What happens after cholecystectomy?

Gallbladder is a very important digestive organ and an important part of digestive system. Cholecystectomy will cause heavy harm to human body, causing long-term indigestion, abdominal distension and diarrhea. Many people's bad complexion and poor health after cholecystectomy are caused by long-term indigestion. Harm of cholecystectomy

Recent studies have found that cholecystectomy has at least the following adverse effects on the human body:

1, causing indigestion, abdominal distension and diarrhea.

Hepatocytes secrete about 800~ 1200ml bile every day, of which water accounts for 97%. Bile secreted by hepatocytes enters the gallbladder for storage and concentration: due to the strong selective absorption of water and electrolyte in bile by gallbladder mucosa, 90% of the water in bile can be concentrated and stored in the gallbladder for about 30 times after being absorbed by the gallbladder. After eating, especially in high-fat foods, under the regulation of vagus nerve and cholecystokinin, bile discharged by gallbladder contraction enters the duodenum to participate in digestion. If the gallbladder is removed, there is no place for the liver to discharge liver bile at this time, so whether the human body needs it or not, liver bile must be continuously discharged into the intestine. When eating delicious home-cooked dishes, a lot of bile is needed to help digestion, but there is no "extra bile" in the body at this time, which affects the digestion and absorption of food, especially fat. Therefore, firstly, it will lead to fatty diarrhea and fat-soluble vitamin deficiency, and secondly, it will lead to indigestion, abdominal distension and diarrhea. This is the reason why most patients will become thin and yellow in the future after cholecystectomy.

2. Causing alkaline reflux gastritis

After normal people eat, gallbladder contraction makes bile concentrate and enter the intestine in large quantities. This process is synchronized with the secretion and peristalsis of gastroduodenal regularly. After cholecystectomy, bile continues to enter the intestine, lacking the neutralization of food and gastric acid. Bile can accumulate in the duodenum and enter the stomach reversely, which increases the PH value in the stomach, makes bacteria multiply, and increases the congestion, edema and brittleness of the gastric mucosa. Gastric gland atrophy and ulcer formation. Some people examined the gastric juice of patients 6 months after cholecystectomy, and found that the bile acid content increased obviously, with a minimum increase of 2 times, a maximum increase of 380 times and an average increase of 24 times. Gastric acid secretion was significantly reduced and gastric parietal cells were damaged. Diffuse inflammatory changes can be seen under gastroscope.

3. The incidence of choledocholithiasis increased after cholecystectomy.

In the process of treating choledocholithiasis, it can be found that the group with more than 50 cases of cholecystectomy is significantly higher than the group without cholecystectomy. Therefore, although choledocholithiasis is removed after cholecystectomy, it is likely to attract choledocholithiasis, because before cholecystectomy, gallbladder has the function of concentrating bile, and concentrated bile has high solubility in cholesterol; However, after cholecystectomy, the bile salt pool was significantly reduced and the bile concentration lost its position. The decrease of bile acid concentration in hepatobiliary duct leads to the decrease of cholesterol dissolving ability. Over time, it is easy to accumulate cholesterol, which is easy to form stones, that is, choledocholithiasis. The treatment of choledocholithiasis is much more difficult than choledocholithiasis.

4. The incidence of colon cancer may increase after cholecystectomy.

In recent years, many scholars have found a phenomenon and doubt that cholecystectomy accounts for a large proportion of colon cancer cases:

1) According to the clinical investigation of European scholars, the risk of colon cancer after cholecystectomy is 45 times higher than that without cholecystectomy.

2) After a retrospective analysis of 7000 cases of colon cancer, it was found that 6000 cases had a history of cholecystectomy, and it was found that the ratio of colorectal cancer to cancer in patients who had undergone cholecystectomy for more than 10 years increased significantly from 2 1.8% to 38.5%. Others have followed up the cases of cholecystectomy for more than 65,438+00 years and found that the incidence of colon cancer in women is about 70% higher than that in general women.

Why does the incidence of colon cancer increase after cholecystectomy?

