Doko Marko, Zovak Mario, Kopljar Mario, Glavan Elizabet, Ljubicic Neven, Hochstädter Hrvoje
Department of Surgery, Clinical Hospital Sestre Milosrdnice, Vinogradska Cesta 29, 10000 Zagreb, Croatia.
World J Surg. 2003 Apr;27(4):400-4. doi: 10.1007/s00268-002-6569-0.
Gallstone ileus is an uncommon cause of small bowel obstruction, accounting for only 1% to 4% of all intestinal obstructions. In the group of patients over 65 years of age, gallstones cause about 25% of all non-strangulated obstructions of the small bowel. Gallstone ileus is burdened with high mortality rate, ranging from 12% to 18%, and most patients are of advanced age, with many other concomitant diseases that may increase the operative risk. The purpose of this study was to compare the two investigated surgical procedures: treatment of intestinal obstruction alone or combined with urgent cholecystectomy and fistula repair. Analysis of 30 patients undergoing operation for gallstone ileus at the Clinical Hospital "Sestre milosrdnice" between 1985 and 2001 is presented. Patients were treated either for ileus alone (group 1, 11 patients) or as one-stage procedure with urgent fistula closure (group 2, 19 patients). Operating time was significantly longer for the one-stage procedure. Complications occurred in 3 of 11 patients (27.3%) from group 1 and in 11 of 18 patients (61.1%) from group 2 (one tailed, p = 0.043). One patient in group 1 died and two patients in group 2 died. Urgent fistula repair was significantly associated with the occurrence of complications (odds ratio [OR] 12.1, 95% confidence internal [95% CI] 1.2-121.5). Simple enterotomy should be the procedure of choice for patients with gallstone ileus. The one-stage procedure including urgent fistula repair should be reserved only for highly selected patients with absolute indications.
胆石性肠梗阻是小肠梗阻的一种罕见病因，仅占所有肠梗阻病例的1%至4%。在65岁以上的患者群体中，胆结石导致的小肠非绞窄性梗阻约占25%。胆石性肠梗阻的死亡率较高，在12%至18%之间，且大多数患者年龄较大，伴有许多其他可能增加手术风险的合并症。本研究的目的是比较两种研究性手术方法：单纯治疗肠梗阻或联合急诊胆囊切除术及瘘管修复术。本文分析了1985年至2001年间在“Sestre milosrdnice”临床医院接受胆石性肠梗阻手术的30例患者。患者要么仅接受肠梗阻治疗（第1组，11例患者），要么接受急诊瘘管闭合的一期手术（第2组，19例患者）。一期手术的手术时间明显更长。第1组11例患者中有3例（27.3%）发生并发症，第2组18例患者中有11例（61.1%）发生并发症（单尾检验，p = 0.043）。第1组有1例患者死亡，第2组有2例患者死亡。急诊瘘管修复与并发症的发生显著相关（优势比[OR] 12.1，95%置信区间[95% CI] 1.2 - 121.5）。对于胆石性肠梗阻患者，单纯肠切开术应是首选的手术方法。包括急诊瘘管修复的一期手术仅应保留给有绝对指征的高度选择的患者。
