胆囊胆固醇息肉和胆囊结石发病关系的研究

Study on the relationship between gallbladder cholesterol polyps and the pathogenesis of gallstones

目的探讨胆囊胆固醇息肉和胆囊结石的发生关系。方法选择2008年4～9月上海交通大学医学院附属瑞金医院外科微创中心行腹腔镜胆囊切除术病人62例,分别收集病人的胆石、胆汁及胆囊壁全层组织,其中胆固醇息肉31例,胆固醇胆囊结石18例,对照组13例。入院后上午餐前及餐后1h行B超胆囊三径测量,计算胆囊排空率对比显示胆囊功能。测定结石胆固醇含量及胆汁胆固醇、磷脂、胆汁酸浓度,胆囊壁组织做病理检查。结果胆固醇息肉组病人平均胆囊排空率为(47.3±18.6)%,较健康成人平均胆囊排空率(71.7±8.1)%明显降低,其差异有统计学意义(P<0.01),而胆固醇息肉组和胆固醇结石组病人平均胆囊排空率(47.6±23.7)%比较,差异无统计学意义。胆固醇息肉组胆汁胆固醇饱和指数为(1.0±0.2),较对照组胆固醇饱和指数(0.6±0.3)明显增高,其差异有统计学意义(P<0.01),而胆固醇息肉组和胆固醇结石组胆固醇饱和指数(1.0±0.2)比较,差异无统计学意义。31例胆固醇息肉病人中,合并胆囊结石13例,结石发病率为41.9%。结论胆囊胆固醇息肉的存在可以促使胆囊结石形成。

Objective To study on the relationship between gallbladder cholesterol polyps and the pathogenesis of gallstone. Methods gallbladder stone, bile and part of gallbladder full-thickness tissue were collected from 62 patients who underwent laparoscopic cholecystectomy from April 2008 to september 2008 in our center, including 31 patients with gallbladder cholesterol polyps, 18 patients with cholesterol gallstones and 13 patients in control（6 patients with gallbladder adenoma and 7 patients with non-cholesterol gallstone ）. sonography was applied to measure the gallbladder three diameter before and 1 hour after breakfast to evaluate the contracted function of gallbladder. The contents of cholesterol in gallstone and cholesterol, bile acid and phospholipid in bile were measured, and the full-thickness tissue of the gallbladder wall was done the pathological examination. Results Emptying Rate of Gallbladder in the patients with cholesterol polyps was（47.3 ± 18.6） %, it was significantly decreased comparing with those that in the healthy people（71.7 ±8.1）%, P 〈 0.01, but there ware no differences between the patients in group of cholesterol polyps and in group of gallstones（47.6±23.7）%. Cholesterol saturation index was higher in the patients with cholesterol polyps comparing with those that in control group（1.0＋0.2 vs 0.6＋0.3, P 〈 0.01）, but there ware no differences between the patients in group of cholesterol polyps and in group of gallstones （1.0＋0.2 vs1.0＋0.2, P 〉 0.05）. Gallstones and cholesterol polyps coexistence in 13 patients among 31 patients who with the gallbladder cholesterol polyps, and the incidence of gallstone is 41.9%. Conclusion the existence of gallbladder cholesterol polyps may lead to the formation of gallbladder stone.