2864人胆囊壁胆固醇结晶自然转归初步观察  

Preliminary observation on the natural course of cholesterol crystals in gallbladder wall in 2864 cases

作　　者：吕永峰 孙海明 钱丽萍 董黎 王晓年 钱章选 钱芬英 

机构地区：[1]浙江省长兴县人民医院外科,浙江湖州313100

出　　处：《肝胆胰外科杂志》2012年第5期370-372,376,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：浙江省医药卫生科研项目(2009A204)

摘　　要：目的探讨胆囊壁胆固醇结晶的自然转归及与其他良性胆囊疾患的关系。方法对2009年7月始在我院进行体检的长兴县城镇居民2 864人进行2年的前瞻性观察,比较胆囊壁胆固醇结晶组与非结晶组并发其他胆囊良性疾患的差异,记录胆囊壁胆固醇结晶消失、新增、并发或转变为胆囊结石或胆囊息肉的人数,并进行比较。结果胆囊壁胆固醇结晶组并发胆囊炎的发病率明显高于非结晶组,有统计学差异(P<0.01),而并发胆囊结石或胆囊息肉的发病率与非结晶组无明显差别。随诊期间,结晶组胆固醇结晶自然消失114例(45.8%),结晶消失后未见有胆囊结石出现,9例(3.6%)转化为胆囊息肉样病变;结晶组另135例仍然发现有结晶,其中3例并发新的胆囊结石,2例并发新的胆囊息肉样病变;45例(18.1%)在随诊期间发作不同程度的胆囊炎,3例因并发急性胆囊炎或胆囊结石进行胆囊切除术,病理提示胆固醇沉着症。非结晶组有116例(4.44%)出现结晶,104例(4.0%)发作不同程度的胆囊炎,与结晶组比较有统计学差异(P<0.01)。结论胆囊壁胆固醇结晶可自然消失,结晶的持续存在可对胆囊壁造成损害,是胆囊炎发生的高危因素;胆囊壁胆固醇结晶与胆固醇沉着症存在关联,未发现与胆囊结石相关。Objective To explore the natural course of cholesterol crystals in gallbladder walland its relationship with other benign gallbladder diseases.Methods A 2-year prospective study on 2 864 persons was carried out since July 2009.The natural outcome of cholesterol crystals in gallbladder wall diagnosed by ultrasonography was observed,and the incidence of other gallbladder diseases was compared between the crystal group and non-crystal group（control）.Results The incidence of cholecystitis in the crystal group was higher than that in the control（P 0.01）,while there was no difference in the incidence of cholesterol polyps or gallstone.During the follow-up period,cholesterol crystals disappeared in 114 cases（45.8%） in the crystal group,with no gallstone occurred after crystal disappeared,9 cases（3.6%） became cholesterol polyps.In other 135 cases the crystals were still found,of whom,gallstone occurred in 3 cases,cholesterol polyps occurred in 2 cases;45 cases（18.1%） had cholecystitis.The 3 gallbladders were excised because of association with cholelithiasis or cholesterolosis.In the control group,cholesterol crystals appeared in 116 cases（4.44%）,104 cases（4.0%） had cholecystitis,with marked difference compared with the crystal group（P 0.01）.Conclusion Cholesterol crystals in gallbladder wall tend to disappear naturally,persistence of the crystal may do harm to the gallbladder wall,it is a high risk factor of cholecystitis.Cholesterol crystal in gallbladder wall is a distinctive category,which may be the early stage of cholesterolosis,but it has no relationship with the formation of gallstone.

关 键 词：胆囊 胆固醇结晶 胆固醇沉着症 胆囊结石 胆囊炎 

分 类 号：R657.4[医药卫生—外科学]