内镜微创保胆取石术与胆囊切除术后综合征

Endoscopic minimally invasive gallbladder-preserving cholecystolithotomy and post-cholecystectomy syndrome

目的探讨胆囊切除术后综合征的病因、预防及处理。方法对收治的胆石症患者进行随机抽样调查,共调查253例,其中微创保胆取石术133例,腹腔镜胆囊切除术25例,开腹胆囊切除术95例。结果 120例胆囊切除术后发生非器质性胆囊切除后综合征11例(9.2%),133例保胆术后发生非器质性保胆术后综合征11例(8.3%)。结论胆囊是否切除与胆囊手术后综合征的发生无直接关系,胆道压力变化及长期清淡饮食导致的胆道顺应性下降可能是发生胆囊切除或保胆术后综合征的病因;胆囊功能的保留对缓冲与维持正常的胆道压力至关重要;胆道功能康复训练将有效降低上述症状的发生率。[中国普通外科杂志,2011,20(3):273-275]

Objective To study the etiology,prevention and treatment of post-cholecystectomy syndrome. Methods A total of 253 patients with cholelithiasis treated in our hospital between 1998 and 2008 were surveyed.Of these patients,133 underwent endoscopic minimally invasive gallbladder-preserving cholecystolithotomy,25 patients laparoscopic cholecystectomy and 95 patients open cholecystectomy. Results Among the 120 patients who underwent cholecystectomy,non-organic post-cholecystectomy syndrome occurred in 11 patients（9.2%）,and non-organic post-gallbladder-preserving operation syndrome occurred in 11 of 133 cases（8.3%）.There was no significant differences in the rate of non-organic postoperative syndrome between cholecystectomy group and endoscopic minimally invasive gallbladder-preserving cholecystolithotomy group. Conclusions Postcholecystectomy syndrome is not related to whethar or not cholecystectomy is perforned.The decreasing of biliary compliance caused by bile duct pressure changes and long-term bland diet may be the etiology of postoperative syndrome.Gallbladder-preservation is important for buffering and maintaining normal bile duct pressure.Recovery training of biliary function can decrease the rate of postoperative syndrome.