• 1.武警醫(yī)學院附屬醫(yī)院普通外科(天津 300162);;
  • 2.西安交通大學第一醫(yī)院肝膽外科研究室(西安 710061);

　　膽囊切除術(包括開腹膽囊切除術和腹腔鏡膽囊切除術)是外科治療膽囊良性疾病的標準術式，但是大約10%～30%的膽囊切除術患者會出現(xiàn)上腹或右上腹痛、餐后腹脹、消化不良、膽道感染或梗阻等臨床癥候群，發(fā)病時間從術后數(shù)周到數(shù)年，Pribram于1950年將上述癥候群稱為膽囊切除術后綜合征(postcholecystectomy syndrome，PCS)，但何種原因?qū)е律鲜霭Y候群的出現(xiàn)未能明確［1］。隨著影像學、內(nèi)鏡技術的發(fā)展，以及臨床診斷技術的進步，特別是CT、MRI及磁共振胰膽管造影術(magnetic resonance cholangiopancreatography，MRCP)、內(nèi)鏡技術包括內(nèi)鏡超聲(endoscopic ultrasound，EUS)和經(jīng)內(nèi)鏡逆行性胰膽管造影術(endoscopic retrograde cholangiopancreatography，ERCP)的發(fā)展，絕大多數(shù)PCS患者能夠明確病因并得到有效治療。

