胆囊切除术后腹泻的中西医研究现状

殷西; 杨兴武; 王国泰; 闫晓莉

doi:10.3969/j.issn.1671-038X.2022.12.12

胆囊切除术后腹泻的中西医研究现状

- 1.
  陕西中医药大学第一临床医学院(陕西咸阳，712046)
- 2.
  陕西中医药大学附属医院肝胆外科
- 3.
  陕西中医药大学附属医院妇科

详细信息

通讯作者: 杨兴武，E-mail：1078251005@qq.com

^Δ审校者

中图分类号: R735.2

收稿日期: 2022-08-30

刊出日期: 2022-12-15

Research status of Chinese and Western medicine on post-cholecystectomydiarrhea

- 1.
  The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, 712046, China
- 2.
  Department of Hepatological Surgery, Affiliated Hospital of Shaanxi University of Chinese Medicine
- 3.
  Department of Gynaecology, Affiliated Hospital of Shaanxi University of Chinese Medicine

More Information

Corresponding author: YANG Xingwu, E-mail: 1078251005@qq.com

Received Date: 30 August 2022

Publish Date: 15 December 2022

摘要

摘要: 随着生活作息与饮食习惯的改变，胆囊疾病的患病率逐年升高，胆囊切除治疗作为大多数患者首选的治疗方式，术后面临着一系列并发症，其中腹泻的发生率较高，治疗不及时会导致电解质紊乱、营养不良，逐渐演变成慢性腹泻，反复发作，迁延不愈，对患者身心造成严重困扰。近年来，中西医临床工作者对其进行研究，并取得了一定的成果，该文通过对近年来胆囊切除术后腹泻发病机制及中西医治疗现状进行综述，以期为临床治疗提供新思路，缓解患者的腹泻症状，提高生活质量。
- 胆囊切除术后腹泻 /
- 发病机制 /
- 中西医治疗 /
- 研究进展
Abstract: With the change of life, rest and eating habits, the prevalence of gallbladder disease is increasing year by year. As the first choice of treatment for most patients, cholecystectomy faces a series of complications after surgery, among which the incidence of diarrhea is high. It caused serious physical and mental distress to patients. In recent years, clinical workers of Traditional Chinese and western medicine have studied it and achieved certain results. This article reviews the pathogenesis of post-cholecystectomy diarrhea and the status of Traditional Chinese and western medicine treatment in recent years, in order to provide new ideas for clinical treatment, relieve the symptoms of diarrhea and improve the quality of life of patients.
- post-cholecystectomy diarrhea /
- pathogenesis /
- Traditional Chinese and western medicine treatment /
- research progress

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参考文献(60)

