Rudolph R, Williams J S
Department of Surgery, Memorial Medical Center Inc, Savannah, Georgia 31403-3089.
J Natl Med Assoc. 1992 Aug;84(8):692-6.
The treatment of patients with sickle cell disease and cholelithiasis is controversial. This retrospective study assesses the outcome of preoperative transfusion and timely cholecystectomy in symptomatic sickle cell disease patients. Fourteen patients who had undergone cholecystectomy were determined to have sickle cell disease. The patients' mean age was 17.9 years. Eleven patients were female. Thirteen patients had complained of abdominal pain. Ultrasound confirmed the diagnosis of cholelithiasis in 12 of 13 patients tested. Hemoglobin before treatment averaged 7.7 g/dL. Transfusion or exchange transfusion was given to 12 patients, raising the average hemoglobin to 10.3 g/dL. Postoperative morbidity was 14%: one patient had a urinary tract infection and another a left-lower-lobe pneumonia. No sickle cell crises or deaths occurred. Postoperative hospital stay averaged 4.4 days. With judicious use of preoperative transfusion, early cholecystectomy for symptomatic gallstones was well tolerated by sickle cell disease patients and is advisable to avoid the morbid sequelae of acute cholecystitis and peroperative sickle cell crisis.
镰状细胞病合并胆石症患者的治疗存在争议。这项回顾性研究评估了有症状的镰状细胞病患者术前输血及及时行胆囊切除术的结果。14例行胆囊切除术的患者被确诊患有镰状细胞病。患者的平均年龄为17.9岁。11例为女性。13例患者主诉腹痛。13例接受检查的患者中，12例经超声确诊为胆石症。治疗前血红蛋白平均为7.7 g/dL。12例患者接受了输血或换血输血，使平均血红蛋白升至10.3 g/dL。术后发病率为14%：1例患者发生尿路感染，另1例发生左下叶肺炎。未发生镰状细胞危象或死亡。术后平均住院时间为4.4天。通过合理使用术前输血，镰状细胞病患者对有症状胆结石行早期胆囊切除术耐受性良好，为避免急性胆囊炎和术中镰状细胞危象的不良后遗症，建议行早期胆囊切除术。
