Surgical Choice for Different Types of Gallbladder Adenomyomatosis: An Initial Experience of 20 Years Laparoscopic Cholecystectomy
Surgical Choice for Different Types of Gallbladder Adenomyomatosis: An Initial Experience of 20 Years Laparoscopic Cholecystectomy
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不同类型胆囊腺肌瘤的手术选择：腹腔镜胆囊切除术20年初体验
DOI：
10.1097/sle.0000000000000776
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发表时间：
2020-04-01
影响因子：
1
通讯作者：
Kong，Jing
中科院分区：
文献类型：
--
作者：
Pang，Liwei;Wu，Shuodong;Kong，Jing
目的：本研究的目的是比较不同类型胆囊腺肌瘤病（GA）临床生化统计学的差异。探讨3种不同类型GA对患者的影响。材料与方法：回顾性分析我院2010 - 2018年收治的子宫腺肌瘤病患者的临床资料。根据术前影像学表现（均为择期手术）分为3组：A组：宫底型（局限型）; B组：节段型; C组：弥漫型。每组的数字是136，27，17。我们分析了生化指标（总胆红素、直接胆红素、血清胆汁酸、丙氨酸转氨酶、天冬氨酸转氨酶、胆碱酯酶等）。探讨3组间手术方式、手术时间及预后的差异。结果如下：（1）肝功能统计中，谷草转氨酶有统计学意义弥漫型腺肌瘤病胆汁酸水平可能高于弥漫型腺肌瘤病（F=4.974，P=0.012）（3）节段性、弥漫性子宫腺肌瘤病易合并结石（4）子宫底腺肌瘤病的预后较好，住院时间短（F=4.519，P=0.018），引流时间短（F=6.575，P =0.004），并发症少（χ2=29.429，P<0.001）。结论：GA是一种以胆囊壁肌肉上皮增生和肥大为特征的疾病，粘膜突入或穿过增厚的肌肉层，根据现有证据，不能视为癌前病变。至于无症状的GA，建议保守治疗，每年进行两次超声检查。胃底型GA可行腹腔镜胆囊部分切除术。节段性和弥漫性胆囊炎应行全腹腔镜胆囊切除术。
Objectives: The objective of this study was to compare the difference of clinical biochemical statistics in different types of gallbladder adenomyomatosis (GA). To investigate the different effects of patients between the 3 different types of GA. Materials and Methods: Retrospective analysis of the clinical data of the adenomyomatosis patients that come from our hospital between 2010 to 2018. According to the preoperative image (all cases are performed as elective surgery), it could be divided into 3 groups: group A: fundal (localized) type; group B: segmental type; group C: diffuse type. The number of each group is 136, 27, 17. We analyze the biochemical statistics (total bilirubin, direct bilirubin, serum bile acid, alanine aminotransferase, aspartate aminotransferase, cholinesterase, etc.) of the 3 groups to explore the difference in operative mode, operative time and prognosis between these 3 groups. Results: (1) In the liver function statistics, aspartate aminotransferase has the statistical significance (F=4.974, P=0.012); (2) And the diffuse adenomyomatosis might have a higher bile acid (F=6.048, P=0.005); (3) The segmental and diffuse adenomyomatosis is easier to be combined with stones (F=19.226, P<0.001); (4) The fundal adenomyomatosis seems to have a better prognosis: fewer hospital stay (F=4.519, P=0.018), fewer drainage time (F=6.575, P=0.004) and fewer complications (χ2=29.429, P<0.001). Conclusions: GA is a disease characterized by epithelial proliferation and hypertrophy of the muscles of the gallbladder wall with an outpouching of the mucosa into or through the thickened muscular layer and cannot be regarded as a precancerous lesion based on available evidence. As for asymptomatic GA, conservative treatment is recommended with ultrasound examinations twice a year. The fundal type GA can be treated by partial laparoscopic cholecystectomy. The segmental and diffuse-type should undergo a total laparoscopic cholecystectomy.