膽囊切除術後症候群

膽囊切除術後症候群
膽囊切除術後症候群
分類和外部資源
醫學專科	胃腸學
ICD-11	DC14.1
ICD-9-CM	576.0
	[編輯此條目的維基數據]

膽囊切除術後症候群（Postcholecystectomy syndrome）是描述在膽囊切除術（英語：cholecystectomy）之後出現的一系列腹部症狀。

大約5-40%的膽囊切除術患者會出現此類術後症候群^[1]，此類症狀可能暫時出現，可能持續一陣子，也有一些人伴隨終身^[2]^[3]。有約10%的術後患者出現慢性症狀。

術後症候群的腹痛症狀可能來自於歐蒂氏括約肌功能不全（英語：sphincter of Oddi dysfunction）或術後沾黏^[4]。一項近期研究顯示術後症候群可能肇因於膽道微結石（英語：biliary microlithiasis）^[5]。約50%的病例是源自於膽道系統，例如殘餘結石、膽道損傷、膽道運動不良，以及膽道囊腫（英語：choledochal cyst）。非膽道源性術後症候群則可能肇因於腸胃道功能性失調，例如消化不良^[6]。

慢性膽囊切除術後症候群屬於一種膽酸性腹瀉（英語：bile acid diarrhea）^[3]，此類患者可以使用膽酸結合劑（英語：bile acid sequestrant）進行治療，如可林斯提拉明酯（英語：cholestyramine）（cholestyramine）^[3]、考來替泊（英語：colestipol）（colestipol）^[2]，或colesevelam（英語：colesevelam）^[7]等藥物都能夠治療且安全^[8]。

症狀

相關症狀包含^[9]：

消化不良、噁心，和嘔吐
放屁、腹部脹氣，和腹瀉。
持續性右上腹痛^[10]。

診斷

腹部超音波
常規性血液檢查及生化檢驗
靜脈膽管造影術
胃十二指腸內視鏡
經內視鏡逆行性膽胰管攝影術（英語：endoscopic retrograde cholangiopancreatography）（ERCP）
經內視鏡逆行性膽胰管攝影術（英語：endoscopic retrograde cholangiopancreatography）（ERCP）取得膽泥（英語：biliary sludge）分析
SeHCAT（英語：SeHCAT）或其他與膽酸性腹瀉（英語：bile acid diarrhea）相關檢驗

參考文獻

^ Postcholecystectomy syndrome. WebMD. [2009-03-07]. （原始內容存檔於2007-07-02）.
^ ^2.0 ^2.1 Danley T, St Anna L. Clinical inquiry. Postcholecystectomy diarrhea: what relieves it?. The Journal of Family Practice. October 2011, 60 (10): 632c–d [2019-04-11]. PMID 21977493. （原始內容存檔於2019-12-13）.
^ ^3.0 ^3.1 ^3.2 Sciarretta G, Furno A, Mazzoni M, Malaguti P. Post-cholecystectomy diarrhea: evidence of bile acid malabsorption assessed by SeHCAT test. The American Journal of Gastroenterology. December 1992, 87 (12): 1852–4. PMID 1449156.
^ Hyvärinen H, Sipponen P, Silvennoinen E. Intestinal adhesions: an overlooked cause of the postcholecystectomy syndrome. Hepatogastroenterology. December 1990, 37 (Suppl 2): 58–61. PMID 2083937.
^ Okoro N, Patel A, Goldstein M, Narahari N, Cai Q. Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis. Gastrointestinal Endoscopy. July 2008, 68 (1): 69–74. PMID 18577477. doi:10.1016/j.gie.2007.09.046.
^ Post-cholecystectomy symptoms were caused by persistence of a functional gastrointestinal disorder. [2019-04-11]. （原始內容存檔於2019-12-17）.
^ Odunsi-Shiyanbade ST, Camilleri M, McKinzie S, et al. Effects of chenodeoxycholate and a bile acid sequestrant, colesevelam, on intestinal transit and bowel function. Clinical Gastroenterology and Hepatology. February 2010, 8 (2): 159–65. PMC 2822105  . PMID 19879973. doi:10.1016/j.cgh.2009.10.020.
^ Mottacki N, Simrén M, Bajor A. Review article: bile acid diarrhoea - pathogenesis, diagnosis and management. Aliment. Pharmacol. Ther. 2016, 43: 884–898. PMID 26913381. doi:10.1111/apt.13570.
^ nhs.uk, Complications of a gallbladder removal （頁面存檔備份，存於網際網路檔案館）
^ Lamberts MP, Lugtenberg M, Rovers MM, Roukema AJ, Drenth JP, Westert GP, van Laarhoven CJ. Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg Endosc. 2013, 27 (3): 709–18. PMID 23052498. doi:10.1007/s00464-012-2516-9.

外部連結

[1] Postcholecystectomy syndrome. WebMD. [2009-03-07]. （原始內容存檔於2007-07-02）.

[pmid21977493-2] 2.0 ^2.1 Danley T, St Anna L. Clinical inquiry. Postcholecystectomy diarrhea: what relieves it?. The Journal of Family Practice. October 2011, 60 (10): 632c–d [2019-04-11]. PMID 21977493. （原始內容存檔於2019-12-13）.

[pmid1449156-3] 3.0 ^3.1 ^3.2 Sciarretta G, Furno A, Mazzoni M, Malaguti P. Post-cholecystectomy diarrhea: evidence of bile acid malabsorption assessed by SeHCAT test. The American Journal of Gastroenterology. December 1992, 87 (12): 1852–4. PMID 1449156.

[finl-4] Hyvärinen H, Sipponen P, Silvennoinen E. Intestinal adhesions: an overlooked cause of the postcholecystectomy syndrome. Hepatogastroenterology. December 1990, 37 (Suppl 2): 58–61. PMID 2083937.

[pmid18577477-5] Okoro N, Patel A, Goldstein M, Narahari N, Cai Q. Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis. Gastrointestinal Endoscopy. July 2008, 68 (1): 69–74. PMID 18577477. doi:10.1016/j.gie.2007.09.046.

[6] Post-cholecystectomy symptoms were caused by persistence of a functional gastrointestinal disorder. [2019-04-11]. （原始內容存檔於2019-12-17）.

[7] Odunsi-Shiyanbade ST, Camilleri M, McKinzie S, et al. Effects of chenodeoxycholate and a bile acid sequestrant, colesevelam, on intestinal transit and bowel function. Clinical Gastroenterology and Hepatology. February 2010, 8 (2): 159–65. PMC 2822105  . PMID 19879973. doi:10.1016/j.cgh.2009.10.020.

[pmid26913381-8] Mottacki N, Simrén M, Bajor A. Review article: bile acid diarrhoea - pathogenesis, diagnosis and management. Aliment. Pharmacol. Ther. 2016, 43: 884–898. PMID 26913381. doi:10.1111/apt.13570.

[9] s.uk, Complications of a gallbladder removal （頁面存檔備份，存於網際網路檔案館）

[pmid23052498-10] Lamberts MP, Lugtenberg M, Rovers MM, Roukema AJ, Drenth JP, Westert GP, van Laarhoven CJ. Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg Endosc. 2013, 27 (3): 709–18. PMID 23052498. doi:10.1007/s00464-012-2516-9.

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