胆囊胆固醇沉积症对胆囊结石形态的影响  

The impact of gallbladder cholesterolosis on the morphology of gallstones

作　　者：张红雷 孔祥余 项雨凯 邱晨 张诚 达选博 吕贝宁 王玉彬 胡海[1] 田伏洲 杨玉龙 Zhang Honglei;Kong Xiangyu;Xiang Yukai;Qiu Chen;Zhang Cheng;Da Xuanbo;Lyu Beining;Wang Yubin;Hu Hai;Tian Fuzhou;Yang Yulong(Gallstone Disease Center,Tongji University Affiliated East Hospital,Institute of Gallstone Disease,School of Medicine,Tongji University,Shanghai 200120,China;General Surgery Center,Western Theater General Hospital of PLA,Chengdu 610083,China)

机构地区：[1]同济大学附属东方医院胆石病中心,同济大学医学院胆石病研究所,上海200120 [2]西部战区总医院全军普通外科中心,成都610083

出　　处：《中华医学杂志》2024年第23期2179-2183,共5页National Medical Journal of China

基　　金：上海市浦东新区卫生系统重点专科建设(PWZzk2022-17);上海市东方医院临床研究(DFLC2022019)

摘　　要：目的探讨胆囊胆固醇沉积症对胆囊结石形态的影响。方法回顾性纳入2020年12月至2021年10月在同济大学附属东方医院胆石病中心行胆囊切除术的胆囊结石患者,根据胆囊结石形态,分为病例组(泥沙样结石)和对照组(非泥沙样结石),比较2组患者的临床基线特征;通过多因素logistic回归分析影响胆囊结石形态的相关因素。结果共纳入110例患者,病例组30例,男13例,女17例,年龄26~73(54±14)岁;对照组80例,男24例,女56例,年龄18~75(45±13)岁,病例组的年龄高于对照组(P=0.003)。病例组的隐匿性胰胆反流(OPBR)发生率高于对照组[33.3%(10/30)比13.8%(11/80),P=0.020];胆囊胆固醇沉积症发生率低于对照组[30.0%(9/30)比73.8%(59/80),P<0.001]。多因素logistic回归分析结果显示:胆囊胆固醇沉积症(OR=0.19,95%CI:0.07~0.49,P=0.001)是泥沙样结石的相关因素。结论胆囊胆固醇沉积症导致不同形态的胆囊结石的形成,促进“固体形结石”的发生发展。Objective To investigate the impact of gallbladder cholesterolosis on the morphology of gallstones.Methods The patients with gallstone who underwent cholecystectomy at the Gallstone Disease Center of East Hospital Affiliated to Tongjin University from December 2020 to October 2021 were retrospectively included.The patients were divided into the case group(sludge-like)and the control group(non-sludge-like stone),based on gallstone morphology.Clinical baseline characteristics between the two groups were compared.The related factors influencing gallstone morphology were analyzed using multivariate logistic regression analysis.Results A total of 110 patients were included,with 30 cases in the case group(13 males,17 females),aged 26-73(54±14)years,80 cases in the control group(24 males,56 females),aged 18-75(45±13)years.The age of the case group was higher than that of the control group(P=0.003).The occurrence rate of occult pancreaticobiliary reflux(OPBR)was higher in the case group compared to the control group[33.3%(10/30)vs 13.8%(11/80),P=0.020];the occurrence rate of gallbladder cholesterolosis was lower in the case group compared to the control group[30.0%(9/30)vs 73.8%(59/80),P<0.001].The results of multivariate logistic regression analysis showed that gallbladder cholesterolosis(OR=0.19,95%CI:0.07-0.49,P=0.001)was a significant factor associated with sludge-like stones.Conclusion Gallbladder cholesterolosis can cause the formation of different forms of cholecystolithiasis,and promote the occurrence and development of"solid stones".

关 键 词：胆囊结石病 胆囊胆固醇沉积症 隐匿性胰胆反流 

分 类 号：R657.42[医药卫生—外科学]