微创胆囊切除术后胆总管扩张患者血浆VIP、CCK水平的研究

Plasma VIP and CCK levels in patients with common bile duct dilatation following minimally invasive cholecystectomy

目的:探讨微创胆囊切除术后胆总管扩张患者血浆胆囊收缩素(CCK)、血管活性肠肽(VIP)水平的变化。方法:选择南方医科大学顺德医院消化内科2015年1月~2016年12月确诊的胆囊切除术后合并胆总管扩张患者20例(观察组)、胆囊切除术后未合并胆总管扩张患者20例(对照组),99m TcEHIDA肝胆动态功能显像对各组对象胆总管区域胆汁流变学定量分析,且通过酶联免疫吸附法(ELISA)测定患者空腹及餐后血浆VIP、CCK水平。结果:观察组T_(max)(CBD)胆总管高峰时间、T_(1/2)(CBD)胆总管半排时间均显著长于对照组(P<0.05);观察组空腹血浆VIP、CCK水平与对照组比较差异无统计学意义(P>0.05);观察组餐后血浆VIP、CCK水平分别为(331.05±25.27)pg/m L、(1018.21±112.08)pg/m L,均显著高于对照组的(233.09±21.24)pg/m L、(691.15±111.37)pg/m L(P<0.05)。结论:腹腔镜胆囊切除术后胆总管扩张患者胆总管区域胆汁流变学有影响,餐后血浆VIP、CCK水平显著高。

Objective: To investigate the changes in plasma levels of cholecystokinin( CCK) and vasoactive intestinal peptide( VIP) in patients with common bile duct dilatation following minimally invasive cholecystectomy. Methods: Included in this study were post-cholecystectomic patients with previous common bile duct dilatation( n = 20,study group) and those without( n = 20,control group) identified between January 2015 and December 2016 at the Department of Gastroenterology,Shunde Hospital of Southern Medical University.Quantitative analysis of biliary rheology of the common bile duct area was performed by ^(99 m)Tc-EHIDA hepatobiliary dynamic functional imaging. Enzyme-linked immunosorbent assay( ELISA) was used to determine the fasting and postprandial plasma VIP and CCK levels. Results: The study group showed significantly longer time to peak bile-emptying [Tmax( CBD) ]and half-emptying [T_(1/2)( CBD) ]of the common bile duct than did the control group( P<0.05). There was no significant difference in fasting plasma VIP and CCK levels between the study group and the control group( P>0. 05). The postprandial plasma VIP and CCK levels in the study group were( 331.05±25.27) pg/m L and( 1018.21±112.08) pg/m L,respectively,which were significantly higher than those in the control group [( 233. 09 ± 21. 24) pg/m L and( 691. 15 ± 111. 37) Pg/m L,respectively ],with statistically significant differences( P<0.05). Conclusion: After laparoscopic cholecystectomy,the biliary rheology is altered in patients with previous common bile duct dilation,resulting in significantly higher postprandial plasma levels of VIP and CCK.