内镜微创保胆术后结石复发患者胆囊中胆汁成分分析

Biliary composition analysis of recurrence of gallstones after minimally-invasive operation with gallbladder reservation

摘要:

目的 探讨胆囊胆汁成分与内镜微创保胆术后胆囊结石复发的关系。 方法 测定150例胆囊结石、80例非肝胆疾病患者的胆囊胆汁成分，该150例患者均行腹腔镜联合胆道镜保胆取石术，术后发现胆囊结石复发12例。测定所有患者胆汁成分。 结果 结石组和复发组胆固醇浓度均较正常组明显升高；复发组胆固醇浓度高于结石组；结石组及复发组糖蛋白含量浓度及钙离子浓度明显高于正常组，复发组糖蛋白含量浓度及钙离子浓度高于结石组；正常组PH值明显低于结石组和复发者，差异均有显著性。 结论 胆囊胆汁中胆固醇浓度升高是保胆取石术后胆囊结石复发的重要因素。糖蛋白及钙离子浓度可促使胆固醇结石的形成和发展，在保胆术后结石复发中起到一定作用。

Abstract:

【Objective】 To observe the recurrence rate of cholecystolithiasis after minimally invasive cholecystolithotomy and to analyze their correlation. 【Methods】 All bladder bile samples were collected from 150 patients with cholesterol gallstones and 80 patients who had negative results of ultrasound examinations, normal liver function tests, and no history of hepatobiliary disease(NHBD). Biliary cholesterol, phospholipids, glycoprotein, Ca2+, K+, Na+, Cl-concentrations and PH were measured and compared. 【Results】 The results showed that the cholesterol concentration in CP and CS groups were much higher than that in NHBD group. The glycoprotein concentration in cholesterol gallstones group was significantly higher than that in NHBD group. The PH value in cholesterol gallstones group was those than that in NHBD groups. These results indicated that biliary supersaturation with cholesterol may be a necessary but not a determinant cause for cholesterol gallstones formation. 【Conclusion】 Increased gallbladder mucus glycoprotein and calcium accelerate cholesterol nucleation and stone formation.