Recognition of Postcholecystectomy Syndrome_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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朱愛軍 ¹ , 石景森 ²

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Keywords：

膽囊切除術后綜合征; 病因; 診斷

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　　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，發病時間從術后數周到數年，Pribram于1950年將上述癥候群稱為膽囊切除術后綜合征(postcholecystectomy syndrome，PCS)，但何種原因導致上述癥候群的出現未能明確［1］。隨著影像學、內鏡技術的發展，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)、內鏡技術包括內鏡超聲(endoscopic ultrasound，EUS)和經內鏡逆行性胰膽管造影術(endoscopic retrograde cholangiopancreatography，ERCP)的發展，絕大多數PCS患者能夠明確病因并得到有效治療。

Citation： 朱愛軍,石景森. Recognition of Postcholecystectomy Syndrome. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(4): 314-316. doi: Copy

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. 術前超聲內鏡檢查預防腹腔鏡膽囊切除術膽總管殘余結石的臨床價值 [J]. 中國實用外科雜志, 2009； 29(11): 928-930.

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. 術前超聲內鏡檢查預防腹腔鏡膽囊切除術膽總管殘余結石的臨床價值 [J]. 中國實用外科雜志, 2009； 29(11): 928-930.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Recognition of Postcholecystectomy Syndrome

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