腹腔镜胰十二指肠切除术患者围手术期血清胃泌素和胃动素水平变化及其与术后胃瘫的关系

Changes of serum gastrin and motilin levels in the perioperative period of laparoscopic pancreat-icoduodenectomy and the correlation with postoperative gastroparesis

目的探讨行腹腔镜胰十二指肠切除术(laparoscopic pancreatoduodenectomy,LPD)患者围手术期血清胃泌素和胃动素水平变化,分析胃泌素和胃动素与LPD术后胃瘫的关系。方法对2019年2月至2020年8月在南充市中心医院接受腹腔镜胰十二指肠切除术的32例患者资料进行回顾性分析,测定患者血清胃泌素和胃动素水平,根据术后有无发生胃瘫,分为胃瘫组(5例)和无胃瘫组(27例),比较两组的血清胃泌素和胃动素水平差异。结果32例患者术前及术后第1、3、7天总体胃泌素和胃动素的表达呈上升趋势,但差异均无统计学意义(P>0.05)。胃瘫组(n=5)术前胃泌素、胃动素均低于无胃瘫组(n=27);术后1、3、7天胃瘫组胃泌素下降;胃动素先下降,后上升至术前水平;无胃瘫组术后胃泌素和胃动素均逐步上升。胃瘫组术前、术后第1、3、7天胃泌素分别为(71.25±20.24)pg/mL、(64.26±19.88)pg/mL、(62.81±16.27)pg/mL、(63.45±22.34)pg/mL,无胃瘫组为(128.78±37.54)pg/mL、(147.12±67.22)pg/mL、(179.25±48.67)pg/mL、(185.98±57.27)pg/mL],两组总体比较(F_(分组)=39.040,P=0.002)、变化趋势(F_(时间)=17.256,P=0.026)、变化幅度(F_(交互)=11.275,P=0.031)差异均有统计学意义。胃瘫组术前、术后第1、3、7天胃动素分别为(164.90±16.98)pg/mL、(136.45±16.77)pg/mL、(165.70±39.36)pg/mL、(169.62±16.41)pg/mL;无胃瘫组为(225.34±74.58)pg/mL、(277.17±117.45)pg/mL、(348.52±89.71)pg/mL、(338.28±84.27)pg/mL,两组总体比较(F_(分组)=28.457,P=0.003)、变化趋势(F_(时间)=19.248,P=0.021)、变化幅度(F_(交互)=13.623,P=0.027)差异均有统计学意义。结论围手术期胃泌素、胃动素的分泌不足可能是胰十二指肠切除术后胃瘫综合征发生的诱因。

Objective To investigate the levels of gastrin and motilin in the perioperative period of laparoscopic pancreaticoduodenectomy(LPD)and the correlation with postoperative gastroparesis.Methods Clinical data of 32 patiens treated with LPD in Nanchong Central Hospital between Feb.2019 and Aug.2020 were retrospectively analyzed.The serum gastrin and motilin before surgery and 1^(st),3^(rd),7^(th) day after LPD were detected.According to the occurrence of gastroparesis after LPD,patients were divided into gastroparesis group(5 cases)and non-gastroparesis group(27 cases).Levels of gastrin and motilin were compared between the two groups.Results The total levels of serum gastrin and motilin in all 32 cases were increased gradually before LPD and 1^(st),3^(rd),7^(th) day after LPD(P>0.05).Before LPD,levels of gastrin and motilin in gastroparesis group were both lower than those in non-gastroparesis group.In gastroparesis group,levels of gastrin decreased on the 1^(st),3^(rd),7^(th) day after LPD,Levels of gastrin decreased on the 1st day postoperation and increased to the level of preoperative.In non-gastroparesis group,levels of gastrin and motilin both increased after LPD.The gastrin levels in gastroparesis group before LPD and 1^(st),3^(rd),7^(th) day after LPD were(71.25±20.24)pg/mL,(64.26±19.88)pg/mL,(62.81±16.27)pg/mL and(63.45±22.34)pg/mL,and which in non-gastroparesis group were(128.78±37.54)pg/mL,(147.12±67.22)pg/mL,(179.25±48.67)pg/mL,(185.98±57.27)pg/mL respectively.There were statistical differences in overall comparison(F_(group)=39.040,P=0.002),change trend of(F_(time)=17.256,P=0.026),and change amplitude of variation(F_(interactive)=11.275,P=0.031)between the two groups.The gastrin levels in gastroparesis group before LPD and 1^(st),3^(rd),7^(th) day after LPD were(164.90±16.98)pg/mL,(136.45±16.77)pg/mL,(165.70±39.36)pg/mL,(169.62±16.41)pg/mL,and which in non-gastroparesis group were(225.34±74.58)pg/mL,(277.17±117.45)pg/mL,(348.52±89.71)pg/mL,(338.28±84.27)pg/mL respectively.There were statistical differences in overall comparison(F_(group)=28.457,P=0.003),change trend of(F_(time)=19.248,P=0.021),and change amplitude of variation(F_(interactive)=13.623,P=0.027)between the two groups.Conclusion This study suggests that insufficient secretion of motilin and gastrin during perioperative period of LPD maybe the cause of gastroparesis syndrome.