良性胆囊微创切除术前后CCK、L-γ-GGT、CBD改变与胆囊切除术后综合征的关联

doi:10.3760/cma.j.cn441417-20241129-10022

摘要/Abstract

摘要：

目的　探讨腹腔镜下胆囊切除（laparoscopic cholecystectomy，LC）术前后胆囊收缩素（cholecystokinin，CCK）、L-γ-谷氨酰基转移酶（L-γ-glutamyltransferase，L-γ-GGT）、胆总管内径（common bile duct diameter，CBD）与胆囊切除术后综合征（post cholecystectomy syndromes，PCS）的关联。方法　本次研究采用回顾性队列研究，即观察性分析性研究。选取广州医科大学附属中医医院2021年1月至2023年6月因胆囊良性病变行LC符合观察条件的80例患者，男43例，女37例，年龄（56.0±7.8）岁。随访12个月，根据术后是否出现PCS分为非PCS组、PCS组。观察男、女发病情况，记录术前及术后1、6、12个月CBD值及血清CCK、L-γ-GGT水平。采用单因素方差分析、χ2检验、t检验进行统计比较。结果　随访12个月，80例胆囊良性病变行LC术后患者发生PCS 17例，其中女11例，男6例，女性PCS发病率高于男性（P<0.05）。术后患者CCK、L-γ-GGT、CBD均高于术前，差异均有统计学意义（均P<0.05），并呈升高趋势，且呈时间依赖性（均P<0.05）；PCS组CCK低于非PCS组［（0.65±0.14）pmol/L比（0.89±0.22）pmol/L］，L-γ-GGT、CBD均高于非PCS组［（82.00±16.00）U/L比（41.00±12.00）U/L、（8.70±1.80）mm比（4.80±1.40）mm］，差异均有统计学意义（均P<0.05）。结论　LC术后患者出现PCS可能与肠道内激素变化、胆囊缺失后胆总管压力增加有关，提示保留胆囊对胆囊良性病变的治疗有重要意义，切除胆囊需要严格掌握手术适应证。

关键词: 胆囊切除术后综合征, , , 胆囊良性病变, , , 胆囊收缩素, , , L-γ-谷氨酰基转移酶, , , 胆总管内径

Abstract:

Objective　To explore the association of the levels of cholecystokinin (CCK), L-γ-glutamyltransferase (L-γ-GGT), and common bile duct diameter (CBD) before and after laparoscopic cholecystectomy (LC) with post cholecystectomy syndrome (PCS). Methods　This was a retrospective cohort study. Eighty patients who conformed with the observation criteria after LC due to benign gallbladder lesions in Traditional Chinese Medicine Hospital Affiliated to Guangzhou Medical University from January 2021 to June 2023 were selected as the study objects, including 43 males and 37 females who were (56.0±7.8) years old. The patients were followed up 12 months. According to whether they had PCS, the patients were divided into a non-PCS group and a PCS group. The incidence rates in the males and females were observed. The CBD's and serum levels of CCK and L-γ-GGT before and 1, 6, and 12 months after the operation were recorded. One-way analysis of variance and χ² and t tests were used for the statistical comparisons. Results　During the 12 months' follow up, 17 cases had PCS after LC, including 11 females and 6 females; the incidence rate of PCS in the females was higher than that in the males (P<0.05). The levels of CCK and L-γ-GGT and CBD were higher after than before the operation, with statistical differences (all P<0.05), and increased with time (P<0.05). The CCK level in the PCS group was lower than that in the non-PCS group [(0.65±0.14) pmol/L vs. (0.89±0.22) pmol/L], and the L-γ-GGT level and CBD were higher [(82.00±16.00) U/L vs. (41.00±12.00) U/L and (8.70±1.80) mm vs. (4.80±1.40) mm], with statistical differences (all P<0.05). Conclusion　PCS after LC may correlate with changes of gut hormones and increased common bile duct pressure after gallbladder loss, indicating that gallbladder preservation is of great significance in the treatment of benign gallbladder lesions, and removing the gallbladder requires strict adherence to surgical indications.

Key words: , Post cholecystectomy syndrome, , Benign gallbladder lesions, , Cholecystokinin, , L-γ-glutamyltransferase, , Common bile duct diameter

张惠东苏劲松林荣武. 良性胆囊微创切除术前后CCK、L-γ-GGT、CBD改变与胆囊切除术后综合征的关联 [J]. 国际医药卫生导报, 2025, 31(10): 1692-1695.

Zhang Huidong, Su Jinsong, Lin Rongwu.

Association of levels of CCK, L-γ-GGT, and CBD before and after benign laparoscopic cholecystectomy with post cholecystectomy syndrome [J]. International Medicine and Health Guidance News, 2025, 31(10): 1692-1695.

