胆囊泥沙样与非泥沙样结石保胆取石术后复发情况的比较

Recurrence after gallbladder-preserving cholecystolithotomy for sand-like and non-sand-like gallstones: a comparative analysis

目的比较胆囊泥沙样结石与非泥沙样结石患者行腹腔镜胆囊切开取石术后1-3年结石复发情况。方法对2012年10月-2014年12月在空军总医院行保胆治疗的155例胆囊结石患者进行回顾性分析,分为泥沙样结石组（n=29）和非泥沙样结石组（n=126）。观察术后1-3年结石复发情况。计量资料组间比较采用t检验,计数资料组间比较采用χ^2检验。结果 2组患者手术时间比较差异有统计学意义[（126.13±20.52）min vs（75.64±16.58）min,t=7.709,P〈0.001]。术后1-3年泥沙样结石组共有6例复发,1、2、3年复发率分别为13.79%、20.69%、20.69%;非泥沙样结石组共有8例复发,1、2、3年复发率分别为3.97%、6.35%、6.35%;其中2、3年复发率2组间比较差异有统计学意义（χ^2值均为4.284,P值均为0.038）。结论胆囊泥沙样结石患者复发率明显高于非泥沙样结石患者,手术时间也明显延长,因此胆囊泥沙样结石患者应避免行保胆取石术。

Objective To investigate the recurrence at 1- 3 years after laparoscopic cholecystolithotomy in patients with sand- like and non-sand- like gallstones. Methods A retrospective analysis was performed for the clinical data of 155 patients with gallstones who underwent gallbladder- preserving cholecystolithotomy in Air Force General Hospital,PLA from October 2012 to December 2014,and these patients were divided into sand- like stone group（ 29 patients） and non- sand- like stone group（ 126 patients）. The recurrence of stones was observed at1- 3 years after surgery. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results The time of operation showed a significant difference between the sand- like stone group and the non- sand- like stone group（ 126. 13 ± 20. 52 min vs 75. 64 ± 16. 58 min,t = 7. 709,P〈0. 001）. At 1- 3 years after surgery,6 patients in the sand- like stone group and 8 in the non- sand- like stone group experienced recurrence,and the 2- and 3- year recurrence rates showed significant differences between the two groups（ 2- year recurrence rate： 20. 69% vs 6. 35%,χ^2= 4. 284,P =0. 038; 3- year recurrence rate： 20. 69% vs 6. 35%,χ^2= 4. 284,P = 0. 038）. Conclusion The patients with sand- like gallstones have a significantly higher recurrence rate and a significantly longer time of operation than those with non- sand- like gallstones,and therefore,they should avoid gallbladder- preserving cholecystolithotomy.