Liu Haipeng, Liu Jie, Xu Wei, Chen Xiao
Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China.
The Second Clinical Medical College, Lanzhou University, Lanzhou, China.
Front Oncol. 2022 Sep 13;12:897853. doi: 10.3389/fonc.2022.897853. eCollection 2022.
The main treatment for gastric cancer is surgical excision. Gallstones are one of the common postoperative complications of gastric cancer. To avoid the adverse effects of gallstone formation after gastric cancer surgery, we reviewed the causes and risk factors and mechanisms involved in gallstone formation after gastric cancer surgery. The evidence and value regarding prophylactic cholecystectomy (PC) during gastric cancer surgery was also reviewed. Based on previous evidence, we summarized the mechanism and believe that injury or resection of the vagus nerve or changes in intestinal hormone secretion can lead to physiological dysfunction of the gallbladder and Oddi sphincter, and the lithogenic components in the bile are also changed, ultimately leading to CL. Previous studies also have identified many independent risk factors for CL after gastric cancer, such as type of gastrectomy, reconstruction of the digestive tract, degree of lymph node dissection, weight, liver function, sex, age, diabetes and gallbladder volume are closely related to CL development. At present, there are no uniform guidelines for the selection of treatment strategies. As a new treatment strategy, PC has undeniable advantages and is expected to become the standard treatment for CL after gastric cancer in the future. The individualized PC strategy for CL after gastric cancer is the main direction of future research.
胃癌的主要治疗方法是手术切除。胆结石是胃癌术后常见的并发症之一。为避免胃癌手术后形成胆结石的不良影响，我们回顾了胃癌手术后胆结石形成的原因、危险因素及相关机制。还回顾了胃癌手术期间预防性胆囊切除术（PC）的证据及价值。基于先前的证据，我们总结了其机制，认为迷走神经损伤或切除或肠道激素分泌变化可导致胆囊和Oddi括约肌生理功能障碍，胆汁中的致石成分也发生改变，最终导致胆结石形成。先前的研究还确定了许多胃癌后胆结石形成的独立危险因素，如胃切除术类型、消化道重建、淋巴结清扫程度、体重、肝功能、性别、年龄、糖尿病和胆囊体积与胆结石形成密切相关。目前，治疗策略的选择尚无统一指南。作为一种新的治疗策略，PC具有不可否认的优势，有望成为未来胃癌后胆结石形成的标准治疗方法。胃癌后胆结石形成的个体化PC策略是未来研究的主要方向。
