胃癌根治术后并发胆石症的分析

Clinical Study of Cholelithiasis after Radical Gastrectomy

目的回顾分析胃癌根治术后并发胆石症的病例特征，并探讨其可能形成机制。方法随访胃癌根治术术后长期存活（5～10年）和胃大部切除术后病例，观察比较术后胆结石的发病情况。结果共随访145例胃癌根治术后患者，45例（31．0％）出现胆结石；胃大部切除术后患者41例，胆结石发病率为22．0％；两组胆结石发病率均显著高于自然人群的6．5％（P〈0．01）。结石的发病与淋巴结清扫程度有关，清扫范围越广发病率越高（P=0．0107）；以不经十二指肠通路的Roux-en-Y、毕Ⅱ式消化道重建的发病率更高。胆结石以多发性小结石为特点。结论胃癌根治术后有较高的胆石症发病率，两者密切相关；胆道动力学改变在结石的发生中起着重要作用。

Objective To analyse the characteristics of cholelithiasis after radical gastrectomy and the possible causes. Methods Gastric cancer patients who underwent radical gastrectomy with a long term survival （5 -10 years） and patients who underwent gastrectomy were followed up. The incidence of cholelithiasis postoperation was observed and compared. Results A total of 145 patients with radical gastrectomy and 41 with gastrectomy were followed up. Of the two groups, 45（31.0% ） and 9（22.0% ） patients developed gallstones, respectively. Both significantly differed with the acknowledged 6.5% of gallstone incidence for normal population （P 〈 0.01 ）. The incidence of postoperative cholelithiasis was positively related to the extent of lymph node dissection（P =0. 0107）. The operation of Roux-en-Y and Billroth Ⅱ led to a higher incidence of cholelithiasis. The type of gallstones under ultrasonics was more likely multiple and small. Conclusion Patients develop cholelithiasis at a high frequency after radical gasterctomy. It is mainly associated with the changes in the motility of bile duct system.