内镜微创保胆术后结石复发的胆囊因素分析

Analysis of the factors of gallbladder stone recurrence after minimal invasive gallbladder preserved choledochoscopy

目的 研究内镜微创保胆术后复发的胆囊病变因素。方法 将行内镜微创保胆手术的患者根据胆囊的病变的情况分为9组：①胆囊壁光滑,厚度小于5 mm,②胆囊壁光滑,厚度大于5 mm,③胆囊内分隔,④胆囊壁间结石,⑤胆囊颈部结石嵌顿,⑥胆囊壁胆固醇沉积,⑦胆囊壁厚度大于5 mm伴有胆囊壁间结石,⑧胆囊分隔,胆囊壁厚度大于5 mm,⑨胆囊分隔伴有胆囊壁间结石。每年B超复查,在第5年后统计结石复发率。结果 胆囊壁光滑,厚度小于5 mm,其5年复发率为3.0%;胆囊壁光滑,厚度大于5 mm,其5年复发率为2.4%;胆囊分隔术后5年复发率为4.7%;胆囊颈部结石嵌顿术后5年复发率为2.3%;胆囊壁胆固醇沉积术后5年复发率为2.3%~4.5%;胆囊分隔,胆囊壁厚度大于5 cm术后5年复发率为6.4%;胆囊壁间结石术后5年复发率为0.0%~7.5%;胆囊壁间结石伴有胆囊分隔术后复发率为7.4%~16.9%;胆囊壁厚度大于5 mm伴壁间结石其术后5年复发率为12.5%。结论 胆囊结石行保胆手术时,胆囊壁厚度、胆固醇沉积、胆囊分隔及胆囊壁间结石其复发率不高,可行保胆手术,当胆囊壁间结石合并有胆囊分隔,其术后5年复发率明显升高,应考虑胆囊切除。

[ Objective ] The factors of gallbladder diseases may lead to the recurrence of gallbladder stone after the operation of minimal invasive with gallbladder preserved via choledochoscopy （OMIGPC）. [Methods] The cases after OMIGPC were divided into 9 groups according to gallbladder lesions： （1）The thickness of gallbladder wall is less than 5 mm and the gallbladder wall is smooth; （2）The thickness of gallbladder wall is greater than 5 mm and the gallbladder wall is all smooth; （3）Gallbladder compartment; （4）Intramural gallstones into the gallbladder wall; （5）Stone incarcerated in the neck of gallbladder; （6）Cholesterol deposition on the gallbladder wall; （7）The thickness of gallbladder wall is greater than 5 mm and the gallbladder wall has the intramural gallstones; （8）The gallbladder compart- ment and the thickness of gallbladder wall is greater than 5 mm; （9）The gallbladder compartment and gallbladder wall has the intramural gallstones ; All cases were examined by B ultrasound every year for five years, then the stone recurrence rate was counted with statistical method. [ Results] The recurrence rates of gallbladder stone were 3%, 2.4%, 4.7%, 2.3%, 2.3%-4.5%, 6.9%, 0.0%-7.5%, 7.g%M6.9%, 12.5% about the nine groups in proper order. [ Conclusion ] When the gallbladder of patients is simply with the thickness of gallbladder, cholesterol deposition on the gallbladder wall, the 5 year recurrence rates of gallbladder stone are lower and we suggest that this kind of patients may receive the gallbladder-preserved operation; however when the gallbladder of patients has the intramural gallstones and the gallbladder compartment simultaneously, the 5 year recurrence rates of gallbladder stone are obvi-ously raised and we suggest that this kind of patients may perform cholecystectomy.