Cucchiaro G, Rossitch J C, Bowie J, Branum G D, Niotis M T, Watters C R, Meyers W C
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
Dig Dis Sci. 1990 Apr;35(4):417-21. doi: 10.1007/BF01536912.
The clinical profiles of 139 patients with gallstones found coincidentally during ultrasonography were reviewed and the patients followed prospectively for five years. Indications for ultrasonography included follow-up of abdominal malignancy (33%), evaluation of abdominal aortic aneurysm or other arteriosclerotic vascular disease (22%), renal insufficiency (12%), and lower abdominal pain (7%). At the time of gallstone detection, 14 patients (10%) had symptoms attributable to cholelithiasis. Over the next five years, only 15 patients (11%) developed episodes resembling biliary pain. Nine patients underwent cholecystectomy during this period. Three of the cholecystectomies were incidental to other abdominal procedures. Two cholecystectomies were performed as emergencies for gallstone complications with no perioperative mortality. Interestingly, 54 patients (40%) with coincidental gallstones died during the follow-up period. All the deaths were unrelated to gallstones. These data indicate that ultrasonographically detected coincidental gallstones rarely have clinical significance, leading strong support to the expectant management of most patients with purely coincidental gallstones.
回顾了139例在超声检查时偶然发现胆结石患者的临床资料，并对这些患者进行了为期五年的前瞻性随访。超声检查的适应证包括腹部恶性肿瘤的随访（33%）、腹主动脉瘤或其他动脉硬化性血管疾病的评估（22%）、肾功能不全（12%）以及下腹部疼痛（7%）。在发现胆结石时，14例患者（10%）有可归因于胆石症的症状。在接下来的五年中，只有15例患者（11%）出现类似胆绞痛的发作。在此期间，9例患者接受了胆囊切除术。其中3例胆囊切除术是在进行其他腹部手术时顺带进行的。2例胆囊切除术是作为胆结石并发症的急诊手术进行的，围手术期无死亡病例。有趣的是，54例（40%）偶然发现胆结石的患者在随访期间死亡。所有死亡均与胆结石无关。这些数据表明，超声检查偶然发现的胆结石很少具有临床意义，这为大多数单纯偶然发现胆结石患者的期待性处理提供了有力支持。
