Surgical Choice for Different Types of Gallbladder Adenomyomatosis: An Initial Experience of 20 Years Laparoscopic Cholecystectomy. Issue 2 (April 2020) - Pang, Liwei
Abstract : Objectives: The objective of this study was to compare the difference of clinical biochemical statistics in different types of gallbladder adenomyomatosis (GA). To investigate the different effects of patients between the 3 different types of GA. Materials and Methods: Retrospective analysis of the clinical data of the adenomyomatosis patients that come from our hospital between 2010 to 2018. According to the preoperative image (all cases are performed as elective surgery), it could be divided into 3 groups: group A: fundal (localized) type; group B: segmental type; group C: diffuse type. The number of each group is 136, 27, 17. We analyze the biochemical statistics (total bilirubin, direct bilirubin, serum bile acid, alanine aminotransferase, aspartate aminotransferase, cholinesterase, etc.) of the 3 groups to explore the difference in operative mode, operative time and prognosis between these 3 groups. Results: (1) In the liver function statistics, aspartate aminotransferase has the statistical significance ( F =4.974, P =0.012); (2) And the diffuse adenomyomatosis might have a higher bile acid ( F =6.048, P =0.005); (3) The segmental and diffuse adenomyomatosis is easier to be combined with stones ( F =19.226, P <0.001); (4) The fundal adenomyomatosis seems to have a better prognosis: fewer hospital stay ( F =4.519, P =0.018), fewer drainage time ( F =6.575, P =0.004) and fewer complications (χ 2 =29.429, P <0.001). Conclusions: GA is a disease characterized by epithelial proliferation and hypertrophy of the muscles of the gallbladder wall with an outpouching of the mucosa into or through the thickened muscular layer and cannot be regarded as a precancerous lesion based on available evidence. As for asymptomatic GA, conservative treatment is recommended with ultrasound examinations twice a year. The fundal type GA can be treated by partial laparoscopic cholecystectomy. The segmental and diffuse-type should undergo a total laparoscopic cholecystectomy.