胆囊皱襞的异常存在对取石保胆术后胆囊恢复的影响

The influence of the abnormal gallbladder pleat on the turnover of gallbladder after gallbladder-preserving cholelithotomy

目的探讨胆囊皱襞的异常存在对胆囊结石患者取石保胆术后胆囊恢复的影响。方法采用彩色超声多普勒随访观察221例在该院普外科接受取石保胆手术的胆囊结石患者,分别于术前12 h、术后6个月及1年观察胆囊形态、胆囊内有无异常皱襞、胆囊腔内情况,以及术后不同时间胆囊收缩功能的变化。结果 221例胆囊结石患者中131例胆囊内无异常皱襞,90例有异常皱襞。1取石保胆术后半年复查:胆囊内有异常皱襞组胆囊沉积物发生率为55.6%,高于胆囊内无异常皱襞组(29%)(P=0.00)。2术后1年:同一组研究对象,胆囊内有异常皱襞组胆囊沉积物发生率(34.4%)与胆囊内无异常皱襞组(29%)相比差异无显著性(P=0.39)。3经服用硫酸镁等利胆药物后,术后1年与术后半年相比,胆囊内有异常皱襞组胆囊沉积物发生率降低(P=0.004),胆囊收缩功能明显增强(P=0.036)。结论胆囊皱襞的异常存在是胆囊沉积物形成的潜在危险因素之一,经服用硫酸镁等利胆药物后,沉积物能明显减少,胆囊收缩功能明显增强。

【Objective】 To explore the influence of the abnormal gallbladder pleat on the turnover of gallbladder after gallbladder-preserving cholelithotomy. 【Methods】221 patients with gallbladder stones underwent endoscopic gallbladder-preserving cholelithotomy. Color Doppler ultrasound was used to inspect the pre- and postoperative changes of the gallbladder at 12 hours before the operation and 6 and 12 months after the operation.The gallbladder, the abnormal gallbladder pleat and the gallbladder emptying were evaluated. 【Results】131 of the221 patients with gallbladder stones didn＇t have abnormal gallbladder pleat, 90 of them had abnormal gallbladder pleat. ①The 6 months postoperative recheck indicated that the gallbladder sediments incidence of the patients with abnormal gallbladder pleat was 55.6%, which was higher than that of the patients without abnormal gallbladder pleat（29%）（P =0.00）. ②The one-year postoperative recheck indicated that the gallbladder sediments incidence of the patients with abnormal gallbladder pleat was 33.4%, with no statistical difference compared with that of the patients without abnormal gallbladder pleat（29%）（P =0.39）. ③ After the treatment with magnesium sulfate etc, the gallbladder sediments incidence was decreased（P =0.004） and the gallbladder emptying was increased（P =0.036） for patients with abnormal gallbladder pleat. 【Conclusion】The abnormal gallbladder pleat was the risk factor for the formation of gallbladder sediments, after the treatment with magnesium sulfate, the sediments was decreased and gallbladder emptying was increased.