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目的探讨胃癌手术不同消化道重建方式对患者术后胆囊收缩功能影响。方法选择2010年8月至2014年8月在我院接受胃癌根治术的患者60例作为研究对象。依据胃切除术后消化道重建方式的不同分成A组(n=23)及B组(n=37)。A组给予毕Ⅰ式重建,B组给予调节型双通道重建,随访1年,比较两组患者手术前后的胆囊容积、胆囊收缩功能、血清胆囊收缩素(CCK)水平以及两组的随访症状。结果 A组患者术后3 d、7 d、1个月、6个月及12个月的胆囊容积分别为(20.89±3.12)ml、(21.23±8.10)ml、(23.64±7.88)ml、(24.94±5.32)ml、(27.84±8.81)ml,均较术前(17.15±8.24)ml及B组术后同时期的(17.20±7.94)ml、(17.19±7.22)ml、(17.18±7.99)ml、(17.19±8.54)ml、(17.20±8.20)ml明显增大,差异均有统计学意义(P<0.05);术后A组患者各时期的胆囊排空率分别为13.04%、17.39%、13.04%、17.39%、21.74%,均较B组同时期的37.84%、43.24%、40.54%、43.24%、48.65%均明显下降,差异均有统计学意义(P<0.05);术后A组患者各时期的血清CCK水平分别为(5.32±0.84)pmol/L、(5.35±0.76)pmol/L、(5.36±0.82)pmol/L、(5.38±0.77)pmol/L、(5.36±0.79)pmol/L,均较B组同时期的(4.45±0.39)pmol/L、(4.50±0.62)pmol/L、(4.48±0.41)pmol/L、(4.47±0.84)pmol/L、(4.51±0.33)pmol/L明显上升,差异均有统计学意义(P<0.05);A组患者随访症状中的消化道症状及胆囊结石发生率分别为43.48%、34.78%,均较B组的2.70%、0%高,差异均有统计学意义(P<0.05)。结论胃癌手术中实施调节型双通道的消化道重建方式有利于患者术后胆囊收缩功能的恢复,可提升其生存质量,值得推荐。
Objective To investigate the effect of different modes of digestive tract reconstruction on the gallbladder contractility after operation of gastric cancer. Methods Sixty patients who underwent radical gastrectomy in our hospital from August 2010 to August 2014 were selected as the study objects. According to the method of gastrointestinal reconstruction after gastrectomy, the patients were divided into group A (n = 23) and group B (n = 37). The patients in group A received complete Ⅰ reconstruction, while those in group B received reconstructive double-channel reconstruction. The patients were followed up for 1 year. The gallbladder volume, gallbladder contractility, serum CCK and the follow-up symptoms were compared between the two groups. Results The volume of gallbladder in group A was (20.89 ± 3.12) ml, (21.23 ± 8.10) ml and (23.64 ± 7.88) ml respectively at 3 d, 7 d, 1 month, 6 months and 12 months after operation (17.19 ± 7.22) ml, (17.18 ± 7.99) ml and (17.18 ± 7.99) ml respectively in group A and group B after operation (24.94 ± 5.32 and 27.84 ± 8.81, ml, (17.19 ± 8.54) ml and (17.20 ± 8.20) ml respectively, the differences were statistically significant (P <0.05). The gallbladder emptying rates in each group were 13.04% and 17.39% , 13.04%, 17.39% and 21.74% respectively, which were significantly lower than those in group B (37.84%, 43.24%, 40.54%, 43.24% and 48.65%, respectively) The levels of CCK in each group were 5.32 ± 0.84 pmol / L, 5.35 ± 0.76 pmol / L, 5.36 ± 0.82 pmol / L, 5.38 ± 0.77 pmol / L, 5.36 ± 0.79 (4.45 ± 0.39) pmol / L, (4.50 ± 0.62) pmol / L, (4.48 ± 0.41) pmol / L, (4.47 ± 0.84) pmol / L and ± 0.33) pmol / L, the difference was statistically significant (P <0.05). The incidence of gastrointestinal symptoms and gallstone in follow-up in patients in group A were 43.48% and 34.78% respectively B group 2.70%, 0%, the difference was statistically significant (P <0.05). Conclusions The reconstructive two-channel digestive reconstruction in gastric cancer surgery is beneficial to the recovery of patients with postoperative gallbladder contractility and enhances the quality of life, which is worth recommending.