本文選題：膽囊切除術(shù)后 + 保膽手術(shù)�。� 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的：傳統(tǒng)膽囊切除術(shù)一直是治療膽囊疾病的首選方法，1987-Philippe Moure t完成世界上第一例電視腹腔鏡膽囊切除術(shù)，1991-荀祖武等在我國第一次報道電視腹腔鏡膽囊切除術(shù)。腹腔鏡下膽囊切除術(shù)發(fā)展迅速，因具有創(chuàng)傷小，美觀、恢復(fù)快等優(yōu)點在縣級及以上醫(yī)院已成為常規(guī)膽囊切除術(shù)的首選方法。但膽囊切除后，部分患者出現(xiàn)腹瀉、便秘等大便習(xí)慣和（或）大便性狀改變，甚至腹痛、食欲不振、體重減輕、暖氣和黃疸等癥狀，有人稱之為膽道術(shù)后綜合征（PCS）⑴。且治療效果差，影響患者正常的工作、學(xué)習(xí)；以及遠期監(jiān)測發(fā)現(xiàn)膽囊切除術(shù)后患者結(jié)腸癌發(fā)病率升高，對這些問題至今缺乏較統(tǒng)一和清晰的認識，國內(nèi)外對此問題的報道較少，如何在解決膽囊結(jié)石的同時盡可能少地減少術(shù)后并發(fā)癥是值得研究的問題。本實驗通過比較豚鼠經(jīng)傳統(tǒng)膽囊切除術(shù)和取石后保留膽囊的保膽術(shù)后腸道運動、腸粘膜形態(tài)的差異，為尋找膽囊切除術(shù)后腹瀉、結(jié)腸腫瘤發(fā)病率升高⑵的原因及防治提供一些理論依據(jù)。 方法：取致石食譜喂養(yǎng)的清潔級健康豚鼠60只，體重230-280g，隨機分成A（保膽手術(shù)）、B（膽囊切除）共2組，每組均30只。A組切開膽囊，取盡結(jié)石，B組結(jié)扎膽囊管，，行膽囊切除術(shù)，手術(shù)均遵循無菌原則，相同麻醉條件，術(shù)后1周傷口愈合，飲食正常；術(shù)后4周，禁食12h，禁飲2h，腹腔注射麻醉（局麻）后，消毒，無菌條件下打開豚鼠腹腔，找到胃及盲腸，在胃竇及盲腸處注入相同濃度硫酸鋇混懸液2ml，關(guān)閉腹腔，30min后，將豚鼠均頸部脫臼處死，打開腹腔，切斷并取出胃腸道，清除腸系膜，將全部腸道以5g天平砝碼垂直懸掛，測量全腸長度及小腸和結(jié)腸分別長度；以幽門（幽門環(huán)）、回盲部（回盲瓣）為起點，測量并記錄硫酸鋇在小腸和結(jié)腸中移動的距離，計算相應(yīng)豚鼠硫酸鋇移動距離占小腸及結(jié)腸全腸的百分比，比較2組豚鼠的結(jié)果。并分別取小腸（距幽門20cm，距回盲瓣10cm）和結(jié)腸（距回盲瓣10cm，距肛門15cm）腸壁組織一塊，光鏡下測量空腸、回腸、結(jié)腸厚度及空腸、回腸絨毛高度、寬度。 所有數(shù)據(jù)均采用均數(shù)±標準差（xˉ±s）表示，組間比較采用t檢驗，采用SPSS16.0統(tǒng)計分析軟件上進行。 結(jié)果： 1.各組間硫酸鋇在小腸推進率（百分比）比較：A組：35.05±2.56，B組：43.14±3.03，B組和A組間差別有顯著意義（P0.05）。 2.各組間硫酸鋇在結(jié)腸推進率（百分比）比較：A組：5.15±3.14，B組：7.53±2.89，B組和A組間差別有顯著意義（P0.05）。 3.光鏡下B組小腸絨毛萎縮，隱窩加深，未見腺體增生，固有層少量淋巴細胞浸潤，粘膜下可見散在淋巴小結(jié)，上皮細胞由高柱狀變矮，部分為立方形；結(jié)腸粘膜厚度變薄，上皮細胞完整，杯狀細胞無增生，固有層見淋巴細胞浸潤。 4.1空腸絨毛高度：A組為264.32±35.91μm,B組為239.47±28.51μm，差別有顯著意義（P0.01）。 4.2空腸絨毛寬度：A組為71.46±14.71μm,B組為62.36±11.35μm，差別有顯著意義（P0.01）。 4.3空腸粘膜厚度：A組為342.16±55.32μm,B組為315.82±49.42μm，差別有顯著意義（P0.01）。 4.4回腸絨毛高度：A組為234.24±25.51μm,B組為219.47±22.07μm，差別有顯著意義（P0.01）。 4.5回腸絨毛寬度：A組為75.46±18.37μm,B組為68.36±15.39μm，差別有顯著意義（P0.01）。 4.6回腸粘膜厚度：A組為412.16±40.56μm,B組為401.82±42.72μm，差別有顯著意義（P0.01）。 4.7結(jié)腸粘膜厚度：A組為432.61±42.38μm,B組為420.27±53.22μm，差別有顯著意義（P0.01）。 結(jié)論：膽囊切除后腸道對腸內(nèi)容物的推進功能增強，腸粘膜輕度萎縮，上皮細胞微絨毛縮小，影響腸道的吸收功能，這些可能是患者術(shù)后大便變稀、次數(shù)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 鹵 standard deviation ( x 藟鹵 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 鹵 2.56 , group B : 43.14 鹵 3.03 , there was significant difference between group B and group A ( P0.05 ) .

2 . In group A : 5.15 鹵 3.14 , group B : 7.53 鹵 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 鹵 35.91 渭m in group A and 239.47 鹵 28.51 渭m in group B ( P0.01 ) .

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

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

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

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

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

4.7 The thickness of colonic mucosa was 432 . 61 鹵 42 . 38 渭m in group A and 420 . 27 鹵 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 .

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R657.4

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