[1]	Aguiar RGP, Souza Junior FEA, Rocha Junior JLG, et al. Clinical and Epidemiological Evaluation of Complications Associated With Gallstones in A Tertiary Hospital[J]. Arq Gastroenterol, 2022, 59(3): 352-357. doi: 10.1590/s0004-2803.202203000-64
[2]	陈晨, 张伟辉. 胆囊切除术后综合征发病机制及治疗的研究进展[J]. 疑难病杂志, 2021, 20(9): 963-967, 972. doi: 10.3969/j.issn.1671-6450.2021.09.023
[3]	刘霜月, 席鹏程, 杨士勇, 等. 腹腔镜胆囊切除术319例患者生活质量调查[J]. 中华肝胆外科杂志, 2020, 26(6): 439-442. doi: 10.3760/cma.j.cn113884-20190718-00227
[4]	Li YD, Liu BN, Zhao SH, et al. Changes in gut microbiota composition and diversity associated with post-cholecystectomy diarrhea[J]. World J Gastroenterol, 2021, 27(5): 391-403. doi: 10.3748/wjg.v27.i5.391
[5]	鲁蓓, 石玉宝, 刘斌, 等. 腹腔镜胆囊切除术后胆囊功能缺失的影响[J]. 中国内镜杂志, 2013, 19(9): 906-909. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ201309003.htm
[6]	汤朝晖, 耿智敏, 锁涛, 等. 胆囊切除术后常见并发症的诊断与治疗专家共识(2018版)[J]. 全科医学临床与教育, 2018, 16(3): 244-246. doi: 10.13558/j.cnki.issn1672-3686.2018.03.002
[7]	Farrugia A, Attard JA, Hanmer S, et al. Rates of Bile Acid Diarrhoea After Cholecystectomy: A Multicentre Audit[J]. World J Surg, 2021, 45(8): 2447-2453. doi: 10.1007/s00268-021-06147-8
[8]	Barkun AN, Love J, Gould M, et al. Bile Acid Malabsorption in Chronic Diarrhea: Pathophysiology and Treatment[J]. Can J Gastroenterol, 2013, 27(11): 653-659. doi: 10.1155/2013/485631
[9]	Walters JR, Tasleem AM, Omer OS, et al. A New Mechanism for Bile Acid Diarrhea: Defective Feedback Inhibition of Bile Acid Biosynthesis[J]. Clin Gastroenterol Hepatol, 2009, 7(11): 1189-1194. doi: 10.1016/j.cgh.2009.04.024
[10]	Sauter GH, Moussavian AC, Meyer G, et al. Bowel Habits and Bile Acid Malabsorption in The Months After Cholecystectomy[J]. Am J Gastroenterol, 2002, 97(7): 1732-1735. doi: 10.1111/j.1572-0241.2002.05779.x
[11]	Borup C, Hedback N, Wildt S, et al. Effect of cholecystectomy on bile acid diarrhoea biomarkers: A prospective clinical study[J]. GastroHep, 2021, 3(5): 283-290. doi: 10.1002/ygh2.489
[12]	Fort J, Azpiroz F, Casellas F, et al. Bowel habit after cholecystectomy: Physiological changes and clinical implications[J]. Gastroenterology, 1996, 111(3): 617-622. doi: 10.1053/gast.1996.v111.pm8780565
[13]	许前进. 胆囊结石患者胆囊收缩功能与术后排便功能的相关性分析[J]. 中国实用医药, 2022, 17(4): 24-27. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202204008.htm
[14]	邹大中. 胆囊排空功能与胆囊切除术后腹泻的关系[J]. 现代医学, 2007(3): 238-239. doi: 10.3969/j.issn.1671-7562.2007.03.025
[15]	赵林, 李尚州, 杜俊玉. 胆囊功能对腹腔镜胆囊切除术后腹泻的影响[J]. 吉林医学, 2011, 32(18): 3778. doi: 10.3969/j.issn.1004-0412.2011.18.137
[16]	宋明洋. 胆囊切除术后人体的肠道菌群组成分析[D]. 郑州: 郑州大学, 2021.
[17]	冯其贞, 李建军. 胆囊切除术后腹泻相关因素研究进展[J]. 济宁医学院学报, 2015, 38(2): 142-144, 148. doi: 10.3969/j.issn.1000-9760.2015.02.020
[18]	Terry NA, Lee RA, Walp ER, et al. Dysgenesis of Enteroendocrine Cells in Aristaless-Related Homeobox Polyalanine Expansion Mutations[J]. J Pediatr Gastroenterol Nutr, 2015, 60(2): 192-199. doi: 10.1097/MPG.0000000000000542
[19]	孙海山. 胆囊切除术后肠黏膜组织中5-HT变化的实验研究[D]. 石家庄: 河北医科大学, 2012.
