胃部分切除术后胆囊动力学紊乱的发病机制  

Study on pathogenesis of gallbladder chaotic dynamics after partial gastrectomy

作　　者：刘立人[1] 徐东升[1] 宋雪[1] 全宝库[1] 齐明[1] 禹宏[1] 郑宇[1] 孙备[2] 

机构地区：[1]哈尔滨市第一医院普外一科,哈尔滨150010 [2]哈尔滨医科大学第一临床医学院肝胆胰外科,哈尔滨150036

出　　处：《国际外科学杂志》2009年第5期300-302,共3页International Journal of Surgery

摘　　要：目的探讨胃部分切除术后胆囊动力学紊乱的发病机制。方法随机抽查140例胃部分切除术后6个月以上的患者，分为Billroth Ⅰ式（40例）和Eiselsberg式（100例）2组。应用彩色超声诊断仪测定胆囊动力学功能，放射免疫法测定受检者空腹和餐后30min血浆胆囊收缩素（CCK）的含量。结果Eiselsberg组胆囊空腹体积（BV）和胆囊最小体积（RV）明显大于Billroth Ⅰ组，2组比较P〈0．05，同时显示胆囊收缩率明显不佳。空腹血浆CCK水平2组无明显差异，餐后Billroth Ⅰ组CCK血浓度的上升梯度明显大于Eiselsbeg组。结论胃部分切除术导致术后胆囊动力学紊乱的机制与胃部分切除术式的选择、CCK的分泌减少，术中易损伤迷走神经前干肝支等因素相关并导致胆囊排空障碍，诱发胆囊结石。Objective To investigate the pathogenesis of gallbladder chaotic dynamics after partial gastrectomy. Methods 140 cases operated by partial gastrectomy after 6 months were randomly examined, they included one group of 40 cases by Billroth type and the other 100 cases by Eiselsberg type. The uhrasonograph was applied to evaluate the function of gallbladder dynamics and radio-immunity method to determine the content of CCK at the time of having no food and 30 minutes after meal. Results BV and RV of Eiselsberg group were bigger than Billroth Ⅰ obviously P 〈 0.05. Gallbladder contraction rate displayed not well obviously as too. The plasm level of CCK had no manifested distinctions in empty stomach cases of the 2 groups, but the increasing gradient plasm level of CCK in Billroth Ⅰ exceeded Eiselsberg type. Conclusions The pathogenesis of gallbladder chaotic dynamics after partial gastrectomy was correlated with the alterative type of partial gastrcctomy, the reduction of CCK plasm level, the damage of anterior vagal trunk hepatic branches during the operations and so on led to the disorder of gallbladder emptying and induced eholecystolithiasis.

关 键 词：胃部分切除术 胆囊动力学 胆囊收缩素 

分 类 号：R656.6[医药卫生—外科学] R657.4[医药卫生—临床医学]