合并隐匿性胰胆反流的胆囊结石电镜微观结构观察

Electron microscopic observation of gallstones with occult pancreaticobiliary reflux

目的初步探讨合并隐匿性胰胆反流(occult pancreaticobiliary reflux,OPBR)患者的胆囊结石微观结构特征。方法回顾性分析2018年9月至2020年5月大连大学附属中山医院胆石病微创外科行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗的139例胆囊结石患者临床资料。术中取胆囊胆汁并在30 min内检测胆汁淀粉酶浓度,98例胆汁淀粉酶浓度升高者(>110 U/L)作为OPBR组,41例胆汁淀粉酶浓度正常者作为对照组。术后取出胆囊内结石,观察并比较两组胆囊结石的电镜微观结构。结果两组基线资料比较,差异无统计学意义(P>0.05)。电镜下观察,两组胆囊结石均由大量形态、大小各异的晶粒堆砌而成,周围可见类球形颗粒。OPBR组中有64例结石晶粒间填充物增多,微观晶体呈整块状或类整块状分布的相对紧密型,晶粒堆砌紧密程度高于对照组;OPBR组中结石为相对紧密型比率高于对照组[65.3%(64/98)vs 43.9%(18/41),χ2=5.474,P<0.05]。结论胆囊结石是一种具有晶体特征的特殊生物晶体。合并OPBR的胆囊结石晶粒间填充物增多,晶粒堆砌更加紧密,结石晶体微观结构呈整块状或类整块状分布几率更高。

Objective To investigate the microstructure and diagenesis mechanism of gallstones with occult pancreaticobiliary reflux(OPBR).Methods The clinical data of 146 patients with cholecystolithiasis treated by laparoscopic cholecystectomy(LC)in Affiliated Zhongshan Hospital of Dalian University from Sep.2018 to May 2020 were retrospectively analyzed.The gallbladder bile was taken during the operation,and bile amylase level was detected within 30 minutes.98 cases with high level of bile amylase(>110 U/L)were enrolled in OPBR group,and 41 cases with normal level of bile amylase were enrolled in control group.The gallstones were taken out of gallbladder after operation,and then the microstructure of gallbladder stones were observed and compared between the two groups.Results There was no significant difference in baseline data between the two groups(P>0.05).By scanning electron microscopy,the gallbladder stones from two groups are made up of large number of grains with different shapes and sizes,and spherical particles are visible around.In the OPBR group,stone intercrystalline filler increased in 64 cases,and the microscopic crystals were relatively compact with the monoblock or monobloc analogue,the compactness of crystal grains was higher than that in the control group.In the OPBR group,the ratio of relatively compact gallstones is higher than that in the control group[65.3%(64/98)vs 43.9%(18/41),χ2=5.474,P<0.05].Conclusion The gallbladder stones are special biological crystals with crystal characteristics.The intercrystalline filler of gallbladder stones maybe increase for patients with OPBR,and the grains are piled up more tightly.The microstructure of the stone crystal is more likely to be distributed in the form of monoblock or monobloc analogue.