胆囊切除术后综合征的临床争议和研究进展

doi:10.16139/j.1007-9610.2025.03.14

摘要/Abstract

摘要：

胆囊切除术后综合征（PCS）是胆囊切除术后持续或新的腹痛、腹胀及腹泻等症状，对其病因、诊断及治疗的认识不断演进。本文系统回顾PCS概念的演变历程和临床实践中的争议以及改进思考。PCS概念从早期主要指解剖学异常（如残留结石、胆管损伤）逐渐转向功能性障碍（如Oddi括约肌功能障碍、胆汁酸代谢异常及心理因素）。目前PCS诊断严格遵循罗马Ⅳ标准，发病率10%左右，既往临床研究因诊断标准宽泛，发病率差异显著（5%~63%）。已存在的症状胆囊切除术后仍存在或发生变化是否归入PCS，不同研究含糊不清。消化不良PCS治疗既往强调手术治疗明确器质性病变，目前则以药物治疗功能性消化不良为主。针对PCS概念认识的不确定性，本文提出以胆囊切除术后胆源性消化不良（PCBD）替代PCS，强调其术后新发功能性消化不良的特征，并排除术前症状及非胆源性病因。引入PCBD概念有助于统一诊断标准、指导个体化治疗和开展深入研究。

关键词: 腹腔镜胆囊切除术, 胆囊切除术后综合征, 胆源性消化不良

Abstract:

Post-cholecystectomy syndrome (PCS) encompasses persistent or new abdominal pain, bloating, and diarrhea following cholecystectomy. Our understanding of its etiology, diagnosis, and treatment has evolved significantly. This systematic review traced the conceptual progression of PCS and addressed clinical controversies, and reflections on diagnostic and therapeutic improvements. The definition of PCS has shifted from an anatomical focus (e.g., retained stones, biliary duct injury) to functional disorders (e.g., sphincter of Oddi dysfunction, abnormal bile acid metabolism, and psychosomatic factors). Current diagnosis strictly adheres to the Rome Ⅳ criteria, with an approximate prevalence of 10%. Historically broad diagnostic criteria explained the wide variability in reported incidence rates (5%-63%). Ambiguity persists regarding whether pre-existing symptoms persisting or evolving postoperatively should be attributed to PCS.Therapeutic approaches have transitioned from definitive surgical interventions for organic lesions to pharmacological management of functional dyspepsia. Given the inherent conceptual ambiguity in PCS, we proposed replacing PCS with post-cholecystectomy biliary dyspepsia (PCBD)—a term emphasizing its postoperative onset, functional dyspepsia characteristics, and exclusion of preoperative symptoms or non-biliary etiologies. The introduction of the concept of PCBD can help to unify diagnostic criteria, guide individualized treatment, and conduct in-depth research.

Key words: Laparoscopic cholecystectomy(LC), Post-cholecystectomy syndrome(PCS), Post-cholecystectomy biliary dyspepsia(PCBD)

中图分类号:

R657.4

吴雨钊, 蔡杰, 陈燊浩, 陈曦综述, 郑亚民审校. 胆囊切除术后综合征的临床争议和研究进展[J]. 外科理论与实践, 2025, 30(03): 268-271.

WU Yuzhao, CAI Jie, CHEN Shenhao, CHEN Xi, ZHENG Yamin. Clinical controversy and research progress of post-cholecystectomy syndrome[J]. Journal of Surgery Concepts & Practice, 2025, 30(03): 268-271.

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