腹腔镜胆囊切除术后持续症状的发生率：一项前瞻性研究。

Incidence of persistent symptoms after laparoscopic cholecystectomy: a prospective study.

作者信息

Luman W, Adams W H, Nixon S N, Mcintyre I M, Hamer-Hodges D, Wilson G, Palmer K R

机构信息

Gastrointestinal Unit, Western General Hospital, Edinburgh, Scotland.

出版信息

Gut. 1996 Dec;39(6):863-6. doi: 10.1136/gut.39.6.863.

DOI:10.1136/gut.39.6.863

PMID:9038671

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1383461/

Abstract

BACKGROUND AND AIMS

Laparoscopic cholecystectomy is the standard treatment for symptomatic gall stone disease. This study aimed to assess the effect of the operation on patients' symptoms.

METHODS

One hundred consecutive patients undergoing laparoscopic cholecystectomy between June 1994 and June 1995 were evaluated using standard questionnaires examining demographic details, indication for laparoscopic cholecystectomy, characteristics of pain, and other associated dyspeptic and colonic symptoms. A history of psychiatric disturbances and of hysterectomy were also recorded. The same questionnaires were administered again six months after the operation. Operation notes and histological reports were reviewed.

RESULTS

Three patients were converted to open surgery and were excluded from analysis. The median age of the remaining 97 patients was 50.9 (19-85) years; 19 were men. There was one complication each of bleeding and biliary leak. Indications for laparoscopic cholecystectomy were biliary type pain (66 patients) and complicated gall stone disease (acute cholecystitis 21, cholestatic jaundice six, and pancreatitis four). Thirteen patients (13%) had persistent pain and two (3%) developed diarrhoea at follow up. Only one patient with persistent pain after laparoscopic cholecystectomy originated from the complicated gall stone disease group. Logistic discriminant analysis showed that bloating (p < 0.001), constipation (p < 0.05), and previous and current use of psychotrophic drugs (p < 0.001) were significantly more common among those with a poor outcome after laparoscopic cholecystectomy. Heartburn was unaffected. Of patients with persistent symptoms after cholecystectomy 77% had no or mild histological changes of cholecystitis as compared with 30% in the pain free group.

CONCLUSIONS

The incidence of persistent pain after laparoscopic cholecystectomy was 13%. Abdominal bloating and psychiatric medications were predictive for persistence of pain after laparoscopic cholecystectomy.

摘要

背景与目的

腹腔镜胆囊切除术是有症状胆结石疾病的标准治疗方法。本研究旨在评估该手术对患者症状的影响。

方法

对1994年6月至1995年6月期间连续接受腹腔镜胆囊切除术的100例患者，使用标准问卷进行评估，问卷内容包括人口统计学细节、腹腔镜胆囊切除术的指征、疼痛特征以及其他相关的消化不良和结肠症状。还记录了精神障碍病史和子宫切除术史。术后6个月再次发放相同问卷。回顾手术记录和组织学报告。

结果

3例患者转为开放手术并被排除在分析之外。其余97例患者的中位年龄为50.9岁（19 - 85岁）；19例为男性。有1例出血和1例胆漏并发症。腹腔镜胆囊切除术的指征为胆绞痛（66例患者）和复杂胆结石疾病（急性胆囊炎21例、胆汁淤积性黄疸6例、胰腺炎4例）。13例患者（13%）术后持续疼痛，2例（3%）出现腹泻。腹腔镜胆囊切除术后仅有1例持续疼痛患者来自复杂胆结石疾病组。逻辑判别分析显示，腹胀（p < 0.001）、便秘（p < 0.05）以及既往和目前使用精神药物（p < 0.001）在腹腔镜胆囊切除术后预后不良的患者中显著更为常见。烧心不受影响。胆囊切除术后有持续症状的患者中，77%没有或仅有轻度胆囊炎组织学改变，而无痛组这一比例为30%。