胆囊切除术(包括开腹胆囊切除术和腹腔镜胆囊切除术)是外科治疗胆囊良性疾病的标准术式，但是大约10%～30%的胆囊切除术患者会出现上腹或右上腹痛、餐后腹胀、消化不良、胆道感染或梗阻等临床症候群，发病时间从术后数周到数年，Pribram于1950年将上述症候群称为胆囊切除术后综合征(postcholecystectomy syndrome，PCS)，但何种原因导致上述症候群的出现未能明确［1］。随着影像学、内镜技术的发展，以及临床诊断技术的进步，特别是CT、MRI及磁共振胰胆管造影术(magnetic resonance cholangiopancreatography，MRCP)、内镜技术包括内镜超声(endoscopic ultrasound，EUS)和经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography，ERCP)的发展，绝大多数PCS患者能够明确病因并得到有效治疗。
目的探讨经内镜逆行胰胆管造影（ERCP）治疗胆囊切除术后腹痛的治疗效果。 方法对2007年6月至2013年6月期间笔者所在医院收治的43例胆囊切除术后腹痛患者的临床资料行回顾性分析。 结果43例胆囊切除术后腹痛患者均行ERCP诊治，其中胆总管下端狭窄14例，胆总管下端结石19例，胆总管下端狭窄合并结石10例。分别行Oddi括约肌切开术（EST）12例，单纯气囊扩张治疗2例，气囊扩张取石19例，EST+气囊扩张取石10例；其中1例因狭窄段超过2 cm而行气囊扩张+塑料内支架置入治疗。症状完全缓解37例，部分缓解4例，2例无效（单纯气囊扩张者）。43例均获随访，随访时间（30.7±10.4）个月（11～72个月）；有3例EST术后因瘢痕形成再狭窄而再次行EST术，症状缓解。 结论ERCP治疗胆囊切除术后胆管下端狭窄或结石引起的腹痛是一种安全、微创和疗效确切的方法。
ObjectiveTo summarize the changes of gut microbiota after cholecystectomy, the mechanisms of changes, and the relation with colorectal cancer, nonalcoholic fatty liver disease and post-cholecystectomy syndrome after cholecystectomy, in order to provide new ideas for the perioperative management of patients undergoing cholecystectomy. MethodThe studies related to gut microbiota after cholecystectomy at home and abroad were searched and analyzed for review. ResultsThe cholecystectomy disrupted the liver–bile acid–gut flora axis of the patients, and the composition and diversity of the gut microbiota of the patients were altered, and the alteration might lead to the occurrence of colorectal cancer, nonalcoholic fatty liver disease, and post-cholecystectomy syndrome, but the exact mechanism remained unclear. ConclusionsThe balance of intestinal microecology is disrupted after cholecystectomy, and the relation between cholecystectomy and gut microbiota may provide new ideas for the perioperative management of cholecystectomy patients and the prevention and treatment of diseases or symptoms after cholecystectomy, but the effect of cholecystectomy on gut microbiota and the relation with diseases or symptoms still need to be further studied.