影响微创保胆取石术难度的相关因素及患者术后长期随访分析

Correlative factors affecting the difficulty of minimally invasive gallbladder-sparing cholelithotomy and long-term observation after operation

目的探讨腹腔镜下保胆取石术手术难度的影响因素及应用保胆取石术后结石复发的危险因素。方法对150例行腹腔镜保胆取石术治疗的胆囊结石患者进行术前评估及术后24个月内随访,分析可能影响手术难度和术后结石复发的相关因素。结果 (1)胆囊体积≥50 cm2、最大结石直径、胆囊壁厚度≥4 mm、胆囊颈黏连、胆囊底黏连、胆囊颈结石嵌顿是引起手术困难的危险因素;(2)患者年龄≥60岁、体质量指数(BMI)≥25 kg/m2、家族史是引起结石复发的危险因素。结论对于有影响微创手术效果危险因素的患者要对其进行术前综合评估以选择针对性的治疗手段;对于有引起结石复发危险因素的患者术后要进行药物预防性治疗以减少结石复发几率。

Objective To investigate the correlative factors affecting the difficulty of laparoscopic invasive gallbladder-sparing cholelithotomy and the risk factors of concretion recrudescent after operation.Methods Preoperative assessment and follow-up 24 months were made after operation for 150 patients with gallbladder stone who underwent laparoscopic invasive gallbladder-sparing cholelithotomy.The correlative factors that may affect the difficulty in operation and concretion recrudescent after cholelithiasis operation were analyzed.Results （1） The risk factors that caused the operation difficulty were size of gallbladder≥50 cm2,the largest diameter of calculi,thickness of gallbladder wall≥4 mm,adhesions in Calot＇s triangle or in funds of gallbladder and impacted stone in neck of gallbladder.（2）The risk factors that caused concretion recrudescent after cholelithiasis operation were age of patients ≥60,body mass index ≥ 25 kg/m2 and family history.Conclusion Patients with risk factors which affect minimally invasive surgery should be evaluated before the operation and then select the corresponding treatment.Patients with risk factors which may cause concretion recrudescent should be applied medicine for prophylactic treatment so that reduce the risk of concretion recrudescent.