The Natural History Of Asymptomatic Cholecystolithiasis

Objective To evaluate the clinical outcomes of asymptomatic gallstone, the factors affecting the prognosis and time choice for treatment.Methods The clinical information of 1983 cases of asymptomatic gallstone in our hospital outpatient clinic department and medical examination center during December 2007 to April 2010 was collected. All the cases received non-surgical treatment and were followed up (294 cases were lost). They were asked to undergo B-Ultrasound examination and answered the questionaire survey of factors affecting the clinical outcomes. The results were analyzed by univariate and multivariate regression analysis (Logistic regression analysis).Results The clinical information of effective follow-up group (1689 cases) were analyzed by univariate regression analysis, by which we found the following factors had significant difference in Statistics:strength of psychological stress (P=0.038), alcohol consumption (P=0.037), stone size(P=0.023), diet style (P=0.005), with or without diabetes (0.025), body mass index>28(P=0.055). There were 43 cases occurring complications in 161 cases with symptomatic patients, including 34 cases of pancreatitis, 8 cases of common bile duct stones, gallbladder perforation in 1 case.61 cases received surgery intervention, whose postoperative pathologic findings showed 11 cases of suppurative cholecystitis,1 case of gangrenous cholecystitis,49 cases of simple cholecystitis.28 cases (65.1%) had all the high risk factors (psychological stress intensity, alcohol consumption, stone size, bad diet style, diabetes, body mass index> 28) in 43 cases of complications. It was statistically different (p<0.05) compared to patients without any of those risk factors, which only had 3 patients (0.07%) occurring complications. The multivariate analysis (Logistic regression analysis) Results showed that psychological stress intensity, alcohol consumption, stone size, bad diet style, diabetes, body mass index> 28,outdoor activity was also selected in Logistic regression equation as factors affecting the natural outcomes of asymptomatic gallstone. Their regression coeffeciency were body mass index>28(b=-1.261, P=0.000), diet style(b=-1.600, P=0.000), alcohol consumption(b=-0.817, P=0.001), diabetes(b=0.999, P=0.000), stone size(b=-1.732, P=0.000), psychological stress (b=1.194, P=0.000) outdoor activity(b=-1.085, P=0.000)Conclusion Psychological stress, alcohol consumption, stone size, diet style, diabetes, body mass index> 28 were risk factors affecting the outcomes of asymptomatic gallstone. The body mass index, dietary style, outdoor activity, can also affect the outcome of asymptomatic gallstones. Therefore it is necessary to suggest patients of asymptomatic gallstones who has high risk factors to undergo preventive cholecystectomy or gall stone protection surgery. It could also prevent the acute cholecystitis. But the results of this research would be more convincing if there would be a larger sample size, more center and longer follow-up.