保胆手术与传统胆囊切除术后豚鼠肠道形态、功能变化的比较研究

发布时间：2018-05-12 20:27

本文选题：胆囊切除术后 + 保胆手术　；参考：《苏州大学》2014年硕士论文

【摘要】：目的：传统胆囊切除术一直是治疗胆囊疾病的首选方法，1987-Philippe Moure t完成世界上第一例电视腹腔镜胆囊切除术，1991-荀祖武等在我国第一次报道电视腹腔镜胆囊切除术。腹腔镜下胆囊切除术发展迅速，因具有创伤小，美观、恢复快等优点在县级及以上医院已成为常规胆囊切除术的首选方法。但胆囊切除后，部分患者出现腹泻、便秘等大便习惯和（或）大便性状改变，甚至腹痛、食欲不振、体重减轻、暖气和黄疸等症状，有人称之为胆道术后综合征（PCS）⑴。且治疗效果差，影响患者正常的工作、学习；以及远期监测发现胆囊切除术后患者结肠癌发病率升高，对这些问题至今缺乏较统一和清晰的认识，国内外对此问题的报道较少，如何在解决胆囊结石的同时尽可能少地减少术后并发症是值得研究的问题。本实验通过比较豚鼠经传统胆囊切除术和取石后保留胆囊的保胆术后肠道运动、肠粘膜形态的差异，为寻找胆囊切除术后腹泻、结肠肿瘤发病率升高⑵的原因及防治提供一些理论依据。方法：取致石食谱喂养的清洁级健康豚鼠60只，体重230-280g，随机分成A（保胆手术）、B（胆囊切除）共2组，每组均30只。A组切开胆囊，取尽结石，B组结扎胆囊管，，行胆囊切除术，手术均遵循无菌原则，相同麻醉条件，术后1周伤口愈合，饮食正常；术后4周，禁食12h，禁饮2h，腹腔注射麻醉（局麻）后，消毒，无菌条件下打开豚鼠腹腔，找到胃及盲肠，在胃窦及盲肠处注入相同浓度硫酸钡混悬液2ml，关闭腹腔，30min后，将豚鼠均颈部脱臼处死，打开腹腔，切断并取出胃肠道，清除肠系膜，将全部肠道以5g天平砝码垂直悬挂，测量全肠长度及小肠和结肠分别长度；以幽门（幽门环）、回盲部（回盲瓣）为起点，测量并记录硫酸钡在小肠和结肠中移动的距离，计算相应豚鼠硫酸钡移动距离占小肠及结肠全肠的百分比，比较2组豚鼠的结果。并分别取小肠（距幽门20cm，距回盲瓣10cm）和结肠（距回盲瓣10cm，距肛门15cm）肠壁组织一块，光镜下测量空肠、回肠、结肠厚度及空肠、回肠绒毛高度、宽度。所有数据均采用均数±标准差（xˉ±s）表示，组间比较采用t检验，采用SPSS16.0统计分析软件上进行。结果： 1.各组间硫酸钡在小肠推进率（百分比）比较：A组：35.05±2.56，B组：43.14±3.03，B组和A组间差别有显著意义（P0.05）。 2.各组间硫酸钡在结肠推进率（百分比）比较：A组：5.15±3.14，B组：7.53±2.89，B组和A组间差别有显著意义（P0.05）。 3.光镜下B组小肠绒毛萎缩，隐窝加深，未见腺体增生，固有层少量淋巴细胞浸润，粘膜下可见散在淋巴小结，上皮细胞由高柱状变矮，部分为立方形；结肠粘膜厚度变薄，上皮细胞完整，杯状细胞无增生，固有层见淋巴细胞浸润。 4.1空肠绒毛高度：A组为264.32±35.91μm,B组为239.47±28.51μm，差别有显著意义（P0.01）。 4.2空肠绒毛宽度：A组为71.46±14.71μm,B组为62.36±11.35μm，差别有显著意义（P0.01）。 4.3空肠粘膜厚度：A组为342.16±55.32μm,B组为315.82±49.42μm，差别有显著意义（P0.01）。 4.4回肠绒毛高度：A组为234.24±25.51μm,B组为219.47±22.07μm，差别有显著意义（P0.01）。 4.5回肠绒毛宽度：A组为75.46±18.37μm,B组为68.36±15.39μm，差别有显著意义（P0.01）。 4.6回肠粘膜厚度：A组为412.16±40.56μm,B组为401.82±42.72μm，差别有显著意义（P0.01）。 4.7结肠粘膜厚度：A组为432.61±42.38μm,B组为420.27±53.22μm，差别有显著意义（P0.01）。结论：胆囊切除后肠道对肠内容物的推进功能增强，肠粘膜轻度萎缩，上皮细胞微绒毛缩小，影响肠道的吸收功能，这些可能是患者术后大便变稀、次数增多的原因。
[Abstract]:Objective : Conventional cholecystectomy has been the first preferred method for the treatment of gallbladder diseases . In 1987 - Philippe Moure t completed the first TV laparoscopic cholecystectomy in the world , the first time in China to report laparoscopic cholecystectomy in China .
Long - term monitoring showed that the incidence of colon cancer in patients with cholecystectomy increased after cholecystectomy . There was a lack of uniform and clear understanding of these problems . How to reduce postoperative complications at home and abroad is a problem worthy of study . This experiment provides some theoretical basis for finding the causes and prevention of diarrhea and colon tumor incidence after cholecystectomy .

