胆囊结石患者胆囊组织中Cajal样间质细胞数量变化及与胆囊收缩功能及术后排便改变的关系

发布时间：2019-05-05 19:01

【摘要】：目的:通过前瞻性队列研究,试探究胆囊结石患者胆囊收缩功能与胆囊组织中的Cajal样间质细胞数目及与行胆囊切除术后排便改变(排便次数增加或性状改变)之间的关系。方法:对于我院普通外科入院行胆囊切除术的患者进行入组,根据患者临床资料分为结石组及非结石组。入院后收集患者年龄、结石发现年份、术前B超结果等临床资料,并通过空腹饮用酸奶后行B超检查的方式行胆囊收缩功算得出45min胆囊收缩率。切除之胆囊标本取颈、体、底组织各一块,长度分别为0.2cm,0.5cm,0.8cm,蜡块包埋并切片制片,以免疫荧光染色法鉴别Cajal样间质细胞及肥大细胞,单独计数Cajal样间质细胞并测定CD117免疫荧光强度。术后2个月对患者进行随访,调查患者术后是否发生排便习惯改变,整理数据后进行统计学分析。结果:本研究最终共入组患者25例,其中胆囊结石组17例,非结石组8例,对两组间胆囊收缩率及Cajal样间质细胞数目分别进行独立t检验,所得结果均具有统计学意义(89.59±28.77vs 115.89±27.87,P=0.036 和 42.05%±17.19%vs 59.75%±21.21%,P=0.042),以Cajal样间质细胞数目为X轴,胆囊收缩率为Y轴绘制散点图,并进行Person相关分析,所得结果P0.05,两者未见明显相关性。排除行胰十二指肠切除术及全胰切除术等行胆肠吻合术及改变消化道连续性手术者,对两组患者是否发生排便习惯改变行卡方检验,P0.05,差异无显著性,再以患者术后是否发生排便改变为分组变量,对胆囊收缩率进行独立t检验,两组间胆囊收缩率均数为7.25%±13.14%vs 57.45%±21.55%,P=0.012,差异具有统计学意义。以是否发生排便习惯改变为因变量,胆囊收缩率、Cajal样间质细胞数目,CD117免疫荧光强度为自变量,进行logistic回归分析,结果见胆囊收缩率P0.05,B=5.268。结论:胆囊结石患者胆囊组织中的Cajal样间质细胞数量较非结石者明显减少,同时胆囊收缩功能明显降低,但胆囊组织中的Cajal样间质细胞数量与胆囊收缩功能并非简单线性相关,胆囊组织中的Cajal样间质细胞数量不是影响胆囊收缩功能的唯一决定性因素。患者单纯行胆囊切除术术后排便改变的发生与患者是否存在胆囊结石无关,而与胆囊收缩功能有关,且呈正相关。
[Abstract]:Aim: a prospective cohort study was conducted to explore the relationship between gallbladder contractile function and the number of Cajal-like interstitial cells in gallbladder tissue and defecation (increased defecation times or character changes) after cholecystectomy in patients with cholecystolithiasis. Methods: the patients who were admitted to our hospital for cholecystectomy were divided into two groups according to their clinical data: stone group and non-stone group. The age of patients, the year of stone discovery and the results of B-ultrasound before operation were collected after admission. The cholecystoconstriction rate of 45min was calculated by B-ultrasonic examination after drinking yoghurt on an empty stomach. The specimens of the removed gallbladder were taken from the neck, body and basal tissue, and their lengths were 0.2 cm, 0.5 cm, 0.8 cm, respectively. The specimens were embedded in wax and sliced into slices. The Cajal-like stromal cells and mast cells were identified by immunofluorescence staining. Cajal-like interstitial cells were counted separately and the intensity of CD117 immunofluorescence was measured. Two months after operation, the patients were followed up to investigate whether there were changes in defecation habits after operation, and statistical analysis was carried out after collating the data. Results: twenty-five patients were enrolled in this study, including 17 cases of gallstone group and 8 cases of non-stone group. The cholecystokinesis rate and the number of Cajal-like interstitial cells between the two groups were tested by independent t-test. The results were statistically significant (89.59 卤28.77vs 115.89 卤27.87, P = 0.036 and 42.05% 卤17.19%vs 59.75% 卤21.21%, P = 0.042). The number of Cajal-like interstitial cells was the X axis. The cholecystokinesis rate was Y axis and the Person correlation analysis showed that there was no significant correlation between the two groups (P 0.05). Excluding pancreaticoduodenectomy and total pancreatectomy for choledochojejunostomy and alimentary tract continuous surgery, there was no significant difference between the two groups in terms of whether or not defecation habits were changed by Chi-square test (P0.05), and no significant difference was found between the two groups (P > 0.05). The gallbladder contraction rate of the two groups was 7.25% 卤13.14%vs 57.45% 卤21.55%, and the difference was statistically significant (P < 0.05), and the gallbladder contraction rate of the two groups was significantly higher than that of the control group (P < 0.05), and the gallbladder contraction rate was significantly higher than that of the control group (P < 0.05). According to whether defecation habit was changed as dependent variable, cholecystokinesis rate, Cajal-like interstitial cell number and CD117 immunofluorescence intensity as independent variables, logistic regression analysis was carried out. The results showed that cholecystokinesis rate (P0.05) and cholecystokinin-like interstitial cell number were 5.268 (P < 0.05). Conclusion: the number of Cajal-like interstitial cells in gallbladder tissue of patients with gallstone is significantly lower than that of non-calculi, and the contractile function of gallbladder is significantly decreased. However, the number of Cajal-like interstitial cells in gallbladder tissue is not a simple linear correlation with gallbladder contractile function. The number of Cajal-like stromal cells in gallbladder tissue is not the only determinant of gallbladder contractile function. The occurrence of defecation changes after simple cholecystectomy was not associated with the presence of gallstone, but positively correlated with gallbladder contractile function.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.4

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