Pain attacks in non-complicated and complicated gallstone disease have a characteristic pattern and are accompanied by dyspepsia in most patients: The results of a prospective study
Pain attacks in non-complicated and complicated gallstone disease have a characteristic pattern and are accompanied by dyspepsia in most patients: The results of a prospective study
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DOI：
10.1080/00365520510023990
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发表时间：
2006-01-01
影响因子：
1.9
通讯作者：
Sondenaa, K
中科院分区：
文献类型：
--
作者：
Berhane, T;Vetrhus, M;Sondenaa, K
目标。胆结石手术治疗的主要指征是疼痛发作。然而，胆囊切除术后，20%的患者仍有症状。目前尚不清楚胆囊切除术后的症状在多大程度上可归因于术前症状的持续或新的病理。胆结石患者的疼痛和消化模式在最近的超声检查诊断中尚未明确。本研究的目的是描述胆结石疾病的典型疼痛模式，并描述相关消化不良的程度。材料和方法。采用详细的调查问卷对220例伴有并发症（急性胆囊炎和胆总管结石）的症状性胆结石患者进行访谈，了解患者的疼痛模式和消化不良症状。结果。所有患者均有右上腹（RUQ）疼痛，包括上腹部中线。疼痛集中在右侧肋下区（20%）和上腹部（14%），其余（66%）分布较均匀。最大疼痛区域的界定率为90%。51%的患者在肋弓下，41%的患者在上腹部，3%的患者在胸骨后，5%的患者在背部。63%的患者背痛。平均视觉模拟评分（VAS）评分非常高：0-100分为90毫米。90%的患者出现早期或低度警告性疼痛，随后出现相对稳定的状态，直到以同样的方式消退。71%的人有过四处走走的冲动。疼痛发作通常发生在深夜或夜间（77%），85%的发作持续时间超过一小时，几乎从不少于半小时。66%的患者至少对一种食物不耐受，但只有48%的患者对高脂肪食物不耐受。功能性消化不良的症状（胃食管反流、消化不良或肠易激症状）在绝大多数与发作相关。结论。在大多数患者中，胆结石相关的疼痛遵循一定的模式。疼痛位于特定区域，有一个最大强度点，通常是指痛，主要发生在夜间，持续时间超过一小时。大多数患者出现功能性消化不良，主要为反流型或消化不良。
Objective. The cardinal indication for surgical treatment of gallstones is pain attacks. However, following cholecystectomy, 20% of patients remain symptomatic. It is unclear to what extent post-cholecystectomy symptoms can be ascribed to persistence of preoperative symptoms or to new pathology. The pain and digestive pattern in gallstone patients has not been defined in a recent setting with ultrasonography as the diagnostic method. The aim of this study was to characterize a pain pattern that is typical for gallstone disease and to describe the extent of associated dyspepsia. Material and methods. A total of 220 patients with symptomatic gallstone disease including complicated disease (acute cholecystitis and common bile duct stones) were interviewed using detailed questionnaires to disclose pain patterns and symptoms of indigestion. Results. All patients had pain in the right upper quadrant (RUQ) including the upper midline epigastrium. The pain was localized to the right subcostal area in 20% and to the upper epigastrium in 14%, and in the rest (66%) it was more evenly distributed. An area of maximal pain could be defined in 90%. Maximal pain was located under the costal arch in 51% of patients and in the epigastrium in 41%, but in 3% behind the sternum and in 5% in the back. The pain was referred to the back in 63% of the patients. The mean visual analogue scale (VAS) score was very high: 90 mm on a 0-100 scale. A pattern of incipient or low-grade warning pain with a subsequent relatively steady state until subsiding in the same fashion was present in 90% of the patients. An urge to walk around was experienced by 71%. Pain attacks usually occurred in the late evening or at night (77%), with 85% of the attacks lasting for more than one hour and almost never less than half an hour. Sixty-six percent of the patients were intolerant to at least one kind of food, but only 48% to fatty foods. Symptoms of functional indigestion (gastroesophageal reflux, dyspepsia or irritable bowel symptoms) were seen in the vast majority in association with attacks. Conclusions. Gallstone-associated pain follows a certain pattern in the majority of patients. The pain is located in a defined area with a point of maximum intensity, is usually referred, and occurs mainly at night with duration of more than one hour. The majority of patients experience functional indigestion, mainly of the reflux type or dyspepsia.