对于有非典型症状的患者，进行胆囊切除术的外科转诊。

Surgical referral for cholecystectomy in patients with atypical symptoms.

机构信息

Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States.

出版信息

Am J Surg. 2020 Dec;220(6):1451-1455. doi: 10.1016/j.amjsurg.2020.10.016. Epub 2020 Oct 19.

DOI:10.1016/j.amjsurg.2020.10.016

PMID:33289652

Abstract

BACKGROUND

Cholelithiasis referrals often present with concomitant or isolated atypical symptoms such as reflux, bloating, or epigastric pain. We sought to identify the impact of preoperative symptomatology of atypical or dyspepsia-type biliary colic on operative and non-operative clinical outcomes.

METHODS

A retrospective review of patients referred for gallstone disease from 2014 to 2018 at a single institution in Los Angeles County was performed.

RESULTS

Of 746 patients evaluated for gallstone disease, 87.4% (n = 652) underwent cholecystectomy - 90.8% (n = 592) had symptom resolution postoperatively whereas 9.2% (n = 60) did not. Over half presented with concomitant atypical and/or dyspepsia symptoms (n = 411). Heartburn/reflux was significantly associated with unresolved symptoms postoperatively (OR 2.1,1.0-4.4, p = 0.04). Overall, 11.1% (n = 83) of all 746 patients and 20.2% of patients with atypical and/or dyspepsia symptoms improved with medical management of gastritis or Helicobacter pylori triple therapy pre/post-operatively.

CONCLUSION

Atypical biliary colic and/or dyspepsia is associated with unresolved symptoms following cholecystectomy. Such patients may benefit from H. pylori testing or PPI trial prior to cholecystectomy.

摘要

背景

胆石病转诊常伴有或仅有非典型症状，如反流、腹胀或上腹痛。我们旨在确定术前非典型或消化不良型胆绞痛症状对手术和非手术临床结局的影响。

方法

对 2014 年至 2018 年期间洛杉矶县一家机构转诊的胆石病患者进行回顾性研究。

结果

在 746 例评估胆石病的患者中，87.4%（n=652）接受了胆囊切除术-90.8%（n=592）术后症状缓解，而 9.2%（n=60）未缓解。超过一半的患者伴有同时存在的非典型和/或消化不良症状（n=411）。烧心/反流与术后未解决的症状显著相关（OR 2.1，1.0-4.4，p=0.04）。总体而言，746 例患者中有 11.1%（n=83），有非典型和/或消化不良症状的患者中有 20.2%，通过术前和/或术后胃炎或幽门螺杆菌三联疗法的药物治疗得到改善。