胆囊切除术对胆囊结石患者术后排便功能的影响

Influence of cholecystectomy on postoperative defecation function in gallstone patients

目的:比较内镜微创保胆取石术(EGPCL)与胆囊切除术对胆囊结石患者术后排便功能的影响。方法:采用分层随机抽样的方法选取2001—2011年间收治胆囊结石患者330例(术后1年以上)进行问卷进行随访调查,分析患者术后腹泻与便秘的发生情况。结果:共收回有效问卷298例,其中腹腔镜胆囊切除术(LC)28例,开腹胆囊切除术(OC)108例,EGPCL 162例。LC,OC,EGPCL组腹泻的发生率分别为3.57%(1/28),6.48%(7/108),0.62%(1/162);便秘的发生率分别为10.71%(3/28),9.26%(10/108),2.47%(4/162);腹泻并便秘的发生率分别为35.18%(38/108),21.43%(6/28),16.67%(27/162)。EGPCL组以上3种情况的发生率均明显低于胆囊切除术组(OC组+LC组)(均P<0.01)。无论是胆囊切除术还是EGPCL,腹泻与便秘的发生率与患者年龄无明显关系(均P>0.05)。结论:胆囊切除可导致腹泻或便秘的发生,对术前有排便异常的患者,应重视胆囊功能的保留。

Objective： To compare the effects exerted by endoscopic gallbladder-preserving cholecystolithotomy （EGPCL） with those by cholecystectomy on the postoperative defecation function in patients with gallstones. Methods： Questionnaire follow-up investigation was conducted in 330 patients （more than one year after operation）, who were selected, by stratified random sampling, from the gallstone patients treated between 2001 and 2011 in our hospital. The incidences of postoperative diarrhea and constipation of the patients were analyzed. Results： In total, 298 valid questionnaires were returned. Of the patients, 28 cases underwent laparoscopic cholecystectomy （LC）, 108 cases underwent open cholecystectomy （OC） and 162 cases underwent EGPCL.In LC, OC and EGPCL group, the incidence of postoperative diarrhea was 3.57% （1/28）, 6.48% （7/108） and 0.62% （1/162）, incidence of postoperative constipation was 10.71% （3/28）, 9.26% （10/108） and 2.47% （4/162）, and incidence of alternating diarrhea and constipation was 35.18% （38/108）, 21.43% （6/28） and 16.67% （27/162）, respectively The incidences of above three conditions in EGPCL group were all significantly lower than those in cholecystectomy （LC＋OC） group （all P〈0.01）. Both diarrhea and constipation were not associated with the age of the patients undergoing either cholecystectomy or EGPCL （all P〉0.05）. Conclusion： Gallbladder removal may cause diarrhea and/or constipation. Gallbladder function preservationoriented operation is recommended for those with preoperative abnormal defecation dynamics.