腹腔镜胆囊切除术对胆道结石合并糖尿病患者肠屏障功能的影响

华文强; 孔振宇; 张富刚

doi:10.7619/jcmp.20200765

腹腔镜胆囊切除术对胆道结石合并糖尿病患者肠屏障功能的影响

Effect of laparoscopic cholecystectomy on intestinal barrier function in patients with cholelithiasis complicated with diabetes mellitus

摘要

摘要:
目的观察胆道结石合并糖尿病患者腹腔镜胆囊切除术(LC)后肠屏障功能的变化。
方法将择期行LC的126例患者分为糖尿病组41例和非糖尿病组85例。术前及术后第1、3天，采用高效液相色谱法检测尿乳果糖与甘露醇比值(L/M), 并采用酶联免疫吸附法(ELISA)检测尿脂肪酸结合蛋白(IFABP)及血清D-乳酸水平。
结果 2组患者均成功完成手术，无中转开放手术者。糖尿病组术后肛门排气时间长于非糖尿病组，差异有统计学意义(P < 0.05)。糖尿病组术后第1、3天尿L/M、血清D-乳酸、尿IFABP均高于术前及非糖尿病组，差异均有统计学意义(P < 0.05)。
结论合并糖尿病的胆道结石患者行LC后会加重肠屏障功能障碍程度，术前控制好血糖水平或可降低肠道功能损伤的严重程度。

Abstract:
Objective To observe the changes of intestinal barrier function in patients with biliary calculi complicated with diabetes after laparoscopic cholecystectomy (LC).
Methods A total of 126 patients with LC were divided into diabetes group (41 cases) and non-diabetes group (85 cases). The ratio of lactulose to mannitol (L/M) in urine was detected by high-performance liquid chromatography, and the levels of urinary intestinal fatty acid binding protein (IFABP) and serum D-lactate were measured by enzyme-linked immunosorbent assay (ELISA) before operation and on the 1^st and 3^rd day after operation.
Results The patients of two groups successfully completed the operations, no patients transferred to open surgeries. The anal exhaust time in the diabetic group was significantly longer than that in the non-diabetes group (P < 0.05). Urine L/M, serum D-lactic acid and urinary IFABP on the 1^st and 3^rd postoperative day in the diabetic group were significantly higher than those before treatment and non-diabetic group (P < 0.05).
Conclusion Intestinal barrier dysfunction will aggravate in patients with biliary calculi complicated with diabetes undergoing LC surgery. Preoperative control of blood glucose levels may reduce the severity of intestinal damage.

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