[20]	刘巧艳, 王进海. 西安地区胆囊切除术后腹泻流行病学及临床研究[J]. 中国临床研究, 2012, 25(9): 846-848. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK201209007.htm
[21]	Yueh TP, Chen FY, Lin TE, et al. Diarrhea after laparoscopic cholecystectomy: Associated factors and predictors[J]. Asian J Surg, 2014, 37(4): 171-177. doi: 10.1016/j.asjsur.2014.01.008
[22]	Jackson A, Lalji A, Kabir M, et al. The efficacy of a low-fat diet to manage the symptoms of bile acid malabsorption-outcomes in patients previously treated for cancer[J]. Clin Med, 2017, 17(5): 412-418. doi: 10.7861/clinmedicine.17-5-412
[23]	Ribas Blasco Y, Perez Munante M, Gomez-Fernandez L, et al. Low-fat Diet After Cholecystectomy: Should It Be Systematically Recommended?[J]. Clin Med(Lond), 2020, 98(1): 36-42.
[24]	Fisher M, Spilias DC, Tong LK. Diarrhoea after laparoscopic cholecystectomy: incidence and main determinants. [J]. ANZ J Surg, 2008, 78(6): 482-486. doi: 10.1111/j.1445-2197.2008.04539.x
[25]	汪家航, 林明强. 胆囊切除术后腹泻发病率及危险因素临床研究[J]. 医学理论与实践, 2022, 35(10): 1675-1678. doi: 10.19381/j.issn.1001-7585.2022.10.020
[26]	Damsgaard B, Dalby HR, Krogh K, et al. Long-term effect of medical treatment of diarrhoea in 377 patients with SeHCAT scan diagnosed bile acid malabsorption from 2003 to 2016;a retrospective study[J]. Aliment Pharmacol Ther, 2018, 47(7): 951-957. doi: 10.1111/apt.14533
[27]	Walters JRF, Johnston IM, Nolan JD, et al. The response of patients with bile acid diarrhoea to the farnesoid X receptor agonist obeticholic acid[J]. Aliment Pharmacol Ther, 2015, 41(1): 54-64. doi: 10.1111/apt.12999
[28]	闻久辉, 罗世云, 夏中平, 等. 双歧杆菌三联活菌胶囊用于腹腔镜胆囊切除术后患者疗效观察[J]. 中国药师, 2015, 18(3): 439-441. doi: 10.3969/j.issn.1008-049X.2015.03.026
[29]	刘琦, 周芳. 双歧杆菌三联活菌胶囊对胆囊切除术后腹泻患者肠道菌群及sIgA水平的影响[J]. 吉林医学, 2020, 41(3): 642-643. doi: 10.3969/j.issn.1004-0412.2020.03.058
[30]	潘延军. 双歧杆菌四联活菌片治疗对胆囊切除术后腹泻患者胃肠激素水平的影响[J]. 中国药物经济学, 2021, 16(8): 103-106. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYWA202108025.htm
[31]	习意平. 双歧杆菌四联活菌片对胆囊切除术后腹泻患者肠道微生态及胃肠激素的影响[J]. 中国微生态学杂志, 2018, 30(6): 717-720. doi: 10.13381/j.cnki.cjm.201806024
[32]	中华消化杂志编辑委员会. 双歧杆菌三联活菌散/胶囊应用于消化系统疾病的中国专家共识(2021版)[J]. 中华消化杂志, 2022, 42(4): 224-239. doi: 10.3760/cma.j.cn311367-20220110-00022
[33]	沈顺华, 陈杏林, 赵雅莹, 等. 双歧杆菌三联活菌联合匹维溴铵治疗胆囊切除术后腹泻效果观察[J]. 中国乡村医药, 2021, 28(11): 8-9. doi: 10.3969/j.issn.1006-5180.2021.11.004
[34]	陈新, 岳胜利, 谭唱, 等. 国医大师徐景藩运用泄木安土法治疗胆囊切除术后腹泻经验[J]. 中华中医药杂志, 2018, 33(10): 4439-4441. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201810045.htm
[35]	黄岩, 马卓林, 谢晶日. 谢晶日教授治疗胆囊切除术后腹泻经验[J]. 中西医结合肝病杂志, 2022, 32(1): 72-73. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB202201020.htm
[36]	张声生, 王垂杰, 李玉锋, 等. 泄泻中医诊疗专家共识意见(2017)[J]. 中医杂志, 2017, 58(14): 1256-1260. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201714023.htm
[37]	韩翠宁, 黄雅慧. 中医辨证治疗胆囊切除术后腹泻患者43例疗效观察[J]. 现代中医药, 2017, 37(1): 18-20. https://www.cnki.com.cn/Article/CJFDTOTAL-XDZY201701038.htm
[38]	吴俊骥. 胆囊术后腹泻证治规律探讨[D]. 南京: 南京中医药大学, 2019.
[39]	朱泽荃, 吴文忠, 郑曼, 等. 基于"肝郁-脾虚-气血失衡"探讨胆囊切除术后腹泻的病机及治疗进展[J]. 辽宁中医杂志, 2020, 47(8): 218-220. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY202008065.htm
