胆囊结石合并急性胰腺炎患者腹腔镜手术时机选择及胆囊结石形成的分子机制

目的 探讨胆囊结石合并急性胰腺炎患者腹腔镜手术时机选择及胆囊结石形成的分子机制.方法 选取行手术治疗的胆囊结石合并急性胰腺炎患者37例,分为早期手术组(发病48h内行腹腔镜下胆囊切除术)16例,延迟手术组(胰腺炎治愈后3~5周)21例,记录术前和术后两组患者血液学指标和手术情况.收集术中切取的胆囊组织(胆固醇结石17例,胆色素结石13例,胆囊息肉7例),RT-PCR检测不同胆囊组织中Cacna1c mRNA的表达量.结果 两组患者手术时间、术中出血量、中转开腹发生率、术后并发症发生率之间比较差异均无统计学意义(P>0.05);早期手术组患者总住院时间短于延迟手术组,差异具有统计学意义(P<0.05).两组患者术前和术后1 d白细胞计数、中性粒细胞比率、血淀粉酶水平之间比较差异无统计学意义(P>0.05);术后3d早期手术组患者白细胞计数和血淀粉酶均恢复到正常水平,明显低于同期延迟手术组,差异具有统计学意义(P<0.05).胆色素结石和胆囊息肉组织中Cacna1c mRNA表达水平均高于胆固醇结石组织,差异具有统计学意义(P<0.01);胆色素结石组织与胆囊息肉组织Cacna1c mRNA表达水平之间差异无统计学意义(P>0.05).结论 胆囊结石合并急性胰腺炎患者发病48 h内行胆囊切除术安全可行,且疗效理想;Cacna1c基因为钙离子通道在不同胆囊结石组织中分布差异的分子基础,在胆固醇结石形成中发挥调控作用.

Timing of Laparoscopic Cholecystectomy and Molecular Mechanism of Gallstone Formation in Patients with Acute Gallstone Pancreatitis

Objective To explore the timing of laparoscopic cholecystectomy (LC) and the molecular mechanism of gallstone formation in patients with gallstone complicated with acute pancreatitis.Method A total of 37 patients with gallbladder stone complicated with acute pancreatitis were selected.The patients were divided into early operation group (16 patients who underwent laparoscopic cholecystectomy within 48 h),and delayed operation group (21 patients who underwent laparoscopic cholecystectomy 3~5 weeks after the recovery from pancreatitis).The blood indicators and operation of patients in the two groups were recorded before and after operation.The removed gallbladder tissues during the operation were collected (17 cases of cholesterol gallstones,13 cases of bile pigment stones and 7 cases of gallbladder polyps),and the expression of Cacna1c mRNA in the different tissues was detected by RT-PCR.Results The operation time,intraoperative bleeding volume,laparotomy incidence,incidence of postoperative complications were not significantly different between the two groups (P>0.05);the total hospitalization time of patients in the early operation group was shorter than that in the delayed operation group,with a statistically significant difference (P<0.05).There was no significant difference in the patients'' white blood cell count,neutrophil percentage and serum amylase levels between the two groups on the 1st day before and after operation (P>0.05);in the early surgery group,the white blood cell count and serum amylase both returned to the normal levels on the 3rd day after operation,significantly lower than those in the delayed operation group at the same period (P<0.05).The Cacna1c mRNA expression level in both the pigment gallstone and gallbladder polyp tissues were significantly higher than that in the cholesterol gallstone tissue (P<0.01);there was no significant difference in the Cacna1c mRNA expression level between the pigment gallstone and gallbladder polyps tissues (P>0.05).Conclusion To carry out cholecystectomy in cholecy-stolithiasis patients with acute pancreatitis within 48 h should be safe,which can be feasible and achieve an ideal curative effect.Cacna1c gene is the molecular basis for the difference in the distribution of calcium channels in different tissues of gallbladder stones and plays a regulatory role in the cholesterol gallstone formation.