This can be explained by the theory of secondary cholic acid. Secondary cholic acid has carcinogenic or synergistic carcinogenic effects: secondary cholic acid can enhance the mitosis of colonic mucosal cells and easily cause colon cancer. Because the concentration of secondary cholic acid in the proximal colon is high, and the absorption of secondary cholic acid in the right colon is greater than that in the left colon, cancer species in the right colon are more common after cholecystectomy. The main reasons for its pathophysiological changes are:

1) Source of secondary cholic acid: Cholic acid secreted by the hepatobiliary duct is primary cholic acid, which will be converted into secondary cholic acid when it comes into contact with bacteria after entering the intestine.

2) gallbladder function is lost after cholecystectomy, and bile excretion and intestinal residence time cannot be controlled; Therefore, primary cholic acid continuously flows into the intestine for 24 hours and comes into contact with bacteria, producing a large amount of secondary cholic acid, which undoubtedly increases the risk of colon cancer.

In recent years, many European scholars have discovered a phenomenon and doubt that many patients with colon cancer have a history of cholecystectomy. Moehead analyzed 100 patients over 60 who underwent cholecystectomy and 100 patients who did not undergo cholecystectomy, and found that the patients with colon cancer were 12:3, which was very surprising. However, when the gallbladder functions normally, bile is only excreted when eating. On an empty stomach, there is not much bile in the intestine. Obviously, there is little contact between primary cholic acid and bacteria, so the amount of secondary cholic acid is very small. Coupled with the existence of normal gallbladder, there is a lot of Ig in bile, which can protect intestinal mucosa from foreign antigens and secondary cholic acid, which of course reduces the possibility of colon cancer. Therefore, it is very reasonable for doctors who study colon cancer in northern Europe to loudly advise not to remove the gallbladder casually.

5, causing liver damage and colon damage.

At present, it has been proved that lithocholic acid is toxic to hepatocytes. However, after cholecystectomy, the secondary cholic acid increases, and the generated lithocholic acid enters the liver and colon through the enterohepatic circulation, which will cause chronic liver injury and colon injury, and colon injury is likely to be an inducement of colon cancer.

6, lead to bile duct injury

As we all know, during cholecystectomy, due to the importance of Calot angle 3 and the adhesion of local tissues, the complications caused by cholecystectomy are inevitable again, with a certain probability (bile duct injury: 0.18 ~ 2.3%); And there is a certain mortality rate (0. 17%), including bile duct injury, hepatic duct injury, vascular injury, gastrointestinal injury and so on. It is particularly worth emphasizing that most cases of bile duct injury are caused by cholecystectomy. According to Huang's statistics, among 2566 cases of common bile duct injuries, there were 1933 cases caused by cholecystectomy, accounting for 75% of stenosis cases. The complication of bile duct injury is that it is the biggest defect of cholecystectomy. In addition, considering the physiological defects caused by cholecystectomy and its influence on immune function, we should carefully consider the hasty choice of cholecystectomy.

7, leading to "post-cholecystectomy syndrome"

The term "post-cholecystectomy syndrome" is a vague concept; With the development of modern imaging diagnosis technology, the diagnosis of residual stones and bile duct injury after biliary surgery has been ruled out, but only Oddi's sphincter inflammation and dyskinesia after biliary surgery can be called "postoperative syndrome", and the treatment of this syndrome is very difficult in clinic.

Studies have shown that gallbladder plays an important role in the dynamics of biliary system. Gallbladder can hold 30-60cc bile, which can buffer the liquid pressure of biliary tract and maintain the physiological balance of biliary tract pressure. Once the gallbladder is removed, the pressure of biliary system can not be adjusted, which will lead to the dysfunction of Oddi sphincter.

The above-mentioned consequences caused by cholecystectomy are impossible for doctors to explain in detail in advance, and they are only expressed as "possible complications" in the consent form of operation. When serious complications such as biliary tract injury occur, doctors often explain them in complex and irresistible situations, so it is difficult to judge them as medical accidents.

When you consult some doctors, they all say that cholecystectomy has no effect on people. It's not his turn yet. When asked if they could keep the gallbladder, they all said that it would recur after keeping the gallbladder. In fact, they are talking about the old gallbladder-preserving surgery, and the new gallbladder-preserving surgery is no longer the old method of "eating once" and passively waiting for recurrence. Due to many measures to prevent recurrence, the recurrence rate decreased from 30%-40% to 2%-4% or lower in 5- 10 years after operation, and the terrible consequences of cholecystectomy, such as low immune function and increased incidence of colorectal cancer and common bile duct stones after cholecystectomy, were far from happening.