慢性结石性胆囊炎胆囊切除术后腹泻的研究与分析.pdfVIP

摘 要 目的 胆囊切除术后腹泻 （PCD ）的发病率及其相关危险因素分析。 背景 胆囊结石发病率高且近年来有明显上升趋势，胆囊切除术为其首选治疗手段， 尤其腹腔镜胆囊切除术的日益成熟和广泛开展，PCD 患者亦随之增多，应引起临床 重视。目前关于 PCD 的发病率不同文献的结果不同，也未见 PCD 危险因素的研究报 道。 资料与方法 2009.01-2009.07期间根据统一的标准选取行腹腔镜胆囊切除术（LC） 的60例慢性结石性胆囊炎患者，记录其术前、术中、术后病理及术后1月、3月、 6月随访所得的相关指标加以整理、分析。 结果 术后1月时39人、术后3月时24人，术后6月时15人出现不同程度的腹泻， 发生率分别为 65％，40％，25％。年龄（RR＝0.863，P＝0.000）为保护因素，术 前胆囊收缩率 （RR＝2.180，P＝0.000）和术中所见胆囊外观 （RR＝2.016，P＝0.005） 为危险因素。 结论 PCD 发病率随时间推移呈下降趋势，部分患者可在短期内自愈，部分可能迁延 不愈。年龄、术前胆囊收缩率及术中所见胆囊外观可做为 PCD 的预测指标。年龄及 术前胆囊收缩率可做为胆囊结石病个体化治疗的参考指标。 关键词 慢性结石性胆囊炎；胆囊切除术后腹泻（PCD）；发病率；危险因素；术前 胆囊收缩率 ABSTRACT OBJECTIVE To study the incidence and risk factors of postcholecystectomy diarrhoea(PCD). BACKGROUND Cholecystectomy is the first way to treat the disease of gallbladder stones, meanwhile, the amount of PCD patient is increasing because of the high incidence and upward trend of gallbladder stones and the widespreading of laparoscopic cholecystectomy. Attention should be paid to this in clinic. But there were respective results of PCD incidence in different literatures, meanwhile, there was no study to analyze risk factors of PCD. MATERIALS AND METHODS 60 patients with chronic calculous cholecystitis were selected according to uniform standard to receive laparoscopic cholecystectomy (LC) from January to July in 2009.The preoperative, intraoperative, postoperative pathological results and 1 month, 3 months, 6 months follow-up results were evaluated and analyzed RESULTS The amount and the incidence of diarrhoea were respectively 39 and 65%(1month after LC),24 and 40%(3 months after LC), 15 and 25%(6 months after LC). Age was the protective factor of PCD (RR=0.863, P=0.000), preoperative gallbladder contractility (RR =2.180, P = 0.000) and intraoperative appearance of ga