分析罗-阿氏窦（RAS）、罗-阿氏窦结石（RASS）和胆囊腺肌症（ADM）在胆囊壁的发生率和分布情况，初步探讨RASS和ADM形成机制。

本前瞻性研究对象为2017年9月至2019年9月在南京医科大学附属明基医院行腹腔镜胆囊切除术的70例患者胆囊标本。其中男34例，女36例；年龄24~82岁，中位年龄51岁。患者均签署知情同意书，符合医学伦理学规定。将胆囊切割分成胆囊管、胆囊颈部、体部、底部4个区，肉眼及病理镜下观察胆囊壁RAS、RASS、ADM发生率及分布情况，RASS等发生率比较及其分布相关性分析等采用χ²检验。

70例胆囊标本中，胆囊壁肉眼RASS发生率为27%（19/70）；镜下总RAS发生率86%（60/70），其中单纯RAS发生率39%（27/70），RASS发生率30%（21/70），ADM发生率60%(42/70)。总RAS在胆囊管、胆囊颈部、胆囊体部和胆囊底部的发生率分别为44%（31/70）、61%（43/70）、71%（50/70）、66%（46/70）。镜下单纯RAS和RASS在胆囊管、胆囊颈分布具有相关性（χ²=4.399，4.747；P<0.05），其和ADM在胆囊内的总体分布亦具有相关性（χ²=4.432，P<0.05）。男性患者镜下RASS发生率为44%（15/34），明显高于女性患者的17%（6/36） （χ²=6.280，P<0.05）；≥61岁患者肉眼和镜下RASS发生率分为43%（10/23）、35%（8/23），亦明显高于<61岁患者的19%（9/47）、28%（13/47） （χ²=4.622，4.096；P<0.05）；黑色素结石患者胆囊壁肉眼RASS发生率为70%（7/10），亦明显高于胆固醇结石患者的17%（8/46） （χ²=11.593，P<0.05）。

RAS在胆囊管、胆囊颈部、体部和底部各区分布相对均匀，RASS及ADM发生可能与RAS有关。男性、≥61岁及黑色素类结石患者更易发生RASS。

To investigate the incidence and distribution of Rokitansky-Aschoff sinus (RAS), RAS stone (RASS) and gallbladder adenomyosis (ADM) in the gallbladder wall, and to preliminarily unravel the mechanism of RASS and ADM.

In this prospective study, gallbladder specimens were collected from 70 patients who underwent laparoscopic cholecystectomy in BenQ Medical Center Affiliated to Nanjing Medical University from September 2017 to September 2019. Among them, 34 patients were male and 36 female, aged from 24 to 82 years, with a median age of 51 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The gallbladder was cut into 4 parts: cystic duct, neck, body and bottom. The incidence and distribution of RAS, RASS and ADM in the gallbladder wall were observed by naked eyes and pathological microscope. The incidence of RASS and its correlation with the distribution pattern were compared by Chi-square test.

Among 70 gallbladder specimens, the incidence of RASS in the gallbladder wall was 27%(19/70). Under microscope, the overall incidence of RAS was 86%(60/70), 39%(27/70) for simple RAS, the incidence of RASS was 30%(21/70) and the incidence of ADM was 60%(42/70), respectively. The incidence of RAS in the cystic duct, neck, body and bottom was 44%(31/70), 61%(43/70), 71%(50/70) and 66%(46/70), respectively. Microscopically, the distribution of RAS in the cystic duct and neck was significantly correlated with that of RASS (χ²=4.399, 4.747; P<0.05), which was also correlated with the overall distribution of ADM in the gallbladder (χ²=4.432, P<0.05). The incidence of RASS under microscope in male patients was 44%(15/34), significantly higher than 17% (6/36) in female counterparts (χ²=6.280, P<0.05). Under naked eyes and microscope, the incidence of RASS in patients aged ≥61 years was 43%(10/23) and 35%(8/23), respectively, significantly higher compared with 19%(9/47) and 28%(13/47) in those aged <61 years (χ²=4.622, 4.096; P<0.05). The incidence of RASS under naked eye in the gallbladder wall of patients with melanin-like stones was 70%(7/10), significantly higher than 17%(8/46) in those with cholesterol-like stones (χ²=11.593, P<0.05).

RAS is evenly distributed in the cystic duct, neck, body and bottom of gallbladder. The incidence of RASS and ADM is probably associated with RAS. Male, aged ≥61 years and patients with melanin-like stones are more likely to develop RASS.