【摘要】：【目的】探討膽腸吻合術(shù)后膽汁成分的變化是否會(huì)導(dǎo)致術(shù)后患者結(jié)石的形成或復(fù)發(fā)。【方法】收集行膽腸吻合術(shù)2-3個(gè)月后患者經(jīng)“T”形引流管引出的膽汁(實(shí)驗(yàn)組)和因“膽囊息肉”行腹腔鏡下膽囊切除術(shù)(術(shù)前無(wú)炎癥表現(xiàn),術(shù)后病檢均證實(shí)僅為膽囊息肉)患者膽總管內(nèi)的膽汁(對(duì)照組)各20例。對(duì)比兩組膽汁中與結(jié)石成因相關(guān)的成分——總膽紅素、直接膽紅素、間接膽紅素、總膽汁酸、總膽固醇、鈣離子、粘蛋白、β-葡萄糖醛酸苷酶含量的變化和細(xì)菌培養(yǎng)結(jié)果。【結(jié)果】實(shí)驗(yàn)組總膽紅素值(204.01±61.06)umol/L較對(duì)照組總膽紅素值(674.68±162.68)umol/L明顯減低,有顯著性差異(P0.05);實(shí)驗(yàn)組直接膽紅素值(138.78±40.24)umol/L較對(duì)照組直接膽紅素值(441.13±94.30)umol/L明顯減低,有顯著性差異(P0.05);實(shí)驗(yàn)組間接膽紅素值(65.23±21.22)umol/L較對(duì)照組間接膽紅素值(233.56±71.96)umol/L明顯減低,有顯著性差異(P0.05)。實(shí)驗(yàn)組總膽固醇值(1.16±0.27)mmol/L較對(duì)照組總膽固醇值(3.01±0.87)mmol/L明顯減低,有顯著性差異(P0.05)。實(shí)驗(yàn)組鈣離子值(0.80±0.23)mmol/L較對(duì)照組鈣離子值(1.98±0.64)mmol/L明顯減低,有顯著性差異(P0.05)。實(shí)驗(yàn)組粘蛋白值(4.43±1.42)ug/L較對(duì)照組粘蛋白值(6.29±2.04)ug/L明顯減低,有顯著性差異(P0.05)。實(shí)驗(yàn)組總膽汁酸值(633.06±89.82)umol/L較對(duì)照組總膽汁酸值(474.89±75.21)umol/L明顯增高,有顯著性差異(P0.05)。實(shí)驗(yàn)組β-葡萄糖醛酸苷酶值(1.95±0.56)U/L與對(duì)照組β-葡萄糖醛酸苷酶值(2.08±0.64)U/L相比較,兩組間差異無(wú)明顯統(tǒng)計(jì)學(xué)意義(P0.05)。膽腸吻合術(shù)后組20例膽汁標(biāo)本細(xì)菌培養(yǎng)結(jié)果陽(yáng)性率為35%,膽囊息肉組20例膽汁標(biāo)本細(xì)菌培養(yǎng)均無(wú)菌生長(zhǎng)。【結(jié)論】1.從膽腸吻合術(shù)后膽汁成分變化的角度考慮,膽腸吻合術(shù)短期內(nèi)可能不會(huì)導(dǎo)致結(jié)石的形成或復(fù)發(fā),甚至與之呈負(fù)相關(guān)。2.膽腸吻合術(shù)2-3個(gè)月后部分患者膽汁中有細(xì)菌存在,但并不一定是導(dǎo)致術(shù)后結(jié)石形成或復(fù)發(fā)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 鹵61.06) umol/L was significantly lower than that of the control group (674.68 鹵162.68) umol/L. There was significant difference (P 0.05). The direct cholin value of the experimental group (138.78 鹵40.24) umol/L was significantly lower than that of the control group (441.13 鹵94.30) umol/L (P 0.05), and the indirect cholin value of the experimental group (65.23 鹵21.22) umol/L was significantly lower than that of the control group (233.56 鹵7.96) umol/L (P 0.05), and the indirect cholin value of the experimental group (65.23 鹵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 鹵0.27) mmol/L was significantly lower than that of the control group (3.01 鹵0.87) mmol/L (P 0.05). The calcium ion value of the experimental group (0.80 鹵0.23) mmol/L was significantly lower than that of the control group (1.98 鹵0.64) mmol/L (P 0.05). The mucin value of the experimental group (4.43 鹵1.42) ug/L was significantly lower than that of the control group (6.29 鹵2.04) ug/L (P 0.05). The total bile acid value of the experimental group (633.06 鹵89.82) umol/L was significantly higher than that of the control group (474.89 鹵75.21) umol/L (P 0.05). There was no significant difference in 尾-glucuronidase value between the experimental group (1.95 鹵0.56) U / L and the control group (2.08 鹵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.
【學(xué)位授予單位】：湖南師范大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R657.4

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相關(guān)期刊論文 前1條

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