Laparoscopic cholecystectomy (LC) is a highly accepted treatment at this stage, with the increasing incidence of biliary tract disease and the development of endoscopic technique in recent years However, some patients after cholecystectomy still have symptoms similar to preoperative symptoms, such as abdominal pain, diarrhea, indigestion and so on. This series of syndromes has become a common clinical problem at present.This article reviews the research progress of etiology, pathogenesis, diagnosis and treatment of post-cholecystectomy syndrome by reading related literatures

Chen, Guocang

Huang, Xiaoqing

Wang, Xin

Yang, Xingwu

English

Advanced Emergency Medicine (E-Journal)

Volume 12 | Issue 2 -115-Research Progress on Integrated Traditional Chinese andWestern Medicine in the Treatment of Post-CholecystectomySyndromeXiaoqing Huang1, Xingwu Yang2,*, Xin Wang1, Guocang Chen1*corresponding author1. Shaanxi University of Chinese Medicine, Xianyang 710246, China.2. Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712000, China.Abstract: Laparoscopic cholecystectomy (LC) is a highly accepted treatment at this stage, with the increasing incidence ofbiliary tract disease and the development of endoscopic technique in recent years However, some patients aftercholecystectomy still have symptoms similar to preoperative symptoms, such as abdominal pain, diarrhea, indigestion and soon. This series of syndromes has become a common clinical problem at present.This article reviews the research progress ofetiology, pathogenesis, diagnosis and treatment of post-cholecystectomy syndrome by reading related literatures.Keywords: Postcholecystectomy Syndrome; Traditional Chinese Medicine Treatment; Research ProgressIntroductionThe term post cholecystectomy syndrome (PCS) refers to a syndrome in which, after surgical removal of thegallbladder, the original clinical symptoms have not disappeared or, on this basis, new symptoms have developed, such asdiscomfort with abdominal tightness and distension, abdominal pain, shoulder and back pain, dyspepsia, nausea or vomitingwith vomiting, eructation, and increased frequency of stools, and specific biliary symptoms such as severe right upperquadrant pain, biliary colic, fever, jaundice, etc. [1]The onset can occur from within days postoperatively to yearspostoperatively. Genera "abdominal pain ", " jaundice ", "biliary distension " in Chinese medicine.1. Pathogenesis of post cholecystectomy syndrome1.1 Pathogenesis of traditional Chinese MedicineThe traditional chinese medicine holds Dan as the province of “Qiheng”, which is also the first of “six Fu” organs.Theliver and bile are mutually episodic. [2] The clinical symptoms of PCS can be assigned to the categories of "flank pain ", "jaundice ", "biliary distension ", and " fullness " in Traditional Chinese Medicine . According to Prof. Zhengxue Pei, afterdamage to the human body by the scalpel, the human Qi is made deficient, which causes qi stagnation and blood stasis, liverstagnation, and transverse spleen stomach, so that after cholecystectomy, more gallbladder stumps and gastrointestinalinfections exist. [3] Traditional Chinese medicine believed that the disease location was still hepatobiliary, and involved thespleen and stomach, and the disease mechanism was an adverse effect of Shaoyang main and collateral channels. [4]-116- Advanced Emergency Medicine1.2 Pathogenesis of Western MedicineThe current western medical pathogenesis of PCS is not very clear, and it is currently believed that the etiology of PCSis related to bile duct stones before operation, and about half of the patients with bile duct stones develop PCS aftercholecystectomy, and the statistical significance of PCS in this category of patients after open or laparoscopiccholecystectomy reaches 4.76-7.34%. [5-6] The predisposing factor is either related to the damage caused by the operatinginstruments during the operation or to the residual gallbladder, part of the bile duct, bile that accumulates in the stumppredisposing to inflammation or stone formation again triggering PCS. [7] Duodenal parapapillary diverticula were present in38.5% of the patients with PCS. [8] Therefore, some authors believe that duodenal parapapillary diverticulum is also acommon pathogenic factor of PCS. Jiaqing Wu [9] suggested that the onset of PCS is closely related to the thickness of thegallbladder wall, the number and size of stones, the patients' emotions