胆囊切除术后综合征原因分析与治疗对策

Cause analysis and treatment countermeasure of postcholecystestomy syndrome

目的探析胆囊切除术后综合征（PCS）的原因与治疗对策。方法 35例单纯胆囊切除术患者,对其术后发生PCS的临床资料进行回顾性分析。结果 35例患者中,出现PCS原因：胆道因素、胆道外因素及其他因素。胆道因素17例,包括胆道结石5例、胆管扩张3例、胆管狭窄2例、胆道十二指肠瘘1例、胆囊管残留过长4例、胆总管损伤2例;胆道外因素14例,包括缩窄性乳头炎4例、胆汁返流性胃炎4例、上消化道溃疡3例、慢性胰腺炎2例、十二指肠憩室1例;其他因素4例,主要为患者精神紧张及过度劳累所致。手术治疗23例,其中治愈19例、好转2例、无效1例、死亡1例;保守治疗12例,其中治愈9例、好转2例、无效1例。术后随访时间6~36个月,未见复发病例。结论 PCS病因复杂,术前应全面检查,术中规范操作,严格探查,避免损伤胆管和电灼误伤等,可有效减少和杜绝术后PCS发生。可根据PCS病因进行对症治疗,并加强患者心理治疗和护理工作,以促进患者身体恢复,提高生活质量。

Objective To investigate cause and treatment countermeasure of postcholecystestomy syndrome（PCS）. Methods A retrospective analysis was made on clinical data of 35 patients with PCS after single cholecystectomy. Results Causes of PCS in the 35 cases included biliary tract factor, outside biliary tract factor and other factor. There were 17 cases with biliary tract factor, including 5 cases with biliary calculi, 3 cases with cholangiectasis, 2 cases with stenosis of bile duct, 1 case with biliary duodenal fistula, 4 cases with long residual cystic duct, and 2 cases with choledochus injury. There were 14 cases with outside biliary tract factor, including 4 cases with constrictive papillitis of vater, 4 cases with bile reflax gastritis, 3 cases with upper digestive tract ulcer, 2 cases with chronic pancreatitis, and 1 case with duodenal diverticulum. There were 4 cases with the other factors, such as psychentonia and fatigue. Among 23 cases receiving surgical treatment, there were 19 cured cases, 2 improved cases, 1 ineffective case, and 1 death case. Among 12 cases receiving conservative treatment, there were 9 cured cases, 2 improved cases, and 1 ineffective case. Postoperative follow-up lasting for 6~36 months showed no case with recurrence. Conclusion Due to complex causes of PCS, preoperative full examination, standard intraoperative operating and strict inspection are essential for preventing bile duct injury and electric injury. This method can reduce occurrence of postoperative PCS. Implement of symptomatic treatment, enhanced psychological treatment and nursing can accelerate rehabilitation and improve quality of life in patients.