引用本文： 朱愛軍,石景森. 膽囊切除術后綜合征的再認識. 中國普外基礎與臨床雜志, 2010, 17(4): 314-316. doi: 復制

1. Schumpelick V, Truong S, Fass J, et al. Postcholecystectomy syndrome-still a current argument today? [J]. Langenbecks Arch Chir Suppl Ⅱ Verh Dtsch Ges Chir, 1990: 1205-1209.
2. 　Tsoraides SS, Cha AI, Crawford DL. Postcholecystectomy biliary symptoms [J]. J Surg Educ, 2007; 64(4): 228-233.
3. 　畢永林, 朱彤, 潘曉峰, 等. 膽囊切除術后綜合征116例ERCP分析 [J]. 中華肝膽外科雜志, 2007; 13(1): 32-34.
4. 　蔡忠方, 樓曉樓, 劉文勇. 內(nèi)鏡在膽囊切除術后綜合征的病因診治中的價值 [J]. 外科理論與實踐, 2008； 13(2): 157-159.
5. 　黃震, 王日武, 張為民, 等. 內(nèi)鏡在膽囊切除術后綜合征病因診斷和治療中的應用價值 [J]. 肝膽胰外科雜志, 2006; 18(4): 240-242.
6. 　Duensing RA, Williams RA, Collins JC, et al. Managing choledocholithiasis in the laparoscopic era [J]. Am J Surg, 1995; 170(6): 619-623.
7. 　Widdison AL, Longstaff AJ, Armstrong CP. Combined laparoscopic and endoscopic treatment of gallstones and bile duct stones: a prospective study [J]. Br J Surg, 1994; 81(4): 595-597.
8. 　石景森. 膽道外科中不可忽視的問題 [J]. 肝膽胰外科雜志, 2005; 17(3): 178-179.
9. 　吳碩東, 田雨, 蘇洋, 等. 膽道疾病與十二指腸周圍憩室關系的研究 [J]. 外科理論與實踐, 2007; 12(4): 342-344.
10. 　石景森, 朱愛軍, 孫學軍, 等. 膽囊切除術殘留病變21例臨床分析 [J]. 中國實用外科雜志, 2003; 23(2): 110-111.
11. 　Gandolfi L, Torresan F, Solmi L, et al. The role of ultrasound in biliary and pancreatic diseases [J]. Eur J Ultrasound, 2003; 16(3): 141-159.
12. 　Ney MV, Maluf-Filho F, Sakai P, et al. Echo-endoscopy versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct [J]. Arq Gastroenterol, 2005; 42(4): 239-243.
13. 　Buscarini E, Tansini P, Vallisa D, et al. EUS for suspected choledocholithiasis: do benefits outweigh costs? A prospective, controlled study [J]. Gastrointest Endosc, 2003; 57(4): 510-518.
14. 　Tse F, Barkun JS, Romagnuolo J, et al. Nonoperative imaging techniques in suspected biliary tract obstruction [J]. HPB (Oxford), 2006; 8(6): 409-425.
15. 　Filip M, Saftoiu A, Popescu C, et al. Postcholecystectomy syndrome-an algorithmic approach [J]. J Gastrointestin Liver Dis, 2009; 18(1): 67-71.
16. 　Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study [J]. Am J Gastroenterol, 2001; 96(2): 417-423.
17. 　Barthet M, Lesavre N, Desjeux A, et al. Complications of endoscopic sphincterotomy: results from a single tertiary referral center [J]. Endoscopy, 2002; 34(12): 991-997.
18. 　陳流華, 吳志棉, 鄭朝旭, 等. 術前超聲內(nèi)鏡檢查預防腹腔鏡膽囊切除術膽總管殘余結(jié)石的臨床價值 [J]. 中國實用外科雜志, 2009； 29(11): 928-930.
  1. 1. Schumpelick V, Truong S, Fass J, et al. Postcholecystectomy syndrome-still a current argument today? [J]. Langenbecks Arch Chir Suppl Ⅱ Verh Dtsch Ges Chir, 1990: 1205-1209.
  2. 2. 　Tsoraides SS, Cha AI, Crawford DL. Postcholecystectomy biliary symptoms [J]. J Surg Educ, 2007; 64(4): 228-233.
  3. 3. 　畢永林, 朱彤, 潘曉峰, 等. 膽囊切除術后綜合征116例ERCP分析 [J]. 中華肝膽外科雜志, 2007; 13(1): 32-34.
  4. 4. 　蔡忠方, 樓曉樓, 劉文勇. 內(nèi)鏡在膽囊切除術后綜合征的病因診治中的價值 [J]. 外科理論與實踐, 2008； 13(2): 157-159.
  5. 5. 　黃震, 王日武, 張為民, 等. 內(nèi)鏡在膽囊切除術后綜合征病因診斷和治療中的應用價值 [J]. 肝膽胰外科雜志, 2006; 18(4): 240-242.
  6. 6. 　Duensing RA, Williams RA, Collins JC, et al. Managing choledocholithiasis in the laparoscopic era [J]. Am J Surg, 1995; 170(6): 619-623.
  7. 7. 　Widdison AL, Longstaff AJ, Armstrong CP. Combined laparoscopic and endoscopic treatment of gallstones and bile duct stones: a prospective study [J]. Br J Surg, 1994; 81(4): 595-597.
  8. 8. 　石景森. 膽道外科中不可忽視的問題 [J]. 肝膽胰外科雜志, 2005; 17(3): 178-179.
  9. 9. 　吳碩東, 田雨, 蘇洋, 等. 膽道疾病與十二指腸周圍憩室關系的研究 [J]. 外科理論與實踐, 2007; 12(4): 342-344.
  10. 10. 　石景森, 朱愛軍, 孫學軍, 等. 膽囊切除術殘留病變21例臨床分析 [J]. 中國實用外科雜志, 2003; 23(2): 110-111.
  11. 11. 　Gandolfi L, Torresan F, Solmi L, et al. The role of ultrasound in biliary and pancreatic diseases [J]. Eur J Ultrasound, 2003; 16(3): 141-159.
  12. 12. 　Ney MV, Maluf-Filho F, Sakai P, et al. Echo-endoscopy versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct [J]. Arq Gastroenterol, 2005; 42(4): 239-243.
  13. 13. 　Buscarini E, Tansini P, Vallisa D, et al. EUS for suspected choledocholithiasis: do benefits outweigh costs? A prospective, controlled study [J]. Gastrointest Endosc, 2003; 57(4): 510-518.
  14. 14. 　Tse F, Barkun JS, Romagnuolo J, et al. Nonoperative imaging techniques in suspected biliary tract obstruction [J]. HPB (Oxford), 2006; 8(6): 409-425.
  15. 15. 　Filip M, Saftoiu A, Popescu C, et al. Postcholecystectomy syndrome-an algorithmic approach [J]. J Gastrointestin Liver Dis, 2009; 18(1): 67-71.
  16. 16. 　Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study [J]. Am J Gastroenterol, 2001; 96(2): 417-423.
  17. 17. 　Barthet M, Lesavre N, Desjeux A, et al. Complications of endoscopic sphincterotomy: results from a single tertiary referral center [J]. Endoscopy, 2002; 34(12): 991-997.
  18. 18. 　陳流華, 吳志棉, 鄭朝旭, 等. 術前超聲內(nèi)鏡檢查預防腹腔鏡膽囊切除術膽總管殘余結(jié)石的臨床價值 [J]. 中國實用外科雜志, 2009； 29(11): 928-930.