参考文献

[1]侯勇,曹凡,胥江品,等.日间腹腔镜胆囊切除术的应用及评价[J].昆明医科大学学报,2024,45(8):174-181. DOI:10.12259/j.issn.2095-610X.S20240825.

[2]杨敬泽,刘诗.胆囊切除术后综合征[J].医学新知,2023,33(4):303-308. DOI:10.12173/j.issn.1004-5511. 202302046.

[3]M.AS.Diana M,Cynthia L.Recurrent abdominal pain after cholecystectomy:low phospholipid-associated cholelithiasis[J].ACG Case Rep J,2023,10(1):e00958.DOI:0.14309/crj.0000000000000958.

[4]曹泽嘉.微创保胆取石术与腹腔镜胆囊切除术治疗胆囊结石的近期效果及安全性比较研究[J].河南外科学杂志,2024,30(1):62-65.DOI:10.16193/j.cnki.hnwk. 2024.01.007.

[5]中国研究型医院学会微创外科学专业委员会,胡三元,刘荣.单孔腹腔镜胆囊切除术中国专家共识(2024版)[J].临床肝胆病杂志,2024,40(10):1967-1972. DOI:10.12449/JCH241007.

[6]娄玉晗,陈卓然,陈玉曼,等.胆囊良性疾病行胆囊切除术后症状反复的现状及原因分析[J].中国实用医药,2023,18(4):47-52. DOI:10.14163/j.cnki.11-5547/r.2023.04.013.

[7]Chen J, Liu ZT, Lyu JT, et al. Impact of metabolic disorders on gallstone disease and perioperative recovery after laparoscopic cholecystectomy[J]. Hepatobiliary Pancreat Dis Int, 2024,23(6):604-612. DOI: 10.1016/j.hbpd.2024.08.001.

[8]胡刚峰,张美峰,黄侠,等.腹腔镜胆囊切除术后胆总管结石复发的列线图预测模型构建与评估[J].腹腔镜外科杂志,2022,27(4):263-267. DOI:10.13499/j.cnki.fqjwkzz.2022.04.263.

[9]Liao JH, Li JS, Wang TL, et al. Laparoscopic cholecystectomy plus common bile duct exploration for extrahepatic bile duct stones and postoperative recurrence-associated risk factors[J]. World J Gastrointest Surg, 2024,16(11):3511-3519. DOI: 10.4240/wjgs.v16.i11.3511.

[10]赵悦竹,徐小满,宋吉涛,等. Oddi括约肌功能障碍诊治的研究进展[J].临床消化病杂志,2022,34(6):489-492. DOI:10.3870/lcxh.j.issn.1005-541X.2022.06.019.

[11]Villavicencio Kim J, Wu GY. Update on sphincter of Oddi dysfunction: a review[J]. J Clin Transl Hepatol, 2022,10(3):515-521. DOI: 10.14218/JCTH.2021.00167.

[12]Fu K, Yang YY, Chen H, et al. Effect of endoscopic sphincterotomy and endoscopic papillary balloon dilation endoscopic retrograde cholangiopancreatographies on the sphincter of Oddi[J]. World J Gastrointest Surg, 2024,16(6):1726-1733. DOI: 10.4240/wjgs.v16.i6.1726.

[13]Li JH, Zhao SJ, Guo Y, et al. Chronic stress induces wide-spread hyperalgesia: the involvement of spinal CCK1 receptors[J]. Neuropharmacology, 2024,258:110067. DOI: 10.1016/j.neuropharm.2024.110067.

[14]冯华国,冯毅,龚建平,等.乙肝肝硬化合并胆囊结石患者腹腔镜胆囊切除术后并发症的影响因素分析[J].中国普通外科杂志,2021,30(8):902-908. DOI:10.7659/j.issn.1005- 6947. 2021.08.004.

[15]李权,陈大勇,刘建,等.胆囊切除术围手术期G-17、MOT、CCK的变化及联合预测术后综合征的价值[J].海南医学,2023,34(18):2621-2626. DOI:10.3969/j.issn.1003-6350. 2023.18.009.

[16]Luo P, Huang K, Wu D, et al. Correlation between miR-210 and serum levels of GGT, ALP and AST in patients with choledocholithiasis[J]. Cell Mol Biol (Noisy-le-grand), 2024,70(5):139-144. DOI: 10.14715/cmb/2024.70.5.19.

[17]李宇庆,付西峰.胆囊切除术后综合征的研究现状[C]//榆林市医学会.第五届全国医药研究论坛论文集(四).山西医科大学第三医院(山西白求恩医院山西医学科学院同济山西医院)胆胰外科,2024:160-163.DOI:10.26914/c.cnkihy.2024.018458.