Isherwood Jennifer, Oakland Kathryn, Khanna Achal
Department of General Surgery, Milton Keynes Hospital, United Kingdom.
Department of Gastroenterology, Oxford University Hospitals, United Kingdom.
Surgeon. 2019 Feb;17(1):33-42. doi: 10.1016/j.surge.2018.04.001. Epub 2018 May 2.
10% of patients who undergo a cholecystectomy go on to develop post-cholecystectomy syndrome (PCS). The majority of these patients may suffer from extra-biliary or unrelated organic disorders that may have been present before cholecystectomy. The numerous aetiological causes of PCS result in a wide spectrum of management options, each with varying success in abating symptoms. This systematic review aims to provide a summary of the causative aetiologies of post cholecystectomy syndrome, their incidences and efficacy of available management options.
The Medline, Embase and Cochrane databases were searched for studies patients who developed PCS symptoms following laparoscopic cholecystectomy, published between 1990 and 2016. The aetiology, incidence and management options were extracted, with separate collation of randomised control trials and non-randomised studies that reported intervention. Outcomes included recurrent symptoms following intervention, unscheduled primary and secondary care attendances and complications.
Twenty-one studies were included (15 case series, 2 cohort studies, 1 case control, 3 RCTs). Five studies described medical treatment (nifedipine, cisapride, opiates); seven studies described endoscopic or surgical intervention. Early presentation of PCS (<3 years post-cholecystectomy) was more likely to be gastric in origin, and later presentations were found to be more likely due to retained stones. Sphincter of Oddi dysfunction (SOD) accounted for a third of cases in an unselected population with PCS.
Causes of post cholecystectomy syndrome are varied and many can be attributed to extra-biliary causes, which may be present prior to surgery. Early symptoms may warrant early upper gastrointestinal endoscopy. Delayed presentations are more likely to be associated with retained biliary stones. A large proportion of patients will have no cause identified. Treatment options for this latter group are limited.
接受胆囊切除术的患者中有10%会发展为胆囊切除术后综合征（PCS）。这些患者中的大多数可能患有胆囊外或不相关的器质性疾病，这些疾病可能在胆囊切除术之前就已存在。PCS的病因众多，导致了广泛的治疗选择，每种治疗方法在缓解症状方面的成功率各不相同。本系统评价旨在总结胆囊切除术后综合征的病因、发病率以及现有治疗方法的疗效。
检索Medline、Embase和Cochrane数据库，查找1990年至2016年间发表的关于腹腔镜胆囊切除术后出现PCS症状患者的研究。提取病因、发病率和治疗方法，并分别整理报告干预措施的随机对照试验和非随机研究。结果包括干预后的复发症状、计划外的初级和二级护理就诊以及并发症。
纳入21项研究（15个病例系列、2个队列研究、1个病例对照、3个随机对照试验）。5项研究描述了药物治疗（硝苯地平、西沙必利、阿片类药物）；7项研究描述了内镜或手术干预。PCS早期表现（胆囊切除术后<3年）更可能起源于胃部，而后期表现更可能是由于结石残留。在未选择的PCS患者人群中，Oddi括约肌功能障碍（SOD）占三分之一的病例。
胆囊切除术后综合征的病因多种多样，许多可归因于胆囊外病因，这些病因可能在手术前就已存在。早期症状可能需要早期进行上消化道内镜检查。延迟出现的症状更可能与胆管结石残留有关。很大一部分患者无法确定病因。对于后一组患者，治疗选择有限。
