胆管空肠UncutRoux-en-Y吻合术治疗先天性胆总管囊肿疗效及对患儿基质金属蛋白酶-2、基质金属蛋白酶-2组织抑制剂表达的影响  

Effectiveness of Uncut Roux-en-Y choledochojejunostomy in treatment of congenital choledochus cyst and its effect on expression of MMP-2 and TIMP-2 in children

作　　者：张向宁[1] 孙欢 侯崇智[1] 施伟栋[1] ZHANG Xiangning;SUN Huan;HOU Chongzhi;SHI Weidong(Xi’an Children’s Hospital,Xi’an 710003,China)

机构地区：[1]西安市儿童医院,陕西西安710003

出　　处：《陕西医学杂志》2021年第8期949-953,976,共6页Shaanxi Medical Journal

基　　金：陕西省自然科学基础研究计划项目(2021JM-557)。

摘　　要：目的:探讨先天性胆总管囊肿应用胆管空肠Uncut Roux-en-Y吻合术治疗的有效性及对患儿基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-2组织抑制剂(TIMP-2)水平的影响。方法:选取60例先天性胆总管囊肿患儿,随机分为对照组与干预组,每组各30例;对照组实施胆管空肠Roux-en-Y吻合术,干预组实施胆管空肠Uncut Roux-en-Y吻合术;比较两组患儿手术及术后恢复情况,比较两组患儿术前与术后的肝功能指标[谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(GGT)、总胆红素(TB)]、血清炎性反应指标[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C-反应蛋白(CRP)]及MMP-2、TIMP-2水平,比较两组患儿术后并发症发生情况。结果:干预组的手术平均时间、术中出血量以及术后肠鸣音恢复时间、肛门第一次排气时间均低于对照组,两组比较差异均有统计学意义(均P<0.05)。术前,两组患儿的ALT、GGT、TB比较均无统计学差异(均P>0.05);术后7 d,两组患儿的上述指标均显著低于术前,且与对照组比,干预组ALT、GGT的改善程度更大,差异均有统计学意义(均P<0.05),但干预组TB的改善程度与对照组比较无统计学差异(P>0.05)。术前,两组患儿的IL-6、IL-8、CRP水平比较均无统计学差异(均P>0.05);术后7 d,两组患儿的上述指标均显著低于术前,且与对照组比较干预组的改善程度更大,差异均有统计学意义(均P<0.05)。术前,两组患儿的MMP-2、TIMP-2水平比较均无统计学差异(均P>0.05);术后7 d,两组患儿的上述指标均显著低于术前,且与对照组比较干预组的改善程度更大,差异均有统计学意义(均P<0.05)。术后半年内,干预组并发症总发生率显著低于对照组(10.00%与33.33%),其中干预组反流性胆管炎的发生率也显著低于对照组(3.33%与26.67%),差异均有统计学意义(均P<0.05)。结论:胆总管空肠Uncut Roux-en-Y吻合术用于治疗先天性胆总管囊肿,术式安全,可有效改善患儿肝功能�Objective:To investigate the effectiveness of Uncut Roux-en-Y choledochojejunostomy for children with congenital choledochus cyst and its effect on the expression of MMP-2 and TIMP-2.Methods:A total of 60 children with congenital choledochus cyst were randomly divided into control group and intervention group,with 30 cases each.The children in control group were treated with Roux-en-Y choledochojejunostomy,and the children in intervention group were treated with Uncut Roux-en-Y choledochojejunostomy.The operation and postoperative recovery,the preoperative and postoperative liver function indexes(ALT,GGT,TB),serum inflammatory reaction indexes(IL-6,IL-8,CRP),the levels of MMP-2 and TIMP-2,and the postoperative complications of the two groups were compared.Results:The average operation time,intraoperative blood loss,postoperative bowel sound recovery time and the first anal exhaust time of the intervention group were significantly lower than those of the control group(all P<0.05).Before operation,it had no significant difference in ALT,GGT and TB between the two groups(all P>0.05);7 days after operation,compared with those before operation,the above indexes of the two groups were significantly lower,and compared with those in the control group,the improvement degree of ALT and GGT in the intervention group were significantly higher(all P<0.05),but the improvement degree of TB in the intervention group was not significantly different from that in the control group(P>0.05).Before operation,there was no significant difference in IL-6,IL-8 and CRP between the two groups(all P>0.05);7 days after operation,compared with those before operation,the above indexes of the two groups were significantly lower,and compared with those in the control group,the improvement degree of the intervention group were significantly higher(all P<0.05).Before operation,there was no significant difference in MMP-2 and TIMP-2 between the two groups(all P>0.05);7 days after operation,compared with those before operation,the above indexes of th

关 键 词：先天性胆总管囊肿 胆总管空肠Uncut Roux-en-Y吻合术 基质金属蛋白酶-2 基质金属蛋白酶-2组织抑制剂 并发症 

分 类 号：R726.1[医药卫生—儿科]