腹腔镜与开腹胆囊切除术对急性结石性胆囊炎患者肠屏障功能的影响

Effects on the Intestinal Barrier Function of Laparoscopic and Open Cholecystectomy in Patients With Acute Calculous Cholecystitis

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与开腹胆囊切除术(open cholecystectomy,OC)2种手术方法治疗急性结石性胆囊炎对肠屏障功能的影响。方法我院2015年1月~2016年5月急性结石性胆囊炎57例,按患者意愿选择手术方式,32例行LC,25例行OC,比较手术前后尿乳果糖/甘露醇(ratio of lactulose and mannitol,L/M)、D-乳酸水平和肠形脂肪酸结合蛋白(intestinal fatty acid binding protein,IFABP)浓度变化。结果 LC组L/M、D-乳酸水平和IFABP术前后比较无统计学差异(P>0.05)。OC组术后第1、3天尿L/M显著高于术前(F=3643.711,P=0.000),与LC组比较,OC组术后第1天(t=-58.210,P=0.000)、第3天(t=-38.580,P=0.000)均明显升高。与LC组比较,OC组术后2 h D-乳酸水平明显升高(t=-23.212,P=0.000);术后24 h IFABP显著升高(t=-21.749,P=0.000)。OC组术后24 h内排气的例数(χ~2=29.085,P=0.000)、排便时间(t=-10.919,P=0.000)和术后进食时间(t=-6.044,P=0.000)显著少于/长于LC组。结论急性结石性胆囊炎行LC对肠屏障功能损伤微小,有利于肠道功能的迅速恢复,患者是受益的。

Objective To discuss effects on intestinal barrier function of laparoscopic cholecystectomy （LC） and open cholecystectomy （OC） in the treatment of acute calculous cholecystitis. Methods From January 2015 to May 2016, there were 57 patients with acute calculous cholecystitis willing to receive surgery. According to the patient’s choice, there were 32 cases of LC and 25 cases of OC. The urinary ratio of lactulose and mannitol （L/M）, D-lactic acid levels, and intestinal fatty acid binding protein （IFABP） concentrations before and after surgery were compared. Results The LC group had little changes in L/M, D-lactic acid level, and IFABP as compared with preoperation （ P 〉0.05）, whereas the OC group showed significant higher ratio of L/M on the first and third day than preoperation （ F =3643.711, P =0.000）. As compared with the LC group, the OC group had significant higher levels on the postoperative first day （ t =-58.210, P =0.000） and third day （ t =-38.580, P =0.000）. As compared with the LC group, the OC group had significant higher level of D-lactic acid at 2 h after surgery （ t =-23.212, P =0.000） and IFABP concentration at 24 h after operation （ t =-21.749, P =0.000）. The LC group was superior to the OC group in the 24 h exhaust （ χ ^2 = 29.085, P =0.000）, defecation time （ t =-10.919, P =0.000）, and diet time （t =-6.044, P =0.000）. Conclusions LC had slight postoperative damage to intestinal barrier function in patients with acute calculous cholecystitis. It is advantageous to the rapid recovery of intestinal function, which benefits patients.