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KMID : 0371319700120050037
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Journal of the Korean Surgical Society
1970 Volume.12 No. 5 p.37 ~ p.44
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The Stduy on the Dimeter of Common Bile Duct , Its Pressure and Composition of Bile in Gall Stone Patients
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Abstract
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It has been recognized that the incidence of common bile duct stones is more frequent in Koreans
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 gallbladder and common bile duct and
composition of bile.
All subjects were admitted to Yonsei Medical Center and proved cases of gall stones in the various
biliary tract by operation from January, 1st, 1967 to the end of August, 1969.
The diameter of common bile duct was measured in 112 cases. An additional 25 cases were studied
on the pressure, diameter of common bile duct and composition of bile in gall bladder and common
bile duct. 10 cases this who was not affected biliary tract diseases were selected as controls among
those 25 cases. All measurement of pressure and diameter of common bile duct. The pressure measur
ement of common bile duct was made by using water manometer which was connected with 3-way
stop cock, 22-gauge needle insertion. Bile studies were made for the analysis of bilirubin, cholate
and its specific gravity. Specific Gracity was measured using Electric balance under the room temper
ature (18∼20 degree in Centigrade).
Bilirubin measurement was made as follows.
0.2㎖ of bile diluted up to 200 times with 0.1Ｎ, phosphate buffer soution, Ｐ.Ｈ, 7.4 and
it was read with Spectrophotometer at 455mu.
The measurement of cholate was made as follows.
0.2㎖ of bile diluted up to 50 times with 0.1Ｎ, phosphate buffer soution, Ｐ.Ｈ, 7.4 and 1.0㎖.
of the dilutes bile were mixed with 9.0㎖. of 16Ｎ sulfuric acid and 1.0㎖. of frutal solution. The
mixed silution were heated for 13 minutes water bath(65Ｃ) and then it was cooled down to room
temperature. After cooling, the solution was mixed with 5.0㎖. of glacial acetic acid solution and it
was read with Spectrophotometer at 620mu.
The present study reveals that it average value of common bile duct was 1.0㎝ among control
cases, 1.2㎝ in cholelithiasis and 2.4㎝ in choledocholithiasis patients. Also, the pressure of common
bile duct was 103 mmH₂O in control group, 120 mmH₂O in cholelelithiasis and 245 mmH₂O in
choledocholithiasis patients.
The content of bilirubin in gall bladder bile was 236.6㎎% in control group, 141.64 ㎎% in
cholelithiasis and 26.25 ㎎% in choledocholithiasis patients. The content of common bile duct duct bile
was 46.5 ㎎% in control group, 32.1 ㎎% in cholelithiasis and 37.0 ㎎% in choledocholithiasis
patients.
The Specific Gravity (S.G) in gall bladder bile was 1.030 in control group, 1.035 in cholelithiasis
and 1.012 in choledocholithiasis patents. Also the Specific Gravity in common bile duct bile
was 1.009 in control group, 1.010 in cholelithiasis and 1.021 in choledocholithiasis patents.
The value of cholate in gall bladder bile was 22.05 ㎎/㎖ in control group, 15.6 ㎎/㎖. in
cholelithiasis and 5.73 ㎎/㎖. in choledocholithiasis patents. The value of cholate in common bile
duct bile was 4.14 ㎎/㎖. in control group, 4.17 ㎎/㎖. in cholelithiasis and 5.8 ㎎/㎖. in chole
docholithiasis patents.
Conclusions.
1. The diameter of common bile duct was measured in 112 biliary tract diseases patients 10 cases
of non-biliary tract diseases were used as control. The diameter of common bile duct, specific gravity
and composition of bile were measured in 15 cases of cholelithiasis and chiledocholithiasis.
2. The diameter of Common bile duct was dilated in the cases of choledocholithiasis and secondarily
in cholelithiasis combined intrahepatic stones. in the cases of cholelithiasis alone, the diameter of
common bile duct showed no remarkable change from those of the control group.
The pressure of common bile duct was also highest in choledocholithiasis and showed no remarkable cholelithiasis.
The Specific gravity, bilirubin and cholate were remarkabley decreased than those of gallbladder bile
in cholelithiasis.
However, in the choledocholithiasis cases, the results were on the contrary.
3. Some of thesse findings are considered to be very helful for differential diagnesis of biliary tract
diseases preoperetively or intra-operatively and by the same taken.
It would be much help for surgical judgement.
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