胆囊切除术后胆道重构：结构、功能与临床 结局研究进展

Advances in Research on Post-Cholecystectomy Biliary Remodeling: Structural, Functional Alterations and Clinical Outcomes

摘要: 腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)已成为治疗胆囊良性疾病的主流方式。随着手术量的持续增加，大量“无胆囊人群”的长期结局逐渐受到关注。切除胆囊并非单纯的器官减法，而是牵动了解剖结构、流体动力学、神经–内分泌调控以及全身代谢的一系列连锁反应。胆囊切除术后，胆道系统由“储存–脉冲式排放”转为更连续的单出口排放模式；胆囊作为“压力缓冲器”与胆汁浓缩、调节器的缺失，可能改变胆道压力动力学、Oddi括约肌–胆道协调、胆汁酸肠肝循环与肠道生态，从而影响临床症状与远期结局，部分患者在适应过程中出现胆囊切除术后综合征、胆总管结石、胆汁酸性腹泻及非酒精性脂肪性肝病等远期问题。本综述围绕“解剖–功能–症状”三条主线展开讨论，总结了胆囊切除术后胆道结构重构与机体代谢改变的相关证据，梳理了其与临床结局之间的关联，同时，我们还讨论了胆囊切除术后胆管结石复发的主要机制。

Abstract: Laparoscopic cholecystectomy (LC) has become the standard treatment for benign gallbladder diseases. With the continuously increasing surgical volume, growing attention has been directed toward the long-term outcomes of the expanding post-cholecystectomy population. Cholecystectomy is not merely “organ subtraction”; rather, it can trigger a cascade of changes involving anatomy, fluid dynamics, neuroendocrine regulation, and systemic metabolism. After gallbladder removal, the biliary system shifts from a “storage-pulsatile discharge” pattern to a more continuous, single-outlet drainage mode. Loss of the gallbladder as a “pressure buffer” and as a concentrator and regulator of bile may alter biliary pressure dynamics, sphincter of Oddi-biliary coordination, enterohepatic circulation of bile acids, and the gut ecosystem, thereby influencing clinical manifestations and long-term outcomes. During this adaptive process, a subset of patients may develop late complications such as post-cholecystectomy syndrome (PCS), recurrent choledocholithiasis (common bile duct stones, CBDS, CBD stones), bile acid diarrhea (BAD), and nonalcoholic fatty liver disease (NAFLD). This review is organized around three interrelated themes—anatomy-function-symptoms—and summarizes current evidence regarding post-cholecystectomy biliary structural remodeling and metabolic alterations, delineates their associations with clinical outcomes, and further discusses the principal mechanisms underlying recurrence of bile duct stones after cholecystectomy.