不同方法胆囊切除术对胆结石患者血清免疫球蛋白和肠黏膜损伤程度的影响

doi:10.3969/j.issn.1672-5069.2018.03.031

摘要/Abstract

摘要： 目的分析不同手术方法切除胆囊对胆结石患者免疫球蛋白和肠黏膜损伤程度的影响。方法 2015年12月~2016年12月收治的胆结石患者110例,55例对照组接受开腹胆囊切除术（OC）,另55例观察组接受腹腔镜胆囊切除术（LC）。采用放射免疫法测定血浆皮质醇（Cor）;采用全自动特种蛋白分析仪检测血清IgA、IgG、IgM水平;在肠镜下取回肠末端黏膜组织,根据Chiu’s分度标准评估损伤程度。结果术后1周,观察组血清C-反应蛋白为（4.2±0.4） mg/L,血糖为（5.5±1.0） mmol/L,Cor为（249.4±43.1） ng/ml,均显著低于对照组的【（5.3±1.0） mg/L、（6.1±1.1） mmol/L、（267.4±46.8） ng/mL,P<0.05】;血清IgA为（1.8±0.3） g/L,IgG为（1.0±0.2） g/L,IgM为（1.0±0.2）g/L,显著高于对照组的【（1.4±0.2） g/L、（0.9±0.1） g/L、（0.8±0.1） g/L,P<0.05】;术后3个月观察组Chiu’s肠黏膜损伤分级程度低于对照组（U值=11.008,P<0.05）;观察组并发症发生率为5.4%,显著低于对照组的18.2%（P<0.05）。结论与OC术相比,LC术治疗胆结石引起的应激反应小,对免疫功能的影响小,并发症发生率低,尤其对肠粘膜损伤小。

关键词: 胆结石, 腹腔镜胆囊切除术, 应激反应, 肠黏膜屏障功能

Abstract: Objective To investigate the impact of laparoscopic cholecystectomy（LC） on blood immunoglobulin levels and on intestinal mucosa in patients with cholelithiasis,Methods 110 patients with cholelithiasis were recruited in our hospital between December 2015 and December 2016,and 55 received open cholecystectomy （OC） and another 55 received LC. Blood cortisol and immunoglobulin were detected,The specimen of intestinal mucosa was obtained under enteroscopy and was examined pathologically by Chiu's criteria. Results At the end of one week after operation,serum C-reactive protein,blood glucose and cortisol levels in LC group were （4.2±0.4） mg/L,（5.5±1.0） mmol/L and（249.4±43.1） ng/ml,much lower than [（5.3±1.0） mg/L,（6.1±1.1） mmol/L and （267.4±46.8） ng/mL in OC group （P<0.05）;serum IgA,IgG and IgM were （1.8±0.3） g/L,（1.0±0.2） g/L and （1.0±0.2） g/L,much higher than （1.4±0.2） g/L,（0.9±0.1） g/L and （0.8±0.1） g/L in the OC group （P<0.05）;at the end of three months after operation, the Chiu's injury of intestinal mucosa was much milder in the LC group than that in the OC group（U value=11.008,P<0.05）;the complication rate in the LC group was 5.4%,much lower than 18.2% in the OC group（P<0.05）. Conclusion s LC might induce little stress and immune reaction,and lead to mild intestinal mucosa injury.

Key words: Cholelithiasis, Laparoscopic cholecystectomy, Stress reaction, Intestinal mucosa

高俊, 陈功. 不同方法胆囊切除术对胆结石患者血清免疫球蛋白和肠黏膜损伤程度的影响[J]. 实用肝脏病杂志, 2018, 21(3): 443-446.

Gao Jun, Chen Gong. Impact of laparoscopic cholecystectomy on blood immunoglobulin levels and on intestinal mucosa in patients with cholelithiasis[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(3): 443-446.

