Analysis Of Related Factors Of Diarrhea After Laparoscopic Cholecystectomy

[OBJECTIVE]:Through the retrospective study to explore the incidence of diarrhoea at lmonths,3months,6months and 9months after laparoscopic cholecystectomy,the time of occurrence and disappearance of diarrhoea and to find the correlation between the postcholecystectomy diarrhoea with those factors such as sex,age,body weight index,preoperative gallbladder function,psychological status and eating habits of patients after laparoscopic cholecystectomy,in order to analyze relevant factors of postcholecystectomy diarrhoea and to assess and prevent the postoperative diarrhea,and provide clinical guidance for patients requiring laparoscopic cholecystectomy.[METHODS]:By the investigation of the basic cases of laparoscopic cholecystectomy at Laparoscopic surgery of The First Affiliated Hospital of Dalian Medical University from December 2014 to December 2015,the patients were analyzed by telephone,WeChat or e-mail for 1 month,3 months,6 months,9 months follow-up.During the follow-up procedure,patients with bile duct injury,biliary fistula and intestinal fistula were excluded from the operation.During the follow-up period,the patients underwent surgical treatment of secondary common bile duct stones,gastrointestinal tract abdominal surgery for patients with disease and occurrence of infectious diarrhea or preoperative patients with diarrhea-related diseases were excluded from the follow-up.At present,there is no clear clinical criteria to diagnose PCD,the clinical features have not yet been described,through the review of the eighth version of"diagnostic" diagnosis of diarrhoea,Rome Ⅲ diagnostic criteria and relevant literature to determine the basic clinical features of PCD:① laparoscopic cholecystectomy history,no diarrhea symptoms before surgery.② defecation law change,number of bowel movements ≥3 times/day.③ presence of a sense of urgency when diarrhoea,no fever,nausea,vomiting,abdominal pain,mucus and pus.④ defecation traits as shapeless stools,watery stools or visible lipid droplets.By designing the relevant table to record the patient’s gender,age and calculate the patient’s body weight index;by consulting patients with preoperative gallbladder function color Doppler ultrasound examination,recording patients with preoperative gallbladder systolic function;The psychological status assessment was performed using the self-rating anxiety scale.[RESULT]:All patients underwent laparoscopic cholecystectomy from December 2014 to December 2015,of which 122 were eligible for follow-up.The incidence of diarrhea was 54%,33%,28%,19%(χ2= 36.80,P<0.01),respectively,after 1,3,6 and 9 months,the difference was statistically significant.Abou 54%patients had diarrhea at the first month,73%had a complete disappearance of diarrhea at the 9-month follow-up,but 19%of patients continued to have symptoms of diarrhea.There was no significant difference in the incidence of postoperative diarrhea and gender,and there was no definite correlation between sex and diarrhea(χ2= 0.07,P = 0.85);The incidence of PCD was gradually decreased with the increase of the age of the patients.The age of the patients was statistically significant by the χ2 test(χ2= 12.44,P = 0.02).The incidence of PCD was 11%(cholecystic systolic function<20%),22%(20%≤ cholecystic systolic function ≤ 30%),36%(cholecystic systolic function was>30%),the cholecystic systolic function was positively correlated with PCD.The incidence of gallbladder systolic function and PCD was statistically significant(χ2= 23.72,P<0.01).The incidence of PCD was 13%in normal patients,30%in overweight patients and 26%in obese patients.The incidence of PCD and BMI was statistically significant(χ2=23.72 P<0.05).In patients with no anxiety,the incidence of PCD was 15%,In patients with mild anxiety,the incidence of PCD was 24%;the incidence of PCD was 25%in patients with moderate anxiety;the incidence of PCD in patients with severe anxiety was 6%.The rate of PCD was gradually increased((χ2= 13.58,P = 0.01),with the severity of mental anxiety increased.The incidence of PCD was 48%in the normal diet group and 22%in the low-fat diet group(χ2=13.51,P<0.01),The incidence of PCD and eating habits was statistically significant.[CONCLUSIONS]:The incidence of diarrhea in patients with laparoscopic cholecystectomy gradually decreased with time,and some patients with diarrhea symptoms can completely disappear;There is no clear correlation between postoperative diarrhea and gender.Age,BMI,preoperative gallbladder function,the psychological condition,diet are closely associated with laparoscopic cholecystectomy diarrhea.