The Clinical Research Of Factors Affecting The Recovery Of Gallbladder’s Function After Minimally Invasive Cholecystolithotomy(with 96 Cases Analysis)

Purpose: Cholecystolithotomy is getting more attention since it reserves the function of gallbladder. The research concerns the changes of gallbladder’s contraction function in different time periods after the Minimally Invasive Cholecystolithotomy, as well as the different elements(gender, age, weight, preoperative symptoms, number of stones)that affect the recovery of the function. Therefore, more information can be gotten for future Minimally Invasive Cholecystolithotomy surgeries.Method: the subjects are 96 patients who received LRCL(laparoscopic- choledochoscopy-assisted removal of cholecystolithotomy) surgeries between Aug. 2011 and Feb. 2013 at Biliary Surgery Branch of the 2nd Hospital which is attached to Hebei Northern College. The patients’ weight rank from 50 kg to100kg, 34 cases of men,62 cases of women,aged 21 to 74 years old, average age was 46.0±12 years old,with a normal CCK(cholecystokinin). 50 healthy staff, servinf as healthy people, undergo the routine ultrasound examination on the condition of empty stomach and LUNDH Popsicle Test respectively to get the gallbladder’s maximal profile product by measuring the long diameter, short diameter and height. By using the internationally-accepted Dodds method(gallbladder’s volume=0.52×L×W×H), we can get the subjects’ fasting gallbladder’s volume. With the same method, we can get the subjects’ empty gallbladder’s volume 120 minutes after LUNDH Popsicle Test, which can be regarded as the minimal residual volume. By calculating, the maximal contraction percentage is got. With the same method, we can also get the maximal contraction percentage after 3, 12, 24 months of LRCL.Then we can classify those whose maximal contraction percentage after the 24 months’ reexamination is equal or above 50% to the good group of gallbladder’s functional recovery(Group I), while those whose maximal contraction percentage after the 24 months’ reexamination is below 50% to the bad group of gallbladder’s functional recovery(Group II). Then we can compare the groups’ elements, such as gender, age, weight, number of stones, pre-surgery symptoms, etc. The index’ obvious differences(P<0.05) would be regarded as the possible dangerous elements that leading to the mal-recovery of gallbladder’s function and would be researched.Result:1 120 minutes after LUNDH Popsicle Test, the healthy people’s maximal contraction percentage is(50.8%±0.8%)while before- operation cholecystolithiasis patients’ maximal contraction percentage is(35.1%±15.0%).The difference is obvious T=-7.302,P=0.000(<0.05).2 The healthy people’s fasting plasma is CCK(172.34±65.26) ng/l,cholecystolithiasis patients’ fasting plasma is CCK(183.27±60.68) ng/l. There is no statistical difference between the two groups,P=0.316(>0.05).3 The number of patients whose maximal contraction percentage reach 50% is none after 3 months reexamination, 24 after 12 months reexamination, 70 after 24 months reexamination, accounting for 72.9% of all the patients.4 In the 24 months reexamination, there are 70 patients in Group I(27 men and 43 women;51 people between the age 21 to 50 years old,19 people between the age 51-74;41 people between 50-70 kg weight,23 people between 71-80 kg weight,6 people between 81-100 kg weight;Single stone 49 people,Multiple stones 21 people;Preoperative symptoms of 47 people,No preoperative symptoms of 23 people)and 26 in Group II(4 men and 22 women;12 people between the age 21 to 50 years old,14 people between the age 51-74;18 people between 50-70 kg weight,6 people between 71-80 kg weight,2 people between 81-100 kg weight;Single stone 4 people,Multiple stones 22 people;Preoperative symptoms of 24 people,No preoperative symptoms of 2 people). The P values of gender, age, number of stone, pre-surgery symptoms are 0.031, 0.014, 0.000, 0.013 respectively, which are all below 0.05.Statistical analysis shows significant difference. The P value of weight is 0.616, which is above 0.05. Statistical analysis shows no significant difference.5 The 4 obvervational indexes which are visibly different(P<0.05)between the 2 groups are regarded as the possible dangerous elements that lead to the mal-recovery of gallbladder’s function. Through the Logistic analysis screening, it shows that the P values of gender, age, number of stone, pre-surgery symptoms are 0.026, 0.000, 0.013, 0.044 respectively, which are all below 0.05.Conclusions:1 Cholecystolithiasis patients’ gallbladder’ constraction function before operation is worse than healthy people.2 There is no obvious difference in plasma CCK between cholecystolithiasis patients and healthy people.3 Gallbladder’s contraction function can gradually recover after the Minimally Invasive Cholecystolithotomy,about 70% patients gallbladder function back to normal after 24 months of LRCL. 4. The elements that affect the recovery are gender, age, number of stone, pre-surgery symptoms, while no visible relativity is showed to weight.5 Regular oral cholagogic drugs to be effective in preventing stone recurrence and calculi recurrence in patients with continuous oral deoxidation bear bile acid can eliminate calculi in 6 month.6 Male, younger than 50 years old, single stone, no preoperative symptomsmore suitable for patients with biliary surgery.