Department of Organ Transplantation Unit, Acıbadem University Atakent Hospital, İstanbul-Türkiye.
Department of Biochemistry, Kocaeli University Faculty of Medicine, Kocaeli-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2022 Jul;28(7):947-953. doi: 10.14744/tjtes.2022.96572.
Laparoscopic cholecystectomy (LC) is being performed frequently in general surgery practice. Estimation of difficult cholecystectomy is very important to take precautions against complications. Cholecystokinin (CCK) is an important enzyme for gall-bladder motility. CCK receptor is the target for CCK. Fibrosis and emptying problems of gallbladder are related with difficult cholecys-tectomies. We aimed to evaluate the association between plasma CCK and difficult cholecystectomy and try to explain the mechanism.
Prospective cross-sectional study was conducted on a group of patients with cholelithiasis Patients who underwent elective cholecystectomy were classified into easy, difficult and very difficult preoperatively using LC difficulty scores. Pre-operative gallbladder empting ratios were measured by ultrasonography. Serum C-reactive protein, and postprandial serum CCK and pancreas polypeptide levels were measured before the operation. Operation data including operation times, adhesion scores, and complications were collected. Tissue CCK receptor levels and tissue fibrosis scores were obtained.
Easy, difficult, and very difficult LC (DLC) groups were consisted of 34, 28, and 8 patients, respectively. Gallbladder emp-tying was 60% in easy LC group, but 15% in very DLC group. Plasma CCK levels in easy group (37.4 pg/ml) were significantly lower than plasma CCK levels of difficult (58.6 pg/ml), and very difficult groups (66.23 pg/ml). Tissue CCK receptor levels of easy, difficult, and very difficult were 372.4, 178.3, and 144.1 ng/100 mg, respectively. Adhesion scores and fibrosis scores of very difficult group were significantly higher than other groups. Operation times were significantly longer in very difficult group. There were two conversions to open in very DLC group (25%).
CCK is a reliable parameter for determining the difficulty of LC. Decreased CCK receptor levels with fibrosis of gallbladder are the probably responsible mechanism.
腹腔镜胆囊切除术（LC）在普通外科实践中经常进行。估计困难的胆囊切除术非常重要，以防止并发症。胆囊收缩素（CCK）是胆囊运动的重要酶。CCK 受体是 CCK 的靶标。胆囊纤维化和排空问题与困难的胆囊切除术有关。我们旨在评估血浆 CCK 与困难的 LC 之间的关联，并试图解释其机制。
对一组患有胆石症的患者进行前瞻性横断面研究。患者根据 LC 难度评分在术前分为易、难和极难三组。术前通过超声测量胆囊排空率。术前测量血清 C 反应蛋白和餐后血清 CCK 和胰腺多肽水平。收集手术数据，包括手术时间、粘连评分和并发症。获得组织 CCK 受体水平和组织纤维化评分。
易、难和极难 LC（DLC）组分别由 34、28 和 8 例患者组成。易 LC 组的胆囊排空率为 60%，而极难 DLC 组为 15%。易 LC 组（37.4pg/ml）的血浆 CCK 水平明显低于困难（58.6pg/ml）和极难组（66.23pg/ml）。易、难、极难三组组织 CCK 受体水平分别为 372.4、178.3 和 144.1ng/100mg。极难组的粘连评分和纤维化评分明显高于其他组。极难组的手术时间明显延长。极难 DLC 组有 2 例转为开腹（25%）。
CCK 是确定 LC 难度的可靠参数。胆囊纤维化导致 CCK 受体水平降低可能是其机制。
