Postcholecystectomy Diarrhea And Clinical Research Of Influencing Factors

Objective:By reviewing and surveying methods, to find out the present general status of the postcholecystectomy diarrhea, and through this retrospective investigation, to provide relevant information to the forward-looking survey , and enable the forward-looking survey more significative. Through forward-looking studying on preoperative gallbladder function, eating habits of postcholecystectomy and the method of gallbladder operation ,to find the relation between those factors and postcholecystectomy diarrhea ,and analyse relevant factors that may result in cholecystectomy diarrhea, and to provide the evidence for judging whether some perspective is correct and guide patients by a reasonable diet.Methods:In the part of retrospective survey, we select those patients who have resected their gallbladder from January 2003 to October 2005 in our hospital for various reasons .we gain the relevant information about those patients from the medical record room ,and then by sending letters, telephone contacts and visiting them, analyze and summarize finally relevant information. According to clinical experience and the results of the survey, we design three groups of experiments to observe relations between these factors and diarrhea after cholecystectomy . The three experimental groups were: the group of preoperative normal gallbladder function and non-functional group ; postoperative low-fat diet group and the normal diet group ; simple cholecystectomy group and cholecystectomy with the choledochotomy and T-tube drainage group . Before prospective investigation, we first identify the necessary conditions of the patients in the experimental group, and then before, during and after operation ,we ensure the samples to accord with experimental conditions. We register the detailed information of those samples in the preoperative and postoperative. And give the corresponding supervision and guidance to the postoperative patients . Finally, we analyze and summarize the relevant information.Results:In the forward-looking survey ,we collect the related information about postoperative bowel habits change from who have resected their gallbladder.In 173 cases , there are 40 cases who appear diarrhea after cholecystectomy, accounting for 23.12 percent; The characteristics of postcholecystectomy diarrhea are: emergent sense of defecation; the number of defecation increased ;stool become shapeless, water samples, myxoid; the diarrhoea, mostly concentrated in 2-3 weeks after cholecystectomy; have no accompanying symptoms; intermittent, and no significant complications; part of patients do not use medicine ; some patients have medicine, but the effect is not very good.The development trend of patient's condition is gradual improvement, diarrhea occurred in the daytime; in a small number of patients there are drip of flat in stool; there is no obvious inducement before the occurrence of diarrhea in most patients; then there are no obvious abnormalities in conventional test of stool and colonoscopy.In the part of the experiment about the relation between preoperative gallbladder function and postoperative diarrhea, we collect a total of 26 cases: there are 14 patients whose preoperative function of gallbladder are normal, thereinto three suffered from diarrhoea; there are 12 patients whose preoperative gallbladder are non-function, thereinto no one suffered from diarrhoea. According to the Fisher exact probabilities method, P = 0.22, according toα= 0.05, no significant differences between the two different group about the preoperative gallbladder function. In the part of the experiment about the relation between postoperative diet and diarrhea, we collect a total of 30 cases: there are 20 patients who are normal diet after cholecystectomy, thereinto three suffered from diarrhea; there are 10 patients who are low-fat diet after cholecystectomy, thereinto two suffered from diarrhea. According to the Fisher exact probabilities method, P = 1, according toα= 0.05, no significant differences between the two different group about the diet after cholecystectomy. In the part of the experiment about the relation between different operation mode and diarrhea, we collect a total of 42 cases: there are 21 patients who have only been resected their gallbladder , thereinto three suffered from diarrhea; there are 21 patients who have been resected their gallbladder and at the same time the choledochotomy and T-tube drainage has been formered, thereinto two suffered from diarrhea. According to the Fisher exact probabilities method, P = 1, according toα= 0.05, no significant differences between the two different group about the operative mode.Conclusion:There are still high morbidity of diarrhea after cholecystectomy; The post-cholecystectomy diarrhea impacts on the physical and mental health of patients, increases the financial burden to the patients ; bring the inconvenience to patients'life.Whether the function of gallbladder is normal before operation have no significant correlation with diarrhea after cholecystectomy . The gallbladder is non-function before operation does not diminish the morbidity of diarrhea after cholecystectomy. And the low-fat diet and the normal diet after cholecystectomy have no significant correlation with diarrhea after cholecystectomy .The patients who perform cholecystectomy do not need to change dietetical habits. The pressure of bile duct and the volume of bile flowing into the intestinal are different after simple cholecystectomy and cholecystectomy which with the choledochotomy and T-tube drainage, but the results of the experimental group also could not indicate there is a direct relationship between the change of the pressure of bile duct and the volume of bile flowing into the intestinal and the occurrence of post-cholecystectomy diarrhea. Thus this experiment does not support the view that the decrease of the bile flowing into the intestine after cholecystectomy can explain postcholecystectomy diarrhea pressure of bile duct and the volume of bile flowing into the intestinal.