and life habits. When the gallbladder is surgicallyremoved and the function of the bile duct is not fully compensated to replace gallbladder function.After cholecystectomy,bile is discharged into the bile duct, duodenum, after losing the concentration effect of the gallbladder, causing abdominaldiscomfort and other gastrointestinal symptoms. [10]2. Diagnosis of post cholecystectomy syndromeAmong the imaging examinations, hepatobiliary and pancreatic spleen color ultrasound, endoscopic ultrasound (EUS),computed tomography (CT), magnetic resonance cholangiography (MRCP), and endoscopic retrogradecholangiopancreatography (ERCP) were performed. Color ultrasound is easy, fast and noninvasive in the clinic, and isusually used as the initial screening test to exclude gallbladder and bile duct diseases, but it can be disturbed by feedingconditions, gases and other factors, so it is often used as the initial screening test for hepatobiliary pancreaticosplenicdiseases. CT is relatively good for stones, bile duct dilatation, pancreatitis, tumours, but may be too small a diameter of thestone to make a missed diagnosis. MRCP, ERCP are widely used in clinical departments, and both have high-definitiondevelopment ability and can clearly present stone number, size, and location. EUS can be used to find distal common bileduct and ampullary lesions, and also has a high diagnostic yield of 88.9% for stones less than 4 mm in diameter. [11]3. Management of post cholecystectomy syndrome3.1 Traditional Chinese medicine treatmentTraditional Chinese medicine (TCM) has not uniformly developed a syndrome type classification for PCS, and basedon clinical experience, various doctors make an approximate classification of the disease.Clinically, Yangyang Wu [12]applied Chaihu Shugan powder plus and minus formula to treat PCS with remarkable efficacy.Zhengxue Pei[13] believed thatthe treatment of PCS should be Shu-gan- Li-dan, and Chai-hu-Shu-gan-San are often used to treat the disease in clinic. Atthe same time, acupuncture can be combined, however, Xiran Su[14] selected acupuncture points such as Dan Shu, Yang lingquan, and Taichong in clinical studies and applied electroacupuncture, which make Qi and blood in the meridians smooth toimprove symptoms with significant efficacy.3.2 Western medicine treatmentWhen patients experience stomach discomfort and regurgitant acid after surgery, proton pump inhibitors are used toinhibit the secretion of gastric acid and relieve the symptoms of stomach pain and regurgitant acid. Jiali Wei [15] when thepatient developed functional dyspepsia postoperatively, deanxit combined with Mosapride was given, compared with theeffect of Mosapride alone was prominent. Since more than half of patients with bile duct stones develop PCS postoperatively,Volume 12 | Issue 2 -117-Because many symptoms occur after cholecystectomy, the etiology can be found in most cases by the ERCP technique, andthe technique has many advantages such as safety, little patient suffering, and few complications, ERCP treatment should beconsidered the first choice for PCS patients with indications for endoscopic treatment. [16]In patients with PCS sphincter ofOddi dysfunction was observed in some patients, and after LC operation, bile normally secreted by the liver loses the spacefor concentration and storage, bile drained into the bile duct thereby causing the intra biliary pressure to rise, and irregularlydrained into the duodenum through sphincter of Oddi, affecting its normal physiological function. [17-19] However,conservative treatment is still the generally recommended treatment with symptomatic supportive treatment, such as acidsuppression and promotion of gastrointestinal motility, maintenance of water electrolyte balance, administration of vitaminsand hepatoprotective treatment, and administration of antiviral and antispasmodic and sedative treatment if necessary. [20]4. SummaryWhen a cholecystectomy is performed, it is an invasive procedure that is traumatic, and more or less has an impact onthe autonomic function of the patient, with a range of postoperative symptoms occurring. [21] In Traditional ChineseMedicine treatment, it is important to emphasize that treatment based on syndrome differentiation and postoperative peace ofmind and a light diet are effective means, establishment of a standardized TCM treatment regimen for PCS [22] In thetreatment of Western medicine, PCS revisited prevention,a clear preoperative diagnosis, intraoperative attention to protectthe surrounding normal anatomical structures, avoid accidental damage are effective steps in the prevention of PCS.References[1] Rasić S, Kulenović I, Haracić A, Catović A. Left ventricular hypertrophy and risk factors for its development inuraemic patients. Bosn J Basic Med Sci 2004; 4: 34-40.