臺灣博碩士論文加值系統

本研究的目的乃是利用超音波來測量早產兒及足月兒的膽囊容積和收縮並評估相關因子；吾人是以橢圓形方法用超音波來測量50位早產兒及46位足月兒的膽囊容積，且測量的時間是在剛出生、出生後6小時、以及接受規則餵奶後經過3小時和6小時的禁食，每隔十五分鐘持續一小時並計算其膽囊容積和收縮指數；膽囊收縮指數是由餵奶後容積的減少量除以禁食後的起始容積。膽囊容積和最大收縮率均以足月兒較為大 ( p < 0.05 )，足月兒亦顯示出較易達到膽囊容積的最大收縮( p < 0.05 )；早產兒膽囊容積的最大收縮需要在懷孕週數大於 31週或是體重大於 1300公克才較清楚觀察到。因此藉由瞭解禁食與餐後系列的膽囊容積和收縮之變化，可以讓吾人評估早產兒及足月兒是否有肝膽系統的疾病。

The aim of this study was to establish the normal values and evaluate associated factors of gallbladder volume and contractility in term and preterm neonates by using ultrasonography. Sonographic measurement of gallbladder volume was performed by using the ellipsoid method in 50 preterm and 46 term infants. We collected data soon and 6-hour fasting after delivery, at 3-hour and 6-hour fasting following regular milk feeding. Serial postprandial changes of gallbladder volume and contractility were collected at 15-minute intervals for one hour. Gallbladder contraction index (C.I.) was determined as percentage decrement of postprandial size from initial size. Both mean gallbladder volume and maximal contraction ratio were larger in term group (P < 0.05). Term neonates demonstrated significant contraction more readily (C.I. > 50%) (P < 0.05). In preterm infants, significant contraction was clearly observed only at postconceptional age above 31 weeks or when their body weight above 1300 gm. A better understanding of gallbladder physiology and its fasting or postprandial sonographic morphology would facilitate sonographic evaluation for the presence of hepatobiliary diseases in preterm and term neonates.

Title
Abstract
Introduction
Patients and methods
Results
Discussion
Conclusion
References
Tables
Figures

1. Douglas BR, Jebbink MC, Thon-a-Tham RT, Jansen JB, Lamers CB. The effect of loxiglumide (CR-1505) on basal and bombesin-stimulated gallbladder volume in man. Eur J Pharmacol 1989; 166:307-9
2. Corazziari E, Ricci R, Biliotti D, Bontempo I, DeMedici A, Pallotta N. Oral
administration of loxiglumide (CCK antagonist) inhibits postprandial gallbladder contraction without affecting gastric emptying. Dig Dis Sci 1990; 35: 50-4
3. Liddle RA, Goldfine ID, Rosen MS, Taplitz RA, Williams JA. Cholecystokinin
bioactivity in human plasma. Molecular form, responses to feeding, and relationship to gallbladder contraction. J Clin Invest 1985; 75:1144-52
4. Nealon WH, Upp JR, Alexander RW, Gomez G, Townsend Jr CM, Tompson JC. Intravenous aminoacids stimulate human gallbladder emptying and hormone release. Am J Physiol 1990; 259: G173-8
5. MacGregor IL, Deveney C, Way LW, Meyer JH. The effect of acute hyperglycaemia on meal-stimulated gastric, biliary and pancreatic secretion and serum gastrin. Gastroenterology 1976; 70: 197-202
6. De Boer SY, Masclee AAM, Lam WF, Schipper J, Lamers CBHW. Blood glucose modulates gallbladder motility and small intestinal transit time. Gastroenterology 1992; 102: A549
7. Dodds WJ, Darweesh RMA, Lawson TL, Kishk SMA, Kern MK. Sonographic measurement of gallbladder volume. AJR 1985; 145: 1009-11
8. Okano H, Saeki S, Inui A, Kawai Y, Ohno S, Morimoto S, et al. Effect of
trimebutine maleate on emptying of stomach and gallbladder and release of gut peptide following a solid meal in man. Dig Dis Sci 1993; 38: 817-23
9. Jawaheer G, Pierro A, Lloyd DA, Shaw NJ. Gallbladder contractility in neonates: effects of parenteral and enteral feeding. Arch Dis Child 1995; 72: F200-2
10. Lehtonen L, Svedstrom E, Korvenranta H. The size and contractility of the gallbladder in infants. Pediatr Radiol. 1992;
22: 515-18
11. Buchan AMJ, Bryant MG, Polak, JM, Gregor M, Ghayei MA, Bloom SR. Development of regulatory peptides in the human fetal intestine. In: Bloom SR, Polak J, eds. Gut Hormones. Edinburgh: Churchill Livingstone, 1981: 119-24
12. Lucas A, Bloom SR, Aynsley-Green A. Metabolic and endocrine events at the time of the first feed of human milk in preterm and term infants. Arch Dis Child 1978; 53: 731-6.
13. Cano N, Cicero F, Ranieri F, Martin J, DiCostanzo J. Ultrasonographic study of gallbladder motility during total parenteral nutrition. Gastroenterology 1986; 92(2): 313-7
14. Matos C, Avni EF, Gansbeke DV, Pardou A, Struyven J. Total parenteral nutrition (TPN) and gallbladder diseases in neonates - sonsgraphic assesment. J Ultrasound Med 1987; 6: 243-8
15. Dewan PA, Stokes KB, Solomon JR. Pediatric acalculous cholecystitis. Pediatr Surg Int 1987; 2; 120-1
16. Palasciano G, Albano O. Gallstone prevalence and gallbladder volume in children and adolescents: a epidemiological
ultrasonographic survey and relationship to body mass index. Am J Gastroenterol. 1989; 84: 1378-82
17. Ishitani MB, Shaul DB, Padua EA, McAlpin CA. Choledocholithiasis in a premature neonate. J Pediatr. 1996; 128: 853-5
18. Ikeda S, Sera Y, Akagi M. Serial ultrasonic examination to differentiate biliary atresia from neonatal hepatitis - special reference to change in size of the gallbladder. Eur J Pediatr 1989; 148: 396-400
19. Abramson SJ, Treves S, Teele RL. The infant with possible biliary atresia evaluation by ultrasound and nuclear medicine. Pediatr Radiol 1982; 12: 1-5
20. McGahan JP, Phillips HE, Cox KL. Sonography of normal pediatric gallbladder and biliary tract. Radiology 1982; 144:873-5
21. El-Shafie M, Mah C.L. Transient gallbladder distention in sick premature infants: the value of ultrasonography and radionuclide scintigraphy. Pediatr Radiol 1996; 16: 468-71