【摘要】：目的:通過(guò)前瞻性隊(duì)列研究,試探究膽囊結(jié)石患者膽囊收縮功能與膽囊組織中的Cajal樣間質(zhì)細(xì)胞數(shù)目及與行膽囊切除術(shù)后排便改變(排便次數(shù)增加或性狀改變)之間的關(guān)系。方法:對(duì)于我院普通外科入院行膽囊切除術(shù)的患者進(jìn)行入組,根據(jù)患者臨床資料分為結(jié)石組及非結(jié)石組。入院后收集患者年齡、結(jié)石發(fā)現(xiàn)年份、術(shù)前B超結(jié)果等臨床資料,并通過(guò)空腹飲用酸奶后行B超檢查的方式行膽囊收縮功算得出45min膽囊收縮率。切除之膽囊標(biāo)本取頸、體、底組織各一塊,長(zhǎng)度分別為0.2cm,0.5cm,0.8cm,蠟塊包埋并切片制片,以免疫熒光染色法鑒別Cajal樣間質(zhì)細(xì)胞及肥大細(xì)胞,單獨(dú)計(jì)數(shù)Cajal樣間質(zhì)細(xì)胞并測(cè)定CD117免疫熒光強(qiáng)度。術(shù)后2個(gè)月對(duì)患者進(jìn)行隨訪,調(diào)查患者術(shù)后是否發(fā)生排便習(xí)慣改變,整理數(shù)據(jù)后進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:本研究最終共入組患者25例,其中膽囊結(jié)石組17例,非結(jié)石組8例,對(duì)兩組間膽囊收縮率及Cajal樣間質(zhì)細(xì)胞數(shù)目分別進(jìn)行獨(dú)立t檢驗(yàn),所得結(jié)果均具有統(tǒng)計(jì)學(xué)意義(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樣間質(zhì)細(xì)胞數(shù)目為X軸,膽囊收縮率為Y軸繪制散點(diǎn)圖,并進(jìn)行Person相關(guān)分析,所得結(jié)果P0.05,兩者未見(jiàn)明顯相關(guān)性。排除行胰十二指腸切除術(shù)及全胰切除術(shù)等行膽腸吻合術(shù)及改變消化道連續(xù)性手術(shù)者,對(duì)兩組患者是否發(fā)生排便習(xí)慣改變行卡方檢驗(yàn),P0.05,差異無(wú)顯著性,再以患者術(shù)后是否發(fā)生排便改變?yōu)榉纸M變量,對(duì)膽囊收縮率進(jìn)行獨(dú)立t檢驗(yàn),兩組間膽囊收縮率均數(shù)為7.25%±13.14%vs 57.45%±21.55%,P=0.012,差異具有統(tǒng)計(jì)學(xué)意義。以是否發(fā)生排便習(xí)慣改變?yōu)橐蜃兞?膽囊收縮率、Cajal樣間質(zhì)細(xì)胞數(shù)目,CD117免疫熒光強(qiáng)度為自變量,進(jìn)行l(wèi)ogistic回歸分析,結(jié)果見(jiàn)膽囊收縮率P0.05,B=5.268。結(jié)論:膽囊結(jié)石患者膽囊組織中的Cajal樣間質(zhì)細(xì)胞數(shù)量較非結(jié)石者明顯減少,同時(shí)膽囊收縮功能明顯降低,但膽囊組織中的Cajal樣間質(zhì)細(xì)胞數(shù)量與膽囊收縮功能并非簡(jiǎn)單線性相關(guān),膽囊組織中的Cajal樣間質(zhì)細(xì)胞數(shù)量不是影響膽囊收縮功能的唯一決定性因素�；颊邌渭冃心懩仪谐g(shù)術(shù)后排便改變的發(fā)生與患者是否存在膽囊結(jié)石無(wú)關(guān),而與膽囊收縮功能有關(guān),且呈正相關(guān)。
[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 鹵28.77vs 115.89 鹵27.87, P = 0.036 and 42.05% 鹵17.19%vs 59.75% 鹵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% 鹵13.14%vs 57.45% 鹵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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R657.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 陳小平;徐亦熊;盛維為;汪力;楊建設(shè);;腹腔鏡膽囊切除術(shù)后消化功能紊亂的發(fā)生及相關(guān)危險(xiǎn)因素分析[J];江西醫(yī)藥;2016年11期

2 卞錦洋;;對(duì)誘發(fā)膽囊切除術(shù)后腹瀉的原因分析[J];當(dāng)代醫(yī)藥論叢;2014年14期

3 張延彬;曹子洋;呂培瑾;高偉;許玉靜;;針刺穴位與脂餐試驗(yàn)在超聲監(jiān)測(cè)膽囊收縮功能診斷膽囊炎中的臨床研究[J];中國(guó)中西醫(yī)結(jié)合影像學(xué)雜志;2010年03期

4 王洋;王嘯飛;竇劍;高慶軍;曹經(jīng)琳;趙鑫;任貴軍;曾強(qiáng);;膽囊切除術(shù)后腹瀉及影響因素的臨床研究[J];臨床薈萃;2009年24期

5 ;Control of gallbladder contractions by cholecystokinin through cholecystokinin-A receptors on gallbladder interstitial cells of cajal[J];World Journal of Gastroenterology;2008年18期

6 鄒大中;;膽囊排空功能與膽囊切除術(shù)后腹瀉的關(guān)系[J];現(xiàn)代醫(yī)學(xué);2007年03期

7 郭素菊;付俊俐;蔡永明;;膽囊切除后腹瀉原因分析[J];武警醫(yī)學(xué);2006年09期

8 龍慶林,房殿春;胃腸道Cajal細(xì)胞的發(fā)育及SCF對(duì)其發(fā)育影響[J];重慶醫(yī)學(xué);2003年09期

，

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