離子中的首要作用物質(zhì)。鈣離子與膽紅素、糖蛋白分子結(jié)構(gòu)中的羥基很容易結(jié)合形成不能分解的聚合物。鈣離子在膽石網(wǎng)狀結(jié)構(gòu)的形成中起著離子橋的作用。4本研究的特點(diǎn)：我們以肝內(nèi)膽管結(jié)石病人為研究對(duì)象,直接用膽汁為標(biāo)本測(cè)定膽汁中鈣離子含量,這是本研究的與以往相關(guān)研究的不同之處,希望從深層次探討與肝內(nèi)膽管結(jié)石形成及復(fù)發(fā)相關(guān)的因素。鈣離子測(cè)定選用酸性鉻藍(lán)K分光光度法,此方法能測(cè)定膽汁中微量鈣,誤差很小,比較準(zhǔn)確,方法簡(jiǎn)單易行。結(jié)論本研究結(jié)果表明膽汁鈣離子含量與膽管結(jié)石的形成相關(guān),尤其是與肝內(nèi)膽結(jié)石形成關(guān)系更為密切。測(cè)定膽汁糖蛋白含量對(duì)肝內(nèi)膽管結(jié)石病人具有重要的意義。小結(jié)1.肝內(nèi)膽管結(jié)石介紹：肝內(nèi)膽管結(jié)石在西方國(guó)家較為少見,我國(guó)的這類病人相對(duì)比較多。可引起膽管梗阻、感染,病情加重可引起肝膿腫、重癥膽管炎、感染性休克。長(zhǎng)期不愈可能導(dǎo)致肝纖維化、肝硬化甚至肝癌。肝內(nèi)膽管結(jié)石病人的治療方法有肝切除術(shù)、內(nèi)鏡治療、肝移植等等。肝內(nèi)膽管結(jié)石的特點(diǎn)是發(fā)病率高、病情復(fù)雜、治療困難、容易復(fù)發(fā),嚴(yán)重影響了病人的健康甚至生命。但是,它是一類良性疾病,應(yīng)該是可以預(yù)防和治愈的。2.本研究結(jié)果：肝內(nèi)膽管結(jié)石是一種特殊類型的膽管結(jié)石,在結(jié)石形成機(jī)理方面既具有一般膽管結(jié)石形成的基本規(guī)律,又具有其自身的特點(diǎn)。3.本研究對(duì)預(yù)防的意義：對(duì)于具有肝內(nèi)膽管結(jié)石高發(fā)因素同時(shí)膽汁糖蛋白、鈣離子含量增高的病人,在生活工作中應(yīng)特別注意習(xí)慣,飲食,環(huán)境等事項(xiàng)或采取一定的預(yù)防措施如應(yīng)用疏肝利膽的一些藥物等,盡可能減少或避免該病的發(fā)生。4.在治療中的意義：對(duì)于膽汁糖蛋白、鈣離子含量明顯增高的肝內(nèi)膽管結(jié)石病人,應(yīng)采取更積極、確實(shí)的治療方法；要為后續(xù)治療預(yù)留途徑；采用綜合性治療措施；做好隨訪。5.與相關(guān)研究的比較：很多相關(guān)研究與本研究的結(jié)果是一致的,說(shuō)明了結(jié)石形成機(jī)理的一般規(guī)律。個(gè)別結(jié)果不一致,可能與地區(qū)、種族、測(cè)定方法及計(jì)算統(tǒng)計(jì)方法不完全一致有,但不是本質(zhì)的、規(guī)律的不同,不影響本研究的結(jié)果。6.不足之處：本研究的所有過(guò)程都嚴(yán)格按照課題及實(shí)驗(yàn)設(shè)計(jì)的要求進(jìn)行的,但畢竟樣本量有限,實(shí)驗(yàn)結(jié)果尚需要多中心大樣本的隨機(jī)對(duì)照實(shí)驗(yàn)來(lái)進(jìn)一步證實(shí)。
[Abstract]:Intrahepatic choledocholithiasis, which occurs in the bile duct of the left and right hepatic duct, is rare in the western countries. In China, the patients with intrahepatic cholangiolithiasis occupy a very large proportion in all these patients. Intrahepatic bile duct stones are a high incidence, serious and complicated disease, difficult treatment, and easy to relapse. The occurrence of intrahepatic bile duct stones is closely related to environmental factors, dietary structure, infection, cholestasis, parasite, heredity and other factors. The basis of the formation of the stones is that the cholesterol is saturated or even supersaturated in the bile, or the unbound bilirubin is relatively increased in the bile, and the glycoproteins and metal ions in the bile are all involved in the shape of the stones. Hepatolithiasis can cause severe complications such as recurrent cholangitis, septicemia, portal hypertension, liver function damage and even failure. It can also cause liver cancer and seriously threaten the health and life of the patients. However, the hepatolithiasis is not a malignant tumor. It is a kind of benign disease and should be prevented. The determination of the content of bile glycoprotein in part 1 and its purpose by measuring the content of glycoprotein in bile and comparing the difference of the glycoprotein content in the bile of patients with intrahepatic bile duct stones and extrahepatic bile duct stones, to obtain more convincing results, to explore the related factors of the recurrence of intrahepatic bile duct stones, and to guide the patients. In the life work, how to pay attention to the related matters in order to prevent its occurrence and how to guide the doctor to choose the appropriate treatment to achieve better curative effect provides an important basis. Material and methods 1. patients: 38 cases of cholelithiasis, 17 cases of intrahepatic bile duct stones, and extrahepatic bile duct stones in 02 months of -2014 in December 2012. Group 21 cases, 18 cases of non cholelithiasis patients in the same period as control group, 56 cases of.2. specimens were collected: bile specimens of cholelithiasis patients were sealed and preserved in aseptic test tubes for 3 days after operation (or after EST) by T type drainage tube or nasal bile duct, and placed in the refrigerator to set the temperature of 20 degrees below zero. The bile 20ml was taken from the gallbladder in the intraoperative fine needle puncture, stored in a sterile test tube to be sealed and preserved, and placed in the refrigerator to set a.3. method of 20 degrees Celsius under zero temperature. After the bile samples were defrosting, after the centrifugation, precipitation, and desalination, the protein strip was run out by SDS-PAGE electrophoresis, and the protein strips with molecular weight below 200KD were transferred. It was moved to the nitrocellulose membrane, then the kit was measured with glycoprotein, and the qualitative test of glycoprotein was carried out by the PAS method. The quantitative Lowry method of glycoprotein and the serum albumin as the standard were used to calculate the content of glycoprotein content below 200KD by.4. statistics: the bile of each group of patients was calculated respectively. The content of glycoprotein was expressed with X + S, and the statistical treatment was performed with SPSS17.0 software. The mean comparison of the independent sample experiment was used to take the P value of the corresponding variance homogeneous, and the P value of the corresponding