[40]	庄时刚. 健脾燥湿汤治疗胆囊切除术后慢性腹泻脾虚湿盛证临床疗效[J]. 中华中医药学刊, 2016, 34(1): 239-241. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201601079.htm
[41]	易纪杰, 胡仕祥. 藿朴夏苓汤加味治疗胆囊切除术后肠道湿热型腹泻的疗效研究[J]. 中国中医急症, 2020, 29(10): 1769-1772. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ202010020.htm
[42]	姚飞, 劳萍. 痛泻要方联合四神丸、葛根芩连汤治疗胆囊切除术后慢性腹泻的临床疗效观察[J]. 中国中医药科技, 2017, 24(2): 195-197. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYY201702025.htm
[43]	杨颖, 赵金荣, 居伟, 等. 基于魄门亦为五脏使理论的痛泻要方治疗胆囊切除术后慢性泄泻的临床研究[J]. 中国中医药现代远程教育, 2021, 19(6): 39-41. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYY202106017.htm
[44]	柳青. 疏肝理脾汤治疗胆囊术后泄泻30例[J]. 光明中医, 2016, 31(19): 2825-2827. https://www.cnki.com.cn/Article/CJFDTOTAL-GMZY201619026.htm
[45]	敖雪仁, 廖聪, 吴剑纯, 等. 柴芩止泻方治疗胆囊切除术后胆热脾寒型腹泻36例[J]. 环球中医药, 2022, 15(8): 1473-1476. https://www.cnki.com.cn/Article/CJFDTOTAL-HQZY202208039.htm
[46]	张建斌, 曹岐新, 王群. 柴胡疏肝散合参苓白术散加减治疗胆囊切除术后慢性腹泻60例[J]. 中国中医药科技, 2018, 25(5): 735-737. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYY201805051.htm
[47]	邹来宾, 王晓龙, 陈亮, 等. 痛泻要方合四君子汤治疗胆囊切除术后腹泻的临床观察[J]. 湖北中医药大学学报, 2019, 21(6): 72-74. https://www.cnki.com.cn/Article/CJFDTOTAL-HZXX201906019.htm
[48]	王俊莹. 验方抑肝扶脾汤干预胆囊术后肝郁脾虚型腹泻的临床研究[D]. 南京: 南京中医药大学, 2017.
[49]	朱泽荃. 不同时机电针干预腹腔镜下胆囊切除术后胃肠功能恢复的临床疗效观察[D]. 南京: 南京中医药大学, 2020.
[50]	张培华. 穴位贴敷对腹腔镜胆囊切除术后胃肠功能恢复的影响[J]. 中国中医药科技, 2022, 29(2): 318-319. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYY202202072.htm
[51]	梁镇忠, 安云, 郭茹芳, 等. 胆胃舒膏方联合穴位注射对胆囊切除术后胆汁反流性胃炎患者胃肠激素的影响[J]. 河南中医, 2018, 38(8): 1228-1230. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZY201808025.htm
[52]	王志兵, 曹岐新, 金佳佳. 针刺联合中药治疗胆囊切除术后腹泻效果观察[J]. 中国乡村医药, 2021, 28(16): 23-24. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYY202116012.htm
[53]	李铁, 刘平, 及东林. 参苓白术散联合盐酸洛哌丁胺胶囊治疗腹腔镜胆囊切除术后腹泻疗效及对肠道菌群及胃肠激素的影响[J]. 现代中西医结合杂志, 2017, 26(19): 2097-2101. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJH201719015.htm
[54]	兰乃祥, 汤军, 王卫伟, 等. 参苓白术散联合双歧杆菌四联活菌片治疗胆囊切除术后腹泻的临床效果[J]. 临床医学研究与实践, 2021, 6(19): 133-135. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202119043.htm
[55]	刘烨, 高志海, 安燚, 等. 参苓白术散联合双歧杆菌四联活菌片治疗胆囊切除术后腹泻的临床研究[J]. 现代消化及介入诊疗, 2019, 24(8): 892-895. https://www.cnki.com.cn/Article/CJFDTOTAL-XDXH201908019.htm
[56]	张兆宏, 刘翔, 王兆阳, 等. 人参健脾汤加减联合双歧杆菌四联活菌片治疗腹腔镜胆囊切除术后腹泻临床研究[J]. 新中医, 2021, 53(13): 36-39. https://www.cnki.com.cn/Article/CJFDTOTAL-REND202113008.htm
[57]	谯毅, 郭符琳. 足三里穴位贴敷对胆囊切除术后脾虚湿阻型泄泻患者临床疗效观察[J]. 世界最新医学信息文摘, 2019, 19(20): 187, 190. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201920094.htm
[58]	颜海波, 颜玲玲. 益肾健脾利湿止泻汤联合西医疗法治疗胆囊切除术后腹泻的疗效观察[J]. 中国中医药科技, 2022, 29(5): 857-859. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYY202205049.htm
[59]	徐红伟, 王迎, 王大军, 等. 双镜微创保胆术与胆囊切除术的临床效果比较及对血浆VIP、CCK水平的影响[J]. 罕少疾病杂志, 2021, 28(6): 54-57. https://www.cnki.com.cn/Article/CJFDTOTAL-HSJB202106024.htm
[60]	徐飞. 腹腔镜下保胆取石术与胆囊切除术治疗胆囊结石术后早期生存质量与并发症的比较[J]. 肝胆外科杂志, 2018, 26(2): 137-139. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWZ201802018.htm