内镜微创保胆取石术后胆囊功能的中长期随访报告

目的观察内镜微创保胆取石术后患者胆囊收缩功能，探讨结石复发率、胆囊壶腹部结石嵌顿术后胆囊壁厚度变化。方法对85例术后1年以上的内镜微创保胆取石术进行随访，B超测量脂肪餐前后胆囊壁厚度和胆囊内有无结石等情况。设定胆囊收缩率≥50％为胆囊收缩功能良好，胆囊收缩率〈50％为胆囊收缩功能差。胆囊壁厚度≥3mm为增厚，〈3mm为正常。术前胆囊壁厚度正常40例（正常组），其余45例为炎症组。结果胆囊收缩率42％-98％，（67．7±18．9）％，其中胆囊收缩功能良好72例（84．7％），功能差13例（15．3％）。40例正常组内镜保胆取石术后胆囊颈、体、底厚度正常38例（95．0％），增厚2例（5．0％）；45例炎症组内镜保胆取石术后胆囊颈、体、底厚度正常34例（75．6％），增厚11例（24．4％）。正常组术后7-8年结石复发1例，炎症组术后结石复发10例。结论术前胆囊正常为保胆取石手术的最佳选择，胆囊伴炎症、结石嵌顿的患者也可行保胆手术，但要严格适应证，两镜联合取净结石，术后随访。

Report of Mid- and Long-term Follow-up of Gallbladder Functions after Endoscopic Minimally Invasive Cholecystolithotomy

Objective To observe the condition of gallbladder contraction functions in patients receiving endoscopic minimally invasive choleeystolithotomy and to explore the postoperative stone recurrence rates and gallbladder wall thickness changes after cholecystolithotomy for calculus incarcerated at the gallbladder pot belly. Methods Follow up observations were performed in 85 cases of endoscopic minimally invasive cholecystolithotomy. The gallbladder wall thickness before and after fatty meal was measured, and gallbladder stones were detected under ultrasound examinations. The gallbladder contraction ratio （EF%） ≥ 50% was regarded as good, while the ratio 〈 50% was regarded as poor. The gallbladder wall thickness ≥ 3 mm was regarded as thickening, and 〈 3 mm was classified as normal. There were 40 cases of normal preoperative gallbladder wall （normal group） and 45 cases of inflammation of the gallbladder （ inflammation group）. Results The gallbladder contraction rate was 42% - 98% （ 67.7% ± 18.9% ）. There were 72 cases of good gallbladder functions （84.7%） and 13 cases of dysfunction （15.3%）. In the normal group, the gallbladder thickness at the neck, body, and bottom was normal in 38 cases （95%） and was thickening in 2 cases （5%） after surgery; while in the inflammation group, the gallbladder thickness at the neck, body, and bottom was normal in 34 cases （75.6%） and was thickening in 11 cases （24.4%） after surgery. One case of stone recurrence after surgery was noted in the normal group, while postoperative inflammation stone recurrence was found in 10 eases. Conclusions Normal gallbladder is the best choice for cholecystolithotomy. Cholecystolithotomy can also be feasible for patients with stones incarcerated at the gallbladder pot belly under strict indications, combined use of laparoscope and choledochoscope, and strict postoperative follow-ups.