参考文献

[1] Bartosz S,Maciej P.Factors influencing frequency of conversion during laparoscopic cholecystectomy. Polish J Surg,2008,80(2):62-68.
[2] Mir SA,Hussain Z,Davey CA,et al.Management and outcome of recurrent gallstone ileus:A systematic review. World J Gastrointest Surg,2015,7(8):152-159.
[3] 李震寰,黄晓方,鲁琪,等. 手术联合消炎利胆片治疗老年胆结石患者临床效果研究. 实用肝脏病杂志,2016,19(6):738-739.
[4] Btazej C,Jarostaw C.Reasons for conversion of laparoscopic cholecystectomy-evaluation of risk factors.Polish J Surg,2008,80(4):202-208.
[5] Aspinen S,Harju J,Kinnunen M,et al.A randomized multicenter study of minilaparotomy cholecystectomy versus laparoscopic cholecystectomy with ultrasonic dissection in both groups. Scan J Gastroenterol,2016,51(3):354-359.
[6] Li S,Li Y,Geng J,et al.Concurrent percutaneous transhepatic papillary balloon dilatation combined with laparoscopic cholecystectomy for the treatment of gallstones with common bile duct stones. J Laparoendosc Adv Surg Techn (Part A),2015,25(11):886-891.
[7] 鲁德斌,刘西平,胡林忠,等. 腹腔镜胆囊切除术与开腹胆囊切除术治疗胆囊结石患者外周血淋巴细胞和细胞因子水平的变化. 实用肝脏病杂志,2016,19(3):335-338.
[8] Tayeb M,Raza S,Khan M,et al.Conversion from laparoscopic to open cholecystectomy:multivariate analysis of preoperative risk factors. J Postgrad Med,2005,51(1):17-20.
[9] Stanowski E,Paczyński A,Gotbiowski G.Konwersje wcholecystektomii laparoskopowej. Pol Przegl Chir,2002,74(10): 869-874.
[10] Johansson M,Thune A,Nelvin L,et al.Randomized clinical trial of open versus laparoscopic cholecystectomy for acute cholecystitis. Br J Surg,2005,92(2): 44-49.
[11] Melmer A,Sturm W,Kuhnert B,et al.Incidence of gallstone formation and cholecystectomy 10 years after bariatric surgery. Obes Surg,2015,25(7):1171-1176.
[12] Kama N,Kologlu M,Doganay M,et al.A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg,2001,181(6):520-25.
[13] 魏娜,白顺滟,胡敏,等. 胆石症患者肠黏膜屏障功能的临床研究. 医学临床研究,2015,32(1):32-38.
[14] Lipman J,Claridge J,Haridas,et al. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery,2007,142(4):556-563.
[15] Nachnani J,Supe A.Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Indian J Gastroenterol,2005,24(1):16-18.
[16] Kama N,Kologlu M,Doganay M,et al.A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg,2001,181(6):520-525.
[17] Giger U,Michel J,Opitz I,et al.Risk factors for perioperative complications in patients undergoing laparoscopic cholecystec- tomy:analysis of 22,953 consecutive cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database, Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) Study Group. of 22,953 consecutive cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database, Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) Study Group. J Am Coll Surg,2006,203(5):723-728.
[18] 杨洪颖,刘晓耕,李茂恒,等. 胆结石患者应用开腹手术和腹腔镜手术肠粘连机率的比较.现代消化和介入诊疗,2016,21(2):340-342.
[19] Sepito M,sledziński Z. Analiza wyników cholecystektomii laparoskopowej u chorych w podesztym wieku. Pol Przegl Chir,2002,74(2):183-192.
[20] Kroh M,Chalikonda S,Chand B,et al.Laparoscopic completion cholecystectomy and common bile duct exploration for retained gallbladder after single-incision cholecystectomy. JSLS,2013,17(1):143-147.
[21] 郭伟,张忠涛,韩威,等. 经脐单孔腹腔镜胆囊切除术120例回顾性分析. 中国实用外科杂志,2010,30(4):304-306.
[22] 李承钢. 胆结石胆囊切除术式选择对患者免疫和应激反应的影响. 海南医学院学报,2016,22(21):2538-2540.
[23] 中国中西医结合学会消化系统疾病专业委员会.胆石症中西医结合诊疗共识. 中国中西医结合杂志,2011,31(8):1041-1043.
[24] 闫长红,许艳春.腹腔镜胆囊切除术对患者血清IL-6、IL-10、TNF-α水平的影响. 宁夏医科大学学报,2016,38(4):469-471.
[25] 闫长红,许艳春. 胆囊结石行腹腔镜胆囊切除术对肝功能和应激反应的影响. 长春中医药大学学报,2016,32(1):171-173.