Influence of gallbladder contraction function for gallbladder-preserving cholecystolithotomy by laparoscope combined with choledochoscope / 中国医师进修杂志

ABSTRACT

Objective To explore the influence of gallbladder contraction function for gallbladderpreserving cholecystolithotomy by laparoscope combined with choledochoscope laparoscope.Methods Seventy-three patients with benign gallbladder diseases were selected.Patients treated with laparoscopic cholecystectomy were enrolled in LC group (31 patients),while those treated with endoscopic minimally invasive cholecystolithotomy (EMIC) were enrolled in EMIC group (42 patients).Operation situation,treatment outcome and postoperative complications were analyzed between two groups.At the same time,the level of cholecystokinin was detected with double antibody sandwich method in two groups,and the gallbladder contraction function of patients in EMIC group were detected with color Doppler.Results All patients were completed surgery without relapse cases.The operation time in EMIC group was longer than that in LC group(84.6 ± 11.4) min vs.(72.1 ± 13.6) min,t =4.076,P ＜ 0.05.But the intraoperative bleed and postoperative complications in EMIC group were lower than those in LC group(11.3 ± 4.8) ml vs.(19.6 ± 5.5) ml,t =3.715,P ＜0.05;2.38％ vs.16.14％,x2 =4.469,P ＜0.05.There were no recurrence.The levels of cholecystokinin in two groups before operation had no significant difference (P ＞ 0.05).After treatment for 1,6,12 months,the levels of cholecystokinin in EMIC group were (33.6 ± 10.6),(49.4 ± 12.7),(63.4 ± 14.6)ng/L,in LC group were (21.4 ± 9.1),(11.3 ± 7.4),(6.7 ± 2.7) ng/L,the levels of cholecystokinin in EMIC group were significantly higher than those in LC group (t =3.472,17.514,31.472,P ＜ 0.05 or ＜ 0.01).After treatment for 1 month,the rate of gallbladder contraction in EMIC group was significantly lower than that before treatment(22.8 ± 4.5)％ vs.(39.2 ± 7.6)％,t =6.003,P ＜ 0.05).After treatment for 6 months,the rate of gallbladder contraction in EMIC group was recovered,after treatment for 12 months,the rate of gallbladder contraction in EMIC group was significantly higer than that before treatment(48.8 ± 7.6)％ vs.(39.2 ± 7.6)％,t =3.054,P ＜ 0.01.Conclusions Gallbladder-preserving cholecystolithotomy by laparoscope combined with choledochoscope can get less iatrogenic trauma,which contribute to a protective effect on gallbladder contraction function on the base of high stone removal rate.It has promotive value in benign gallbladder diseases.