| Gallstone, a worldwide common disease has become a serious disease plagued human health. With the development of science and technology, the treatment of gallstone constantly changes. As well known, laparoscopic cholecystectomy (LC) is considered as the "gold standard" for treatment of gallstones."But the removal of the gallbladder, especially removal functional gallbladder brings a lot of complications for patients. Recently, many scholars have carried out laparoscopic-choledochoscopy-assisted removal of cholecystolithotomy (LRCL)-new type microinvasive gallbladder-protected lithotomy which is paid more and more attention to for its theoretically retaining gallbladder function. Whether the retained gallbladder has its function, which gallstone is suitable for LRCL, especially the relation of Gallstone Proportion and Gallbladder contractive function after LRCL has not been reported at home and abroad. The purpose of this study provides the theoretical basis of LRCL indications and the reasonable treatment plan for gallstone patients.100gallstone patients who carried LRCL except for4cases who stop the follow-up for recurrence etc were selected from August2009to February2011at the Second Affiliated Hospital of Hebei North University. Group by gallstone proportion:Group A:gallstone proportion<30%; Group B:gallstone proportion≥30%and≤70%; Group C:gallstone proportion>70%; Group A40cases; Group B35cases; Group C21cases (including9cases full of gallstone). All the preoperative patients of Group A and Group B have the maximum gallbladder contraction rate≥30%; All the preoperative patients of Group C (except for gallbladder full of gallstone) have the maximum gallbladder contractive rate<30%for their gallbladder wall could closely contact to gallstone. After one ice candy of LUNDH test meal on an empty stomach, every one of gallstone patients took routine ultrasonic inspection at15,30,60,90,120,150,180minutes and measured the gallbladder maximum length diameter, short diameter and vertical high. Then, the volumes of gallbladder were calculated on an empty stomach as well as after test meal at each time point. The minimum volume of gallbladder was made the minimum residual volume. And the maximum gallbladder contractive rate was calculated. The patients of Group A, Group B and Group C had carried LCRL.3,12,24months after surgery, the maximum gallbladder contractive rate were detected by the same method. The data was collected for statistical analysis. Group A:3months after surgery, the maximum gallbladder contractive rate was significantly lower than the preoperative (P<0.05);12months after surgery, the maximum gallbladder contractive rate was significantly higher than the rate of3months after surgery (P<0.05); Comparing12months postoperative contractive rate with the preoperative, the difference was not statistically significant (P>0.05);24months after surgery, the maximum gallbladder contractive rate was significantly higher than the rate of12months,3months after surgery and before surgery, the difference was statistically significant (P<0.05). Group B:3months after surgery, the maximum gallbladder contractive rate was significantly lower than the preoperative (P<0.05);12months after surgery, the maximum gallbladder contractive rate was significantly higher than the rate of3months after surgery and before surgery (P<0.05);24months after surgery, the maximum gallbladder contractive rate was significantly higher than the rate of12months,3months after surgery and before surgery (P<0.05). Group C:12months after surgery, the maximum gallbladder contractive rate was significantly higher than the rate of3months after surgery (P<0.05);24months after surgery, the maximum gallbladder contractive rate was significantly higher than the rate of12months and3months after surgery (P<0.05). The difference of maximum gallbladder contractive rate from Group A preoperative and Group B preoperative was not statistically significant (P>0.05).3months after surgery, the difference of maximum gall-bladder contractive rate from Group A, Group B and Group C was not statistically significant (P>0.05).12months after surgery, the difference between Group A and Group B was not statistically significant (P>0.05); The maximum gallbladder contractive rate of Group A and Group B were significantly higher than Group C (P<0.05).24months after surgery, the maximum gallbladder contractive rate of Group B after surgery was significantly higher than Group A and Group C (P<0.05); The maximum gallbladder contractive rate of Group A was significantly higher than Group C (P<0.05). So Gallstone impairs gallbladder contractive function,A gradual improvement can be reached by removing gallstone from the gallbladder; The patients who carried LRCL are in normal gallbladder function (the maximum gallbladder contractive rate≥30%) before the surgery,Their gallbladder contractive function is also well after the surgery and has been improved by the surgery. The patients meet the following conditions:gallstone proportion>70%(including gallbladder full of gallstone), actually measured the maximum gallbladder contractive rate<30%before surgery, the gallbladder contractive trend remains (except for gallbladder full of gallstone), carried the LRCL, Then, the majority of them could reach normal contractive function (this study it’s up to76.19%). The patients who carried LRCL are in normal gallbladder function before the surgery. The more gallstone proportion is shared in gallbladder volume, the more obvious improvement of their gallbladder contractive function appears, after LRCL. |
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