摘要
目的研究胆囊壁结石组织病理学特征及其对胆囊收缩功能的影响,探讨为其施行保胆取石手术(EGPCL)的价值。方法①复习观察胆囊结石胆囊切除标本的病理切片912例,找到胆囊壁结石的组织病理切片,观察显微镜下病理特征及分布。②回顾分析保胆取石病例108例,重点分析胆囊内镜下发现胆囊壁结石患者的临床资料,了解胆囊壁结石与胆囊收缩功能的关系以及保胆手术效果。结果切除胆囊的病理切片中发现胆囊壁结石32例(3.51%),共71颗。其中黏膜层结石5颗(7%),肌层结石16颗(23%),浆膜层结石50颗(70%)。扩张的罗-阿氏窦包裹胆囊壁结石而形似憩室,窦上皮为排列整齐、基本完整的粘膜上皮细胞。在108例保胆取石手术中发现胆囊壁黏膜层以及"黏膜下"结石10例(9.26%),其中术前检查收缩功能良好者8例(80%),功能欠佳2例;8例患者均有轻重不等的临床症状,包括功能欠佳者2例和功能良好者6例。取石术后全部胆囊壁间结石患者症状都得到改善,但2例术前功能欠佳者,术后B超检查分别提示胆囊壁针尖样胆固醇沉积以及胆囊腔内淤滞物。结论胆囊壁结石与胆囊腔内压力增高以及罗-阿氏窦形成密切相关;大部分胆囊壁结石位于浆肌层,保胆手术中难以全部观察到。胆囊内镜仅能取黏膜层结石以及部分浆肌层结石。胆囊壁结石大多数有临床症状。对那些壁间结石少、胆囊壁薄(<4mm)、胆囊功能好者,可取净结石,保留胆囊。而对那些有明显临床症状、胆囊壁结石多和壁厚≥4mm的患者,即使胆囊收缩功能好,笔者也建议行胆囊切除术。
[Objective] To investigate the pathological characteristics of intramural gallstones, and its effect on the gallbladder contraction function, and the value of endoscopic gallbladder-preserving cholecystolithotomy （EGPCL） for the patients with the intramural gallstones. [Methods] ①In 912 gallbladder specimens from cholecystectomy because of gallstones, 32 specimens with intramural gallstones were found. The pathological characteristics and the distribution of the intramural gallstones were studied under light microseopy. ②A total of 108 patients with gallstone underwent EGPCL. The clinical data of 10 cases with intramural gallstones were retrospectively analyzed. The effect of EGPCL on the patients with intramural gallstones and the relationship between gallbladder contraction function and intramural gallstones were studied. [Result] 71 intramural gallstones were found in the pathological sections of 32 cases （32/912, 3.51%）, 5 in the mucous layer （5/71, 7%）, 16 in the muscular layer （16/71, 23%）, 50 in the serosa （50/71, 70%）. The intramural gallstones were located in the dilated Rokitansky-Aschoff sinuses. Most of the epithelium of the sinuses surrounded the intramural gallstones in the muscular layer resembling a diverticulum and the sinus epithelium was composed of well arranged mucous epithelial cells. Among the 108 cases undergoing EGPCL, 10 （9.26%） patients showed the mucosal and intramural gallstones. Of which, 8 （80%） had well functional gallbladder contraction, and 2 （20%） had poor contraction function before EGPCL. All the 8 patients demonstrated clinical symptoms of different degree, and all the symptoms were improved after EGPCL. However, the 2 patients with poor contraction of gall bladder were found to have cholesterol crystal in the gallbladder wall and substance stasis in the gallbladder respectively. [Conclusion] The intramural gallstones are closely related to the elevated intragallbladder pressure and the formation of the Rokitansky-Aschoff sinuses. It is difficult to observe and remove all the intramural gallstones by using cholecystoscope because the majority of the gallstones are located in the muscular layer and the serosal layer. EGPCL was indicated only to the patients who had small stones within the gallbladder wall thinner than 4 mm and with good contraction function, i.e. only under the above circumstance, the stones could be got out and the gall bladder preserved. Cholecystectomy should be suggested when the patients had severer symptoms, many intramural gallstones, gallbladder wall thicker than 4 ram, even though the contraction function of gallbladder was good.
出处
《中国内镜杂志》
CSCD
北大核心
2009年第6期572-576,共5页
China Journal of Endoscopy
关键词
胆囊壁结石
内镜保胆碎石取石术
intramural gallstones
endoscopic gallbladder-preserving cholecystolithotomy （EGPCL）
