McDonnell Ciaran O, Bailey Ian, Stumpf Thomas, Walsh Thomas N, Johnson Colin D
University Surgical Unit, Southampton General Hospital, United Kingdom.
Am J Gastroenterol. 2002 Sep;97(9):2189-92. doi: 10.1111/j.1572-0241.2002.05971.x.
Gallbladder removal is associated with an increased incidence of gastroesophageal reflux, but the mechanism is unclear. Cholecystokinin (CCK) release, which causes gallbladder contraction, is inhibited by bile in the duodenum. This study investigates the effect of cholecystectomy on meal-stimulated CCK secretion.
Three groups of patients were studied. Group 1 (n = 15) were normal controls. Group 2 (n = 27) were patients with symptomatic gallstones. Group 3 (n = 25) were patients who had undergone cholecystectomy. Meal-stimulated CCK levels were measured by radioimmunoassay at defined time points for 60 min after a standard corn oil-based meal.
Fasting CCK levels were similar in all three groups. In postcholecystectomy patients, meal-stimulated plasma CCK levels were significantly elevated compared with controls: median (range) integrated CCK values for 60 min were 116 (28-209) in controls, 123 (20-501) in gallstone patients, and 176 (63-502) after cholecystectomy.
This study suggests that cholecystectomy causes an exaggerated meal-stimulated CCK response. Because CCK is known to relax the lower esophageal sphincter. these findings may help explain the increased incidence of gastroesophageal reflux seen after cholecystectomy.
胆囊切除与胃食管反流发生率增加有关，但机制尚不清楚。十二指肠中的胆汁会抑制引起胆囊收缩的胆囊收缩素（CCK）释放。本研究调查胆囊切除术对进餐刺激的CCK分泌的影响。
对三组患者进行了研究。第一组（n = 15）为正常对照组。第二组（n = 27）为有症状胆结石患者。第三组（n = 25）为接受过胆囊切除术的患者。在食用标准玉米油餐60分钟后的特定时间点，通过放射免疫测定法测量进餐刺激后的CCK水平。
三组患者的空腹CCK水平相似。与对照组相比，胆囊切除术后患者进餐刺激后的血浆CCK水平显著升高：对照组60分钟的CCK综合值中位数（范围）为116（28 - 209），胆结石患者为123（20 - 501），胆囊切除术后为176（63 - 502）。
本研究表明胆囊切除术会导致进餐刺激的CCK反应过度。由于已知CCK会使食管下括约肌松弛，这些发现可能有助于解释胆囊切除术后胃食管反流发生率增加的原因。