Methods : 60 rats weighing 230 - 280 g were randomly divided into two groups : A ( gallbladder - keeping operation ) and B ( cholecystectomy ) group .
After 4 weeks post - operation , the rats were fasted for 12 h , after drinking for 2 h , the abdominal cavity of the guinea pig was opened by intraperitoneal injection of anesthesia ( local anaesthesia ) , the stomach and cecum were opened , the same concentration of barium sulfate suspension was injected into the stomach and the cecum , the abdominal cavity was closed , the gastrointestinal tract was removed , the mesentery was removed , the whole intestinal tract was suspended vertically by 5g balance weight , the length of the whole intestine and the length of the small intestine and colon were measured ;
The distance of barium sulfate moving in small intestine and colon was measured and recorded . The distance of barium sulfate moving in small intestine and colon was measured and recorded , and the results of 2 groups of guinea pigs were compared . The small intestine ( 20 cm from the ileocecal valve and 10 cm from the ileocecal valve ) and the colon ( 10 cm from the ileocecal valve ) were taken to measure the jejunum , ileum , colon thickness and jejunum , height and width of ileum .

All data were expressed by mean 卤 standard deviation ( x 藟卤 s ) , t - test was used between groups , and SPSS 16.0 statistical analysis software was used .

Results :

1 . The ratio of barium sulfate to intestinal propulsive rate ( percentage ) in group A : 35.05 卤 2.56 , group B : 43.14 卤 3.03 , there was significant difference between group B and group A ( P0.05 ) .

2 . In group A : 5.15 卤 3.14 , group B : 7.53 卤 2.89 , there was significant difference between group B and group A ( P0.05 ) .

3 . Under light microscope , the small intestinal villi of group B were atrophy , the recess deepened , no gland hyperplasia was seen , the lamina propria little lymphocyte infiltration , the submucous membrane can be seen scattered in the lymphoid nodules , the epithelial cells are low columnar and short , and the part is vertical square ;
The thickness of the colonic mucosa is thin , the epithelial cells are intact , the cup - shaped cells are not proliferated , and the lamina propria is seen to infiltrate the lymphocytes .

4.1 The height of jejunum and intestine were 264.32 卤 35.91 渭m in group A and 239.47 卤 28.51 渭m in group B ( P0.01 ) .

4 . The width of jejunum was 71.46 卤 14.71 渭m in group A and 62.36 卤 11.35 渭m in group B ( P0.01 ) .

4.3 The mucosal thickness of jejunum was 342.16 卤 55.32 渭m in group A and 315.82 卤 49.42 渭m in group B ( P0.01 ) .

4 . The height of ileum was 234.24 卤 25.51 渭m in group A and 219.47 卤 22.07 渭m in group B ( P0.01 ) .

In group A , 75.46 卤 18.37 渭m and 68.36 卤 15.39 渭m in group B , the difference was significant ( P0.01 ) .

4.6 The mucosal thickness of ileum was 412 . 16 卤 40 . 56 渭m in group A and 401 . 82 卤 42 . 72 渭m in group B ( P0.01 ) .

4.7 The thickness of colonic mucosa was 432 . 61 卤 42 . 38 渭m in group A and 420 . 27 卤 53.22 渭m in group B ( P0.01 ) .

Conclusion : After cholecystectomy , the intestinal contents of intestinal contents were enhanced , the intestinal mucosa was slightly atrophic , the microvilli of epithelial cells were reduced , and the absorption function of intestinal tract was affected .

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R657.4

【参考文献】