Nishimura Atsushi, Shirai Yoshio, Hatakeyama Katsuyoshi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, 951-8510, Niigata, Japan.
J Hepatobiliary Pancreat Surg. 2004;11(5):342-7. doi: 10.1007/s00534-004-0911-x.
BACKGROUND/PURPOSE: The aim of the present study was to clarify the association between adenomyomatosis of the gallbladder and cholecystolithiasis.
A cholecystectomy was performed for cholelithiasis or various other conditions in 1099 patients, of whom 608 had cholecystolithiasis. Adenomyomatosis of the gallbladder was classified as one of three variants: segmental, fundal, and diffuse. Segmental adenomyomatosis has an annular stricture dividing the gallbladder lumen into the "neck compartment" and the "fundal compartment". Bile lipid analysis was performed in 8 patients with segmental adenomyomatosis.
Adenomyomatosis of the gallbladder was observed in 156 patients (14.2%), of whom 99 had segmental adenomyomatosis, 54 had fundal adenomyomatosis, and 3 had diffuse adenomyomatosis. The prevalence of cholecystolithiasis was higher in patients with segmental adenomyomatosis (88.9%) than in those without adenomyomatosis (52.3%; P < 0.001). Gallstones were detected earlier in patients with segmental adenomyomatosis than in those without ( P < 0.001) and were located predominantly in the fundal compartment. Bile in the fundal compartment had lower concentrations of total bile acids ( P = 0.012), with an increased cholesterol saturation index ( P = 0.012), compared to bile in the neck compartment.
Segmental adenomyomatosis is a condition predisposing to cholecystolithiasis, probably due to the lithogenic environment in the fundal compartment. Fundal or diffuse adenomyomatosis appears to be unrelated to cholecystolithiasis.
背景/目的：本研究旨在阐明胆囊腺肌增生症与胆囊结石之间的关联。
对1099例因胆石症或其他各种病症行胆囊切除术的患者进行研究，其中608例患有胆囊结石。胆囊腺肌增生症分为三种类型之一：节段型、基底型和弥漫型。节段型腺肌增生症有一环形狭窄，将胆囊腔分为“颈部腔室”和“底部腔室”。对8例节段型腺肌增生症患者进行了胆汁脂质分析。
156例患者（14.2%）存在胆囊腺肌增生症，其中99例为节段型腺肌增生症，54例为基底型腺肌增生症，3例为弥漫型腺肌增生症。节段型腺肌增生症患者的胆囊结石患病率（88.9%）高于无腺肌增生症患者（52.3%；P<0.001）。节段型腺肌增生症患者比无腺肌增生症患者更早发现胆结石（P<0.001），且胆结石主要位于底部腔室。与颈部腔室的胆汁相比，底部腔室的胆汁总胆汁酸浓度较低（P=0.012），胆固醇饱和指数升高（P=0.012）。
节段型腺肌增生症是胆囊结石的易感因素，可能是由于底部腔室的致石环境。基底型或弥漫型腺肌增生症似乎与胆囊结石无关。
