Study Of The Rate And Distribution Of Rokitansky Aschoff Sinuses And Rokitansky Aschoff Sinuses Stone In Gallbladder Wall

Objective:Rokitansky Aschoff Sinuses(RAS)is a special tissue structure of the gallbladder wall.It is the structure of the gallbladder mucosa going into the muscle layer of the gallbladder wall and even the serosal membrane layer.The formation mechanism is not fully understood.Crystals or stones are often found in this sputum-like structure,and this structure is often seen in the pathological examination of gallbladder adenomyomatosis(ADM).By reviewing the literature,few prospective systematic studies have been published about RAS and Rokitansky Aschoff Sinuses stone(RASS).In order to further study RAS related diseases in the future,we studied the incidence and distribution of Rokitansky Aschoff Sinuses(RAS)and Rokitansky Aschoff Sinuses stone(RASS)by visual observation and microscopic examination,and to analyze the correlation between RAS and RASS and factors such as gallbladder adenomyomatosis(ADM),gallstone composition,age and gender of patients.Methods:Collect gallbladder resection specimens,observe the incidence of RAS,RASS,ADM and total RAS(including RAS,RASS and ADM)in the gallbladder wall by visual and microscopic examination;divide the gallbladder into 4 areas:cystic ducts(A area)),gallbladder neck(B area:B1 area,B2 area),gallbladder body(C area:C1 area,C2 area,C3 area),gallbladder body(D area).The positive rates of RAS,RASS and ADM in each area were observed with the naked eye and the microscope,and the results were statistically analyzed.Results:Collection of 76 cases of laparoscopic cholecystectomy specimens from September 2017 to September 2019 in our hospital for one group of the hepatobiliary and pancreatic surgery department.The results were as follows:1.The incidence of RASS was 27.14%by visual examination,and the incidence of RASS,RAS and ADM was 30%,38.57%,60%observed under the microscope;the incidence of total RAS under the microscope was 85.71%.2.The incidence of RASS in the A,B,C,and D regions was 8.57%,15.71%,15.71%,and 10%,with an average incidence of 12.50%..The incidence of pure RAS in the A,B,C and D areas is12.86%,25.71%,31.43%,22.86%,respectively.The average incidence rate was23.21%.The incidence of RASS in the A,B,C,and D areas was 7.14%,17.14%,15.71%and 12.86%,respectively.The average incidence rate was 13.21%.The incidence of ADM in the A,B,C,and D areas was 24.29%.32.86%,47.14%,30.00%,the average incidence rate was 33.57%.The total RAS was observed in the A area,B area,C area,D,the incidence rates of the district were 44.29%,61.43%,71.43%,and65.71%,respectively,and the average incidence rate was 60.71%.3.There was a significant positive correlation between the distribution of RAS and RASS in the gallbladder area(R~2=0.9074,P<0.05).The distribution of RAS and ADM in the gallbladder area was positively correlated(R2=0.995,P<0.005).4.The incidence of RASS in males was significantly higher than that in females by visual examination(P=0.015).The incidence of RASS in males was significantly higher than that in females under the microscope(P=0.012).Conclusion:1.For the first time,the incidence and distribution of gallbladder in RAS,RASS and ADM were prospectively studied by naked eye and microscopic observation.The incidence of RASS in the naked eye was 27.14%.The microscopic incidence of RASS,RAS and ADM were 30%,38.57%,and 60%,respectively.The incidence of total RAS was 85.71%.2.The results of the distribution of RASS with naked eyes and pure RAS,ADM,RASS and total RAS undre the microscope in the cystic duct(A area),gallbladder neck(B area),gallbladder body(C area),and gallbladder funder(D area),showed a uniform distribution.The positive rate of RAS and RASS in the gallbladder area and the positive rate of RAS and ADM in the gallbladder area were significantly positively correlated,and further verify that RAS is the basis for the formation of RASS and ADM.3.The incidence of RASS in males with naked eyes was significantly higher than that in females.4.Both the naked eye and the microscopic examination of RASS have false negatives,and the combination of the two may reduce the occurrence of false negatives.5.There was no correlation between the occurrence of RASS in the naked eyes and RAS,RASS,ADM and total RAS under the microscope and whether there was acute inflammation in the gallbladder.6,Melanin stones and sediments stones are most likely to be found with RASS in the gallbladder wall,the gallbladder retention of such stones should be more careful during the gallblader protection surgery.7.In gallbladder without stones(such as gallbladder polyps),there is no significant difference in the distribution of RASS with naked eyes and RAS,ADM and RASS undre the microscope in each region;compared with the gallbladder with gallstones,the incidence of the naked eye RASS and microscopic pure RAS,RASS,ADM and total RAS in each district is relatively lower.8.In the comparison of age groups,the incidence of RASSwith naked eyes of the 61-year-old group was 43.49%,which was higher than other groups,suggesting that patients with advanced age should be more cautious during the gallblader protection surgery.9.In the“double-lumen”gallbladder,the total RAS of the big and small gallbladder were positive.The distribution of RASS with naked eyes and pure RAS,ADM and RASS undre the microscope in the gallbladder were consistent.