*Department of Surgery, University of California-Irvine School of Medicine; and †Department of Statistics, University of California-Irvine, Irvine, CA.
Ann Surg. 2014 Feb;259(2):329-35. doi: 10.1097/SLA.0b013e31827eefed.
Gallstone ileus is a mechanical bowel obstruction caused by a biliary calculus originating from a bilioenteric fistula. Because of the limited number of reported cases, the optimal surgical method of treatment has been the subject of ongoing debate.
A retrospective review of the Nationwide Inpatient Sample from 2004 to 2009 was performed for gallstone ileus cases treated surgically by enterotomy with stone extraction alone (ES), enterotomy and cholecystectomy with fistula closure (EF), bowel resection alone (BR), and bowel resection with fistula closure (BF). Patient demographics, hospital factors, comorbidities, and postoperative outcomes were reported. Multivariate analysis was performed comparing mortality, morbidity, length of stay, and total cost for the different procedure types.
Of the estimated 3,452,536 cases of mechanical bowel obstruction from 2004 to 2009, 3268 (0.095%) were due to gallstone ileus-an incidence lower than previously reported. The majority of patients were elderly women (>70%). ES was the most commonly performed procedure (62% of patients) followed by EF (19% of cases). In 19%, a bowel resection was required. The most common complication was acute renal failure (30.44% of cases). In-hospital mortality was 6.67%. On multivariate analysis, EF and BR were independently associated with higher mortality than ES [(odds ratio [OR] = 2.86; confidence interval [CI]: 1.16-7.07) and (OR = 2.96; CI: 1.26-6.96) respectively]. BR was also associated with a higher complication rate, OR