胆囊切除术后胆汁动力学及胃肠激素的研究
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南方医科大学顺德医院(原佛山市顺德区第一人民医院)VIP高级诊疗区,南方医科大学顺德医院(原佛山市顺德区第一人民医院)消化内科,南方医科大学顺德医院(原佛山市顺德区第一人民医院)核医学科,南方医科大学顺德医院(原佛山市顺德区第一人民医院)检验科,南方医科大学顺德医院(原佛山市顺德区第一人民医院)VIP高级诊疗区

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广东省医学科学技术研究基金项目(A2015552)


Changes of bile dynamics and plasma levels of gastrointestinal hormone after cholecystectomy
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Shunde Hospital of Southern Medical University,,,,

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Medical Scientific Research Foundation of Guangdong Province(A2015552)

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    摘要:

    目的 分析胆囊切除术后胆汁动力学及血浆胆囊收缩素(CCK)及血管活性肠肽(VIP)水平的改变。方法 选取29名曾经接受胆囊切除的患者为观察组,分为合并胆管扩张组(14例)和不合并胆管扩张组(15例),选择同期体检健康者17例作为对照组。受试者均接受99mTc-EHIDA肝胆动态核素显像检查并进行定量分析,评估胆道动力学情况;同时通过酶联免疫吸附法(ELISA)测定患者空腹及餐后血浆CCK及VIP水平。结果 3组患者肝脏高峰摄取时间及肝脏半排时间差异无统计学意义(P>0.05);合并胆管扩张组的肝总管显影时间、胆总管高峰时间、胆总管半排时间、十二指肠显影时间、肝门十二指肠通过时间较对照组延长(P<0.05);不合并胆管扩张组十二指肠显影时间、肝门十二指肠通过时间较扩张组及对照组缩短(P<0.05)。3组空腹血浆CCK、VIP水平比较差异无统计学意义(P>0.05);合并胆管扩张组患者餐后血浆CCK、VIP水平均显著高于对照组及不合并胆管扩张组(P<0.05)。结论 胆囊切除术后,不合并胆管扩张患者,在消化间期胆汁在胆管及肠道的流量及流速增加;合并胆管代偿性扩张患者,胆汁滞留胆总管内,排出肠道受阻,且存在胃肠激素调节紊乱。

    Abstract:

    Object To research the changes of bile dynamics and plasma levels of cholecystokinin (CCK) and vasoactive intestinal peptide (VIP) in patients undergoing cholecystectomy. Methods Twenty-nine post-cholecystectomy patients were selected as observation group, including 14 patients combined with bile duct dilatation and 15 without bile duct dilatation. Another 17 healthy subjects were enrolled as the control group. They were assessed with quantitative 99mTc-EHIDA hepatobiliary scintigraphy to determine bile dynamics. Plasma levels of CCK and VIP were measured by enzyme-linked immunosorbent assay (ELISA). Results Scintigraphic analysis demonstrated that the time to maximum counts and half excretion of liver were no significantly different among the three groups (all P>0.05). The time of maximum counts of common bile duct, half excretion of common bile duct, developing time of duodenum, hepatic portal and duodenum transit time were significantly increased in the bile duct dilatation group compared with those of the control group (all P<0.05). Development time of duodenum, hepatic portal and duodenum transit time were significantly less in the non-bile duct dilatation group compared with those in the bile duct dilatation group and the control group (all P<0.05). Fasting plasma levels of CCK and VIP were no significantly different among the three groups (all P>0.05), while postprandial plasma levels of CCK and VIP were significantly higher in the bile duct dilatation group compared to those in the other two groups (P<0.05). Conclusion After cholecystectomy, the flow and velocity of bile in bile duct and intestine increased during the interdigestive period for patients without bile duct dilatation, while for patients with bile duct dilatation, bile remained in common bile duct and blocked from intestine, with gastrointestinal hormone regulation disorder.

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胡亦懿,杜国平,胡元元,等.胆囊切除术后胆汁动力学及胃肠激素的研究[J].中华消化内镜杂志,2018,35(5):350-353.

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  • 收稿日期:2017-12-24
  • 最后修改日期:2018-04-20
  • 录用日期:2018-02-08
  • 在线发布日期: 2018-05-11
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