胃癌术后胆囊结石形成相关因素和预防.docVIP

胃癌术后胆囊结石形成相关因素和预防 摘 要 目的：探讨胃癌术后胆囊结石发病率明显增加的原因及处理原则。方法：彩超定期随访622例胃癌术后患者，跟踪术后胆囊结石出现的时间，分析不同的手术方式、消化道重建方式及淋巴结清扫范围与胆囊结石形成的关系，并进一步随访术后胆囊结石的变化情况及处理方式。结果：18.0%（112/622例）的随访患者并发胆囊结石，69.6%（78/112例）在术后2年内发现；胃癌术后胆囊结石形成与手术方式、消化道重建方式无关，与淋巴结清扫范围密切相关（D1+组与D2+组比较，P=0.011；D2组与D2+组比较，P=0.021），大部分患者（82.1%，92/112例）并不出现胆石症状。结论：淋巴结清扫范围是胃癌患者术后并发胆囊结石的危险因素，因此对于需行广泛淋巴结清扫的患者，可考虑预防性行胆囊切除。 关键词 胃癌切除术 胆囊结石 淋巴结清扫 doi：10.3969/j.issn.1007—614x.2012.29.116 Abstract Objective：To explore the causes and the treatment of Gallstone Formation after Gastric Cancer Surgery.Methods：Gallstone formation was confirmed by ultrasound examinations that were routinely carried out after surgery on a periodic basis.We evaluated the influence of gastrectomy，reconstruction，and lymph—node dissection on the incidence of gallstone formation after gastrectomy.Furthermore，we invested the development and treatment of gallstone formation after gastrectomy.Results：Gallstone formation occurred in 18.0%（112 of 622）patients who had undergone gastrectomy.Gallstones were usually formed within 2 years after gastrectomy.The types of gastrectomy and reconstruction had no significant effect on the incidence，but the extent of lymph—node dissection was a significant factor（D1+ vs.D2+：P=0.011；D2 vs.D2+Pp=0.021）.In most cases，gallstone formation was asymptomatic.Conclusion：The extent of lymph—node dissection was a risky factor in gallstone formation after gastrectomy；therefore，prophylactic cholecystectomy should be considered in cases of extensive lymph—node dissection. Key words Gastrectomy，Gallstone，Lymph—node dissection 随着外科技术不断进步，胃癌患者术后生存期明显延长，因此不能忽略胃癌患者术后的生活质量问题。胃癌术后胆囊结石的高发病率严重影响患者术后的生活质量。对2002～2010年施行胃癌手术后有定期随访患者的临床资料进行回顾性分析，探讨术后胆囊结石形成的原因及处理方法。 资料与方法 2002～2010年收治因胃癌接受胃癌切除术患者1687例，术后坚持定期随访、复查1422例，其中653例术后随访时间超过5年，排除31例术前已发现有肝、胆、胰疾病史。622例随访患者列入此次研究，男55例，367例，年龄24～85岁，平均58.6±5.2岁，远端胃切除253例，全胃切除369例，消化道重建方式包括Billroth Ⅰ、Billroth Ⅱ、Roux—en Y及间置空肠。标准的D2淋巴结清扫范围包括胃周淋巴结及胃左动脉、肝总动脉、脾动脉及腹腔动脉旁淋巴结，将随访患者按淋巴结清扫范围分成3组，D