Department of Surgery, Ninewells Hospital and Medical School, Dundee D1 9SY, UK.
World J Surg. 2011 Mar;35(3):643-7. doi: 10.1007/s00268-010-0908-3.
Gallstones remain a common clinical problem requiring skilled operative and nonoperative management. The aim of the present population-based study was to investigate causes of gallstone-related mortality in Scotland.
Surgical deaths were peer reviewed between 1997 and 2006 through the Scottish Audit of Surgical Mortality (SASM); data were analyzed for patients in whom the principal diagnosis on admission was gallstone disease.
Gallstone disease was responsible for 790/43,271 (1.83%) of the surgical deaths recorded, with an overall mortality for cholecystectomy of 0.307% (176/57,352), endoscopic retrograde cholangiopancreatography (ERCP) of 0.313% (117/37,345), and cholecystostomy of 2.1% (12/578) across the decade. However, the majority of patients who died were elderly (47.6% ≥ 80 years or older) and were managed conservatively. Deaths following cholecystectomy usually followed emergency admission (76%) and were more likely to have been associated with postoperative medical complications (n = 189) than surgical complications (n = 36).
Although cholecystectomy is a relatively safe procedure, patients who die as a result of gallstone disease tend to be elderly, to have been admitted as emergency cases, and to have had co-morbidities. Future combined medical and surgical perioperative management may reduce the mortality rate associated with gallstones.
胆石症仍然是一个常见的临床问题，需要熟练的手术和非手术治疗。本基于人群的研究旨在探讨苏格兰胆石相关死亡率的原因。
1997 年至 2006 年期间，通过苏格兰手术死亡率审核（SASM）对手术死亡进行同行评审；对入院时主要诊断为胆石病的患者进行数据分析。
胆石病导致 790/43271（1.83%）例手术死亡，胆囊切除术的总体死亡率为 0.307%（176/57352），内镜逆行胰胆管造影术（ERCP）为 0.313%（117/37345），胆囊造口术为 2.1%（12/578），在这十年中。然而，大多数死亡患者年龄较大（47.6%≥80 岁或以上）且接受保守治疗。胆囊切除术后死亡通常发生在急诊入院后（76%），并且更可能与术后医疗并发症（n=189）而不是手术并发症（n=36）相关。
尽管胆囊切除术是一种相对安全的手术，但死于胆石症的患者往往年龄较大，作为急诊入院，并且合并症较多。未来的医疗和手术围手术期联合管理可能会降低与胆石相关的死亡率。
