胆肠吻合术后胆汁中与结石成因相关成分的研究

发布时间：2019-06-20 00:37

【摘要】：【目的】探讨胆肠吻合术后胆汁成分的变化是否会导致术后患者结石的形成或复发。【方法】收集行胆肠吻合术2-3个月后患者经“T”形引流管引出的胆汁(实验组)和因“胆囊息肉”行腹腔镜下胆囊切除术(术前无炎症表现,术后病检均证实仅为胆囊息肉)患者胆总管内的胆汁(对照组)各20例。对比两组胆汁中与结石成因相关的成分——总胆红素、直接胆红素、间接胆红素、总胆汁酸、总胆固醇、钙离子、粘蛋白、β-葡萄糖醛酸苷酶含量的变化和细菌培养结果。【结果】实验组总胆红素值(204.01±61.06)umol/L较对照组总胆红素值(674.68±162.68)umol/L明显减低,有显著性差异(P0.05);实验组直接胆红素值(138.78±40.24)umol/L较对照组直接胆红素值(441.13±94.30)umol/L明显减低,有显著性差异(P0.05);实验组间接胆红素值(65.23±21.22)umol/L较对照组间接胆红素值(233.56±71.96)umol/L明显减低,有显著性差异(P0.05)。实验组总胆固醇值(1.16±0.27)mmol/L较对照组总胆固醇值(3.01±0.87)mmol/L明显减低,有显著性差异(P0.05)。实验组钙离子值(0.80±0.23)mmol/L较对照组钙离子值(1.98±0.64)mmol/L明显减低,有显著性差异(P0.05)。实验组粘蛋白值(4.43±1.42)ug/L较对照组粘蛋白值(6.29±2.04)ug/L明显减低,有显著性差异(P0.05)。实验组总胆汁酸值(633.06±89.82)umol/L较对照组总胆汁酸值(474.89±75.21)umol/L明显增高,有显著性差异(P0.05)。实验组β-葡萄糖醛酸苷酶值(1.95±0.56)U/L与对照组β-葡萄糖醛酸苷酶值(2.08±0.64)U/L相比较,两组间差异无明显统计学意义(P0.05)。胆肠吻合术后组20例胆汁标本细菌培养结果阳性率为35%,胆囊息肉组20例胆汁标本细菌培养均无菌生长。【结论】1.从胆肠吻合术后胆汁成分变化的角度考虑,胆肠吻合术短期内可能不会导致结石的形成或复发,甚至与之呈负相关。2.胆肠吻合术2-3个月后部分患者胆汁中有细菌存在,但并不一定是导致术后结石形成或复发的原因。
[Abstract]:[objective] to investigate whether the change of bile composition after choledochointestinal anastomosis will lead to the formation or recurrence of stones in patients after choledochoenteroanastomosis. [methods] the bile extracted by "T" drainage tube (experimental group) and laparoscopic Cholecystectomy due to "gallbladder polyp" (no inflammation before operation) were collected 2 months after choledochoenteroanastomosis. There were 20 cases of bile in common bile duct (control group) and 20 cases of gallbladder polyp (control group). The changes of total bilirubin, direct bilirubin, indirect bilirubin, total bile acid, total cholesterol, calcium ion, mucin, 尾-glucuronidase in bile and the results of bacterial culture were compared between the two groups. [results] the total cholin value of the experimental group (204.01 卤61.06) umol/L was significantly lower than that of the control group (674.68 卤162.68) umol/L. There was significant difference (P 0.05). The direct cholin value of the experimental group (138.78 卤40.24) umol/L was significantly lower than that of the control group (441.13 卤94.30) umol/L (P 0.05), and the indirect cholin value of the experimental group (65.23 卤21.22) umol/L was significantly lower than that of the control group (233.56 卤7.96) umol/L (P 0.05), and the indirect cholin value of the experimental group (65.23 卤21.22) umol/L was significantly lower than that of the control group (P 0.05). The total cholesterol value of the experimental group (1.16 卤0.27) mmol/L was significantly lower than that of the control group (3.01 卤0.87) mmol/L (P 0.05). The calcium ion value of the experimental group (0.80 卤0.23) mmol/L was significantly lower than that of the control group (1.98 卤0.64) mmol/L (P 0.05). The mucin value of the experimental group (4.43 卤1.42) ug/L was significantly lower than that of the control group (6.29 卤2.04) ug/L (P 0.05). The total bile acid value of the experimental group (633.06 卤89.82) umol/L was significantly higher than that of the control group (474.89 卤75.21) umol/L (P 0.05). There was no significant difference in 尾-glucuronidase value between the experimental group (1.95 卤0.56) U / L and the control group (2.08 卤0.64) U / L (P 0.05). The positive rate of bacterial culture in 20 bile specimens after choledochointestinal anastomosis was 35%, and that in gallbladder polyp group was aseptic. [conclusion]. From the point of view of the changes of bile composition after choledochointestinal anastomosis, choledochointestinal anastomosis may not lead to the formation or recurrence of stones in a short period of time, or even negatively correlated with it. 2. There were bacteria in the bile of some patients after choledochoenterostomy 2 or 3 months later, but it was not necessarily the cause of stone formation or recurrence after operation.
【学位授予单位】：湖南师范大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

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