Department of Biliary and Minimally Invasive Surgery, China Medical University Shengjing Hospital, Shenyang, China.
Surg Laparosc Endosc Percutan Tech. 2020 Apr;30(2):151-155. doi: 10.1097/SLE.0000000000000776.
The objective of this study was to compare the difference of clinical biochemical statistics in different types of gallbladder adenomyomatosis (GA). To investigate the different effects of patients between the 3 different types of GA.
Retrospective analysis of the clinical data of the adenomyomatosis patients that come from our hospital between 2010 to 2018. According to the preoperative image (all cases are performed as elective surgery), it could be divided into 3 groups: group A: fundal (localized) type; group B: segmental type; group C: diffuse type. The number of each group is 136, 27, 17. We analyze the biochemical statistics (total bilirubin, direct bilirubin, serum bile acid, alanine aminotransferase, aspartate aminotransferase, cholinesterase, etc.) of the 3 groups to explore the difference in operative mode, operative time and prognosis between these 3 groups.
(1) In the liver function statistics, aspartate aminotransferase has the statistical significance (F=4.974, P=0.012); (2) And the diffuse adenomyomatosis might have a higher bile acid (F=6.048, P=0.005); (3) The segmental and diffuse adenomyomatosis is easier to be combined with stones (F=19.226, P<0.001); (4) The fundal adenomyomatosis seems to have a better prognosis: fewer hospital stay (F=4.519, P=0.018), fewer drainage time (F=6.575, P=0.004) and fewer complications (χ=29.429, P<0.001).
GA is a disease characterized by epithelial proliferation and hypertrophy of the muscles of the gallbladder wall with an outpouching of the mucosa into or through the thickened muscular layer and cannot be regarded as a precancerous lesion based on available evidence. As for asymptomatic GA, conservative treatment is recommended with ultrasound examinations twice a year. The fundal type GA can be treated by partial laparoscopic cholecystectomy. The segmental and diffuse-type should undergo a total laparoscopic cholecystectomy.
本研究旨在比较不同类型胆囊腺肌病（GA）的临床生化统计差异。探讨 3 种不同类型 GA 患者之间的不同影响。
回顾性分析 2010 年至 2018 年我院腺肌病患者的临床资料。根据术前图像（均行择期手术），可分为 3 组：A 组：底部（局限性）型；B 组：节段型；C 组：弥漫型。每组分别为 136、27、17 例。分析 3 组的生化统计数据（总胆红素、直接胆红素、血清胆汁酸、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、胆碱酯酶等），探讨 3 组手术方式、手术时间和预后的差异。
（1）肝功能统计中，天冬氨酸氨基转移酶有统计学意义（F=4.974，P=0.012）；（2）弥漫性腺肌病可能有更高的胆汁酸（F=6.048，P=0.005）；（3）节段性和弥漫性腺肌病更容易合并结石（F=19.226，P<0.001）；（4）底部腺肌病似乎预后较好：住院时间较短（F=4.519，P=0.018）、引流时间较短（F=6.575，P=0.004）和并发症较少（χ=29.429，P<0.001）。
GA 是一种以胆囊壁上皮细胞增生和肥厚为特征的疾病，伴有黏膜向增厚的肌层外突或穿过增厚的肌层，根据现有证据，不能将其视为癌前病变。对于无症状的 GA，建议保守治疗，每年行超声检查 2 次。底部型 GA 可采用部分腹腔镜胆囊切除术治疗。节段性和弥漫性型应行全腹腔镜胆囊切除术。
