Pauletzki J, Althaus R, Holl J, Sackmann M, Paumgartner G
Department of Medicine II, Klinikum Grosshadern, University of Munich, Germany.
Gastroenterology. 1996 Sep;111(3):765-71. doi: 10.1053/gast.1996.v111.pm8780583.
BACKGROUND & AIMS: Gallbladder emptying is reduced in many patients with cholesterol gallstones. To clarify the role of impaired gallbladder motility in recurrent gallstone disease, the effect of gallbladder emptying on the formation of recurrent stones was studied prospectively.
In 54 consecutive patients with single radiolucent gallbladder stones, postprandial gallbladder emptying was assessed sonographically before lithotripsy and 1.8 +/- 0.1 years (mean +/- SE) after gallstone disappearance. Patients were followed up for gallstone recurrence for 0.6-4.1 years (median, 2.6 years).
After gallstone disappearance, gallbladder fasting volume (33.7 +/- 3.4 vs. 27.8 +/- 3.0 mL; P = 0.007) and residual volume (12.6 +/- 1.9 vs. 9.7 +/- 1.3 mL; P = 0.010) decreased, whereas the ejection fraction remained unchanged. However, gallbladder volume did not differ whether initial or recurrent stones were present. Gallbladder emptying was more impaired in patients with than patients without later recurrence (47% +/- 5% vs. 63% +/- 2%; P = 0.001). Cox analysis showed that gallbladder emptying was an independent determinant of the risk of gallstone recurrence (P = 0.002). Within 3 years, recurrent stones formed in 53% (actuarial analysis) of patients with an ejection fraction of < 60% but in only 13% of patients with an ejection fraction of > or = 60%.
Gallbladder emptying is an important factor in the formation of recurrent gallstones.
许多胆固醇结石患者存在胆囊排空功能减退的情况。为阐明胆囊运动功能受损在复发性胆结石疾病中的作用，我们对胆囊排空对复发性结石形成的影响进行了前瞻性研究。
连续纳入54例单发透光性胆囊结石患者，在碎石术前及结石消失后1.8±0.1年（均值±标准误）通过超声评估餐后胆囊排空情况。对患者进行0.6 - 4.1年（中位数为2.6年）的胆结石复发随访。
结石消失后，胆囊空腹容积（33.7±3.4 vs. 27.8±3.0 mL；P = 0.007）和残余容积（12.6±1.9 vs. 9.7±1.3 mL；P = 0.010）减小，而射血分数保持不变。然而，无论存在初始结石还是复发性结石，胆囊容积并无差异。有复发的患者胆囊排空功能比无复发的患者受损更严重（47%±5% vs. 63%±2%；P = 0.001）。Cox分析显示胆囊排空是胆结石复发风险的独立决定因素（P = 0.002）。3年内，射血分数<60%的患者中有53%（精算分析）形成复发性结石，而射血分数≥60%的患者中只有13%形成复发性结石。
胆囊排空是复发性胆结石形成的重要因素。
