胆石症2768例临床病理分析

Clinicopathological analysis of 2768 cases of cholelithiasis.

目的观察胆石症患者胆囊的病理组织学改变，探讨结石的发生及与胆囊癌的关系。方法对2768例经手术治疗的胆石症患者的临床及病理学检查资料进行回顾性分析。结果患者年龄6岁～82岁，平均44．9岁，41岁～60岁年龄组占53．4％，男：女=1：4．1。临床表现以反复间断性发作的右上腹痛为主。病理改变：胆囊粘膜缺损、糜烂，胆囊壁急性及慢性炎症细胞浸润，粘膜间质内胆固醇沉着，胆固醇息肉及胆囊结石形成，腺体修复、上皮细胞增生，不典型增生以至癌变，结石的数目和／或大小与胆囊炎症程度呈正相关。本组病例中发现胆囊癌69例，伴有胆囊结石者53例（76．8％），39例为手术意外发现胆囊癌。结论胆囊非特异性炎症及粘膜损伤与结石的发生、发展关系密切，结石一旦形成，两者互为因果，恶性循环，可致肝损害、胰腺炎等，更为严重的是有诱发胆囊癌的潜在危险，一经确诊，宜尽早手术治疗。

Objective To observe the cholecystic pathologicalhistological change on patients of cholelithiasis, study the cholelith formed and the relation with cholecystic carcinoma. Methods The clinicopatholagical features of 2768 cases of cholelithiasis were investigated. Results The age of the patients were 6 - 82 years old, the middle age was 44.9 years old. 53.4% patients were in 41 -60 years old. More than 80% patients were female and less than 20% patients were male. Clinical lessons were right upward abdominal pain interrupted not occasionally. Pathological change included：The cholecystic mucous coat were damaged. The chronic inflammatory cells were infiltrated , cholesterosis in the stroma, cholesterol polyp and the cholelith were formed,the gland of the mucous coat were repaired, epitheliosis, dysplasia and carcinoma were formed. The quality and the size of the cholelith were relatied to the cholecystic pathological change. We found 69 cases of cholecystic carcinoma in all patients and 53176.8% ） cases with cholelith, 39 cases of cholecystic carcinoma were unexpected gallbladder carcinoma. Conclusion Cholecystitis and cholecystic mucous coat damaged are related to the cholelith, it would cause liver damage pancreatitis and cholecystic carcinoma.