胆囊形态折叠与胆囊结石的关系

Relationship between folded gallbladder and risk of gallstone formation

目的：探讨胆囊形态折叠与形成胆囊结石的关系.方法：随机将2013-01/2014-12大连市友谊医院肝胆外科169例因胆囊结石行腹腔镜胆囊切除的病例进行了分析（结石组）,观察胆囊形态的变化,有无胆囊折叠,并与同期健康体检无胆囊结石人群200名（对照组随机）对比.胆囊折叠诊断标准：（1）对照组术前胆囊超声检查评估,可见胆囊内有分隔;结石组术前超声、计算机断层扫描（computed tomography,CT）结合术中腹腔镜检查：胆囊折叠部分纵轴与胆囊纵轴交角≥60°;（2）病变处除外胆囊腺肌症（结合术后病理）.根据病变占胆囊的体积分折叠1/4,1/3,1/2,2/3.并对其结石类型进行了分析.结果：在结石组发现有胆囊折叠54例,占32%,与对照组（14例,7%）相比有统计学意义（χ^2=37.94,P〈0.05）.折叠占胆囊1/4者6例,1/3者18例,1/2者13例,2/3者17例.向左折叠2例,余为向右折叠.结石类型：折叠病例中胆色素及胆色素为主的结石32例（n=54,占59.3%）,而非折叠胆囊结石患者胆色素及胆色素为主的结石46例（n=115,占40.0%）,相比有统计学意义（χ^2=5.49,P〈0.05）.结论：胆囊形态折叠在胆囊结石患者中占较高的比例,是形成胆囊结石的重要因素之一,并且胆色素结石比例高于胆固醇结石.

AIM： To explore the relationship between morphologically folded gallbladder and gallstone formation.METHODS： A case-control study was performed in 169 patients with cholecystolithiasis who underwent laparoscopic cholecystectomy（stone group） and 200 healthy persons without cholecystolithiasis who underwent physical examination（control group） from January 2013 to December 2014 in the Department of Hepatobiliary Surgery, the Affiliated Dalian Friendship Hospital, Dalian Medical University. Criteria for the diagnosis of folded gallbladder included：（1） ultrasonography showed separation of the gallbladder in the control group, while CT and laparoscopic examinations showed that the angle between the long axis of the gallbladder and the folded part was ≥ 60° in the observation group; and（2） adenomyoma of the gallbladder was excluded pathologically. According to the proportion of the cube of the affected gallbladder, the morphologic folding was classified as 1/4, 1/3, 1/2, and 2/3. The type of cholecystolithiasis was also classified. RESULTS： There were 54（32%） cases of folded gallbladder in the stone group and 14（7%） cases in the control group, and there was a significant difference between the two groups. There were 6 cases with 1/4 folding, 18 cases with 1/3, 13 cases with 1/2, and 17 cases with2/3. There were 52 cases of folding towards the right and 2 cases of folding towards the left. According to the type of cholecystolithiasis, there were 32（n = 54, 59.3%） cases of bile pigment calculus in the folded gallbladder group and 46（n = 115, 40%） cases in the nonfolded group（P〈 0.05）. CONCLUSION： Folded gallbladder has a high incidence rate in patients with gallstones and is one of major risk factors for gallstone formation. The rate of bile pigment calculu is high in patients with folded gallbladder.