[2] Yin HH. Basic theory of traditional Chinese medicine [M]. Shanghai: Shanghai Science and Technology Press,1983:52.[3] Li RR, Ma Q, Ma QQ, et al. professor Xue Zheng Pei for post cholecystectomy syndrome [J]. Asia Pacifictraditional medicine, 2018, 14 (7): 131-132.[4] Du YW, Gu Q, Hong Shan Dai [PubMed: 201709] and Shaoyang recipe for the treatment of postoperativeGallbladder Syndrome [J]. Global traditional Chinese medicine, 2017, 10 (1): 39-41.[5] Hong L, Xiang HP. A comparison of two different surgical modalities for the treatment of chronic lithiasischolecystitis presenting post cholecystectomy syndrome [J]. Hepatobiliary Surg 2016, 24 (3): 206-208.[6] Huang JP. Current treatment of gallbladder postoperative syndrome [J]. Modern remote education in Chinesetraditional medicine, 2017, 15 (2): 151-152.[7] Lan JL, Dong XY, Chang WL, et al.diagnosis and treatment of bile duct injury during laparoscopic cholecystectomy[J]. Chinese Journal of general surgery, 2017, 26 (8): 1076-1080.[8] Wu SD, Tian Y, Su Y, et al.study of the relationship between biliary disease and duodenal peripapillarydiverticulum [J]. Surgical theory and practice, 2007, 12 (4): 342-344.[9] Wu JQ. Current status of syndrome after cholecystectomy and clinical study of syndrome differentiation anddifferentiation [D]. Nanjing: Nanjing University of traditional Chinese medicine, 2018.[10] Yu DG, Zhao LJ, Cai ZF, et al Integrated traditional Chinese and Western medicine in the treatment of postcholecystectomy syndrome in 56 patients [J]. Modern Journal of integrated traditional Chinese and Western medicine, 2006,25 (1): 61-62.[11] Karakan T, Cindoruk M, Alagozlu H, et al. EUS versus endoscopic retrograde cholangiography for patients withintermediate probability of bile duct stones: a prospective randomized trial[J].Gastrointest Endosc,2009,69(2): 244-252.-118- Advanced Emergency Medicine[12] Wu YY. Example case report of a postoperative syndrome treated with Chaihu Shugan Lidan Decoction [J].Journal of practical Gynecological Endocrinology (ePub), 2016, 3 (10): 57-59.[13] Li RR, Ma Q, Bao QQ, et al. Professor Pei Zheng subtyping for post cholecystectomy syndrome [J]. Asia Pacifictraditional medicine, 2018, 14 (7): 131-132.[14] Su XR. Traditional Chinese and Western medicine in the treatment of post cholecystectomy syndrome in 52patients [J]. Practical integration of traditional Chinese and Western medicine clinical, 2008, 8 (4): 28-29.[15] Wei JL. Clinical analysis of a functional dyspepsia selected mosapride combined with delixin treatment [J]. EPub2018, 5 (97): 175-176.[16] Bi YL, Zhu T, Pan XF, et al. ERCP in the etiologic diagnosis and treatment of post cholecystectomy syndrome. [J].Chinese Journal of general surgery, 2008, 17 (2): 120-123.[17] Hu YT, Xu YF, Zhao N, et al. Study of post cholecystectomy syndrome [J], 2021, 33(2):144-147.[18] Schofer JM. Biliary causes of postcholecystectomy syndrome[J]. J Emerg Med, 2010, 39(4): 406-410.[19] Madacsy L, Fejes R, Kurucsai G, et al. Characterization of functional biliary pain and dyspeptic symptoms inpatients with sphinc- ter of Oddi dysfunction: Effect of papillotomy[J].World J Gastroen- terol,2006,12(42) : 6850-6856.[20] Liu HH, Tian Y, Peng Y, et al Diagnosis and prevention of post cholecystectomy syndrome [J]. Journal of clinicalhepatobiliary disease, 2018, 34 (11): 2464-2468.[21] Huang GR, Guo SZ, Sun W. Effecet of laparoscopic surgery on stress and immune function in patients withcholecystolithiasis com- plicated with acute cholecystitis[J]. Clin J Med Offic, 2018,46 ( 3) : 354-355.[22] Yuan XQ, Lei PJ. Progress in the treatment of postcholecystectomy syndrome with traditional Chinese medicine[J]. Clinical Research of Traditional Chinese Medicine, 2015,7(7):142-144.

Research Progress on Integrated Traditional Chinese and Western Medicine in the Treatment of Post-Cholecystectomy Syndrome

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Research Progress on Integrated Traditional Chinese and Western Medicine in the Treatment of Post-Cholecystectomy Syndrome

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