Exploring the Mechanisms of Human Gallbladder Pain

胆结石和其他胆道疾病影响英国10%以上的成年人口。英国每年进行多达60，000次胆囊切除手术，NHS的成本约为4000万英镑。然而，由于我们对疼痛机制缺乏了解，手术往往无法保证缓解症状。本项目的目的是使用力学模型探索疼痛机制。当胆囊在排空期间收缩时，不仅腔内压力升高，而且胆囊的大小和形状也根据下游流动条件而改变。因此，胆囊肌壁中的各种应力分布也发生变化。我们认为，胆囊内的总应力，而不是压力或体积变化，在胆囊疼痛中起关键作用。我们的目标是建立这个新的概念，进行非线性应力分析的胆囊模型，包括被动和主动应力。该模型将针对各种受试者的对照临床实验进行测试。这里提出的工作是重要的理解胆囊疼痛的机制，因为这是第一次使用人体胆道系统的机械建模的方法。虽然一般认为疼痛感受器可能是机械敏感的，但它们之间的确切联系仍不清楚。如果这个新的概念能够在这个项目中得到证实，它将提供一个更清晰的问题，并有助于更有效的手术诊断。

Gallstone and other diseases of the biliary tract affect more than 10% of the adult population of the UK. Up to 60,000 operations to remove the gallbladder are performed in the UK each year, at a cost of approximately 40 million to the NHS. However, due to our lack of understanding of the pain mechanism, surgery is often conducted without any guarantee of relieving the symptoms. The purpose of this project is to explore the pain mechanism using a mechanical model. When gallbladder contracts during emptying, not only the intra-luminal pressure rises, but the size and shape of the gallbladder also change depending on the downstream flow condition. Consequently, the various stress distributions in the gallbladder muscle wall also change. We believe that it is the total stresses in the gallbladder, not the pressure or volume change, that play the key role in the gallbladder pain. We aim to establish this new concept by carrying out a non-linear stress analysis of the gallbladder models, including both the passive and the active stresses. This model will be tested against controlled clinical experiments for various subjects. The work proposed here is significant for understanding the gallbladder pain mechanism since this is the first approach using mechanical modelling of the human biliary system. Although it is generally believed that the pain receptors are likely to be mechano-sensitive, the precise link between these remains unclear. If the new concept can be confirmed in this project, it will provide a much clearer picture of the problem, and help with more efficient surgical diagnosis.