Association of blood lipid levels with the risk of cholecystectomy and postoperative pain / 临床肝胆病杂志

ABSTRACT

Objective To investigate whether blood lipid control can delay the progression of asymptomatic gallstones and reduce the risk of cholecystectomy in patients with gallstones and hyperlipidemia,as well as the influence of hyperlipidemia on postoperative pain after cholecystectomy.Methods A total of 153 patients with asymptomatic gallstones and hyperlipidemia who underwent physical examination from February 2013 to February 2015 were enrolled and randomly divided into experimental group with 72 patients and control group with 81 patients.The patients in the experimental group were given blood lipid control via diet,exercise,and drugs,and according to fasting triglyceride (TG) and total cholesterol (TC) after 3 months,these patients were further divided into normal blood lipid group with 47 patients and abnormal blood lipid group with 25 patients.All the patients were followed up for 2 years with an interval of 3 months.The surgical indications for laparoscopic cholecystectomy were persistent pain in the gallbladder or more than 3 times of gallbladder discomfort within the past one month.A subgroup analysis was performed based on the nunber and size of gallstones to evaluate the risk of cholecystectomy.A numerical pain scale was used to assess the improvement in pain during hospitalization and at 3 and 6 months after surgery.The t-test was used for comparison of continuous data between two groups;a one-way analysis of variance was used for comparison between three groups,and the Bonferroni test was used for further comparison between any two groups.The chi-square test was used for comparison of categorical data between groups.Results The normal blood lipid group had a significantly lower rate of cholecystectomy than the abnormal blood lipid group and the control group (23.4％ vs 68.8％/70.4％,x2 =27.72,P ＜0.O1).The patients in the normal blood lipid group had moderate pain during hospitalization,while those in the abnormal blood lipid group and the control group had severe pain,and there was a significant difference in pain score between the normal blood lipid group and the abnormal blood lipid group/control group (P ＜ 0.05).Among the patients with a single gallstone,multiple gallstones,≥1 cm stones,or ＜ 1 cm stones in the abnormal blood lipid group,61％ (11/18),86％ (6/ 7),88％ (7/8),and 59％ (10/17) underwent cholecystectomy,while in the normal blood lipid group,21％ (6/29),28％ (5/18),35％ (6/17),and 17％ (5/30) underwent cholecystectomy,and there were significant differences in the proportion of patients with different types of gallstones who underwent cholecystectomy between the two groups (x2 =7.86,6.87,6.12,and 8.77,all P ＜ 0.05).Conclusion In patients with gallstones and hyperlipidemia,effective blood lipid control can significantly delay disease progression and reduce the risk of cholecystectomy for different types of gallstones and may alleviate postoperative pain.