variance was not homogeneous, and the difference was statistically significant. Results 1. about the bile glycoprotein content: the intrahepatic bile duct stone group disease. The patients were higher than the extrahepatic bile duct stone group, and the patients with extrahepatic bile duct stone group were higher than those of the control group. The mean value of.2. was statistically significant. The difference between the two groups of the patients in the hepatolithiasis group and the extrahepatic bile duct stone group was significant; the patients in the hepatolithiasis group and the extrahepatic bile duct stone group were respectively with the control group. The difference in human data comparison is significant. Discuss the importance of the 1. study on the pathogenesis of intrahepatic bile duct stones: intrahepatic bile duct stones may lead to death because of their treatment difficulties and serious complications, but it is not a malignant tumor, but a kind of benign disease, which should be prevented and cured. Therefore, explore its cause and hair. The rule of disease, in order to guide the patient to pay attention to the related matters in the life work and to guide the doctor how to choose the appropriate treatment method, it is very important that the mechanism of.2. glycoprotein in the formation of intrahepatic bile duct stone formation: the study found that the coagulation of glycoprotein is the main factor of the formation of bile stones. The glycoproteins in a certain molecular weight range play a role in the formation of cholelithiasis. Glycoprotein or glycoprotein cholangio complex can be used as the core to make the cholesterol crystals or calcium salts of calcium salts to form stones. The cross linking of glycoproteins to the surface of the bile duct mucosa forms a colloidal network, and the microbubbles are transported. The gelatin molecules and calcium ions are adhered to the gel to form a calcium complex of calcium pigments. In the glycoprotein gel, the cholesterol crystallization or the calcium salt of the cholesterol is in the glycoprotein complex or the glycoprotein cholesterin complex. The related research on the formation of.3. glycoprotein by continuous deposition, adhesion and binding: many scholars agree that glycoproteins play an important role in the formation of cholelithiasis through their respective studies. We take the hepatolithiasis patients as the research object and determine the glycoprotein content directly by bile. The factors related to the formation and recurrence of intrahepatic bile duct stones were deeply discussed. The content of bile glycoprotein was determined by PAS staining after SDS-PAGE electrophoresis separation. This method is a more advanced method for the determination of glycoprotein at present. It is economical, reliable, and the data are easy to be obtained. The molecular weight of glycoprotein in the formation of bile duct stones is below 200KD Conclusion the results of this study show that the content of bile glycoprotein is related to the formation of bile duct stones, and the content of bile glycoprotein is more closely related to the formation of intrahepatic gallstones. The determination of the content of bile glycoprotein is of great significance for the patients with intrahepatic bile duct stones. The determination of the content and significance of the second parts of the bile cacalate is the purpose of the study. The content of calcium ion of fixed bile and the difference of calcium content of bile in patients with hepatolithiasis and extrahepatic bile duct stone were compared. The results of more persuasive research were obtained, and the related factors of recurrent intrahepatic bile duct stones were discussed. Material and methods 1. patient data and samples were collected with the first part.2. method: bile specimens were added to the acid chrome blue K buffer solution after the bile specimens were frozen and thawing, and the calcium in the bile was formed into a complex between the acid chrome blue K and the maximum absorption wave of the complex. With a length of 496 n m, the absorbency reduction value of acid chrome blue K solution was measured at the wavelength of 496 n m by spectrophotometric method. The content of calcium ion content was measured by 0 to 60mol/L.3.. The calcium content of the bile was calculated in each group of patients respectively. The obtained data were expressed in X + S, using SPSS17.0 software. The independent sample experiment was used. The average variance was compared with the P value of the homogeneity of variance, and the P value of the variance was not homogeneous, and the difference of P0.05 was statistically significant. Results 1. of the bile calcium ion content: the patients in the intrahepatic bile duct stone group were higher than those in the extrahepatic bile duct stone group, and the patients in the extrahepatic bile duct stone group were higher than those of the control group with the mean comparison of the mean value of.2.. Statistical treatment: the difference of data between the two groups of patients with hepatolithiasis group and extrahepatic bile duct stone group was significant. The difference of the data of the patients in the intrahepatic bile duct stone group and the extrahepatic bile duct stone group were significantly different from those of the control group. The characteristics of the 1 intrahepatic bile duct stones were discussed: the intrahepatic bile duct stones were in me. The incidence of the disease is high in the country, which is related to many factors such as environment, diet, infection and so on. Its formation involves the increase in the proportion of free bilirubin, the formation of stone core, the coagulation of glycoprotein and the involvement of metal ions, mainly the cholestasis, often accompanied by cholestasis and biliary tract infection. A recurrent attack. The treatment is difficult and the curative effect is not satisfied with the specificity of the.2 etiological mechanism: the main components of the intrahepatic bile duct stones are bile pigment and calcium. The proportion of free bilirubin in bile increases as a result of biliary tract infection, which can combine with calcium in the bile to form insoluble bilirubin calcium and form the liver. The mechanism of 3 calcium ion in the formation of intrahepatic choledocholithiasis: the aggregation of free bilirubin and other substances and metal ions is a major process in the formation of intrahepatic bile duct stones, and calcium ions are the primary substances in all ions. Calcium ions and bilirubin, the hydroxyl groups in the molecular structure of glycoprotein are easy to knot. The formation of an incapable polymer. Calcium ions play the role of ion bridge in the formation of the cholelithiasis reticular structure.4: we take the intrahepatic cholelithiasis patients as the research object and determine the calcium content in the bile by direct bile. This is the difference between this study and the related research. Study on the factors associated with the formation and recurrence of intrahepatic bile duct stones. Calcium ion determination is used to determine the trace calcium K in the bile. This method can be used to determine trace calcium in bile. The error is very small and accurate. Conclusion the results of this study show that the calcium content of bile is related to the formation of bile duct stones, especially in the liver gallstones. The determination of the content of bile glycoprotein is of great significance for the patients with intrahepatic bile duct stones. The introduction of 1. intrahepatic bile duct stones: intrahepatic bile duct stones are relatively rare in western countries. There are relatively many cases of these patients in our country. It can cause bile duct obstruction, infection, and aggravation of the disease can cause liver abscess, severe cholangitis and feeling. In the long run, it may lead to liver fibrosis, liver cirrhosis and even liver cancer. The treatment of hepatolithiasis patients include hepatectomy, endoscopic treatment, liver transplantation and so on. The characteristics of hepatolithiasis are high incidence, complicated condition, difficult treatment, easy recurrence, severe weight affecting the health and even life of the patients. However, it is one of the patients. Benign diseases of the class should be the results of the.2. study that can be prevented and cured: intrahepatic bile duct stones are a special type of bile duct stones. The mechanism of stone formation not only has the basic law of the formation of common bile duct stones, but also has its own characteristics: the significance of this Study on prevention: the high incidence of intrahepatic bile duct stones. Patients with higher levels of bile glycoprotein and calcium ions should pay special attention to habits, diet, environment, etc. in life work, or take some preventive measures, such as some drugs, such as the use of Liver Soothing and gallbladder, to reduce or avoid the significance of.4. in the treatment of the disease: for bile glycoprotein and calcium content, The patients with elevated intrahepatic bile duct stones should take more active and true treatment methods; to reserve the way for follow-up treatment; adopt comprehensive treatment measures; do a good job of follow-up.5. and related research: many related studies are consistent with the results of this study, indicating the general rule of the formation mechanism of the formation of stone. It may not be entirely consistent with area, race, determination method and calculation and statistical method, but it is not essential, and the law is different. It does not affect the.6. deficiency of the results of this study. All the processes of this study are strictly based on the requirements of the subject and experimental design, but the sample size is limited and the experimental results still need many central samples. This randomized controlled trial is further confirmed.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.42

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