Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania.
J Gastrointestin Liver Dis. 2009 Mar;18(1):67-71.
The postcholecystectomy syndrome includes a heterogeneous group of diseases, usually presenting as abdominal symptoms following gallbladder removal. The clinical management of these patients is frequently without an evidence-based approach.
We evaluated 80 patients with postcholecystectomy problems consecutively admitted during a period of 36 months. The liver function tests (LFTs) assessment and transabdominal ultrasound (TUS) were followed by endoscopic ultrasound (EUS). Endoscopic retrograde cholangio-pancreatography (ERCP) was then performed depeding on the results. With knowledge of the final diagnosis, the probable evaluation and outcomes were reassessed assuming that ERCP would have been performed as the initial procedure. Final diagnosis was confirmed by a combination of imaging findings, as well as clinical follow-up of 6 months.
In 53 patients biliary or pancreatic diseases were diagnosed: common bile duct stones, chronic pancreatitis, pancreatic cancer, papillary tumors, cholangiocarcinoma, insufficient cholecystectomy or sphincter of Oddi dysfunction. The other 27 patients had non-biliary symptoms (dyspepsia, IBS, etc.) and were consequently managed according to the symptoms. The sensitivity and specificity of EUS were high in the subgroup of patients with biliary or pancreatic symptoms (96.2% and 88.9%) and helped to indicate subsequent ERCP.
An algorithmic approach which used EUS for the initial evaluation of the patients with postcholecystectomy problems decreased the number of ERCPs by 51%, having as a consequence a decreased morbidity and mortality in this group of patients.
胆囊切除术后综合征包括一组异质性疾病，通常表现为胆囊切除术后出现腹部症状。这些患者的临床管理通常缺乏循证方法。
我们连续评估了 36 个月期间连续入院的 80 例胆囊切除术后有问题的患者。在进行肝功能检查（LFT）评估和腹部超声（TUS）后，进行了内镜超声（EUS）检查。然后根据结果进行内镜逆行胰胆管造影（ERCP）。在了解最终诊断的情况下，假设将 ERCP 作为初始程序进行，则重新评估可能的评估和结果。最终诊断通过影像学发现以及 6 个月的临床随访相结合得到确认。
在 53 例患者中诊断出胆道或胰腺疾病：胆总管结石、慢性胰腺炎、胰腺癌、乳头瘤、胆管癌、胆囊切除不足或 Oddi 括约肌功能障碍。另外 27 例患者有非胆道症状（消化不良、IBS 等），因此根据症状进行治疗。EUS 在有胆道或胰腺症状的患者亚组中具有较高的敏感性和特异性（96.2%和 88.9%），有助于指示随后进行 ERCP。
在胆囊切除术后问题患者中，使用 EUS 进行初始评估的算法方法可将 ERCP 的数量减少 51%，从而降低了该组患者的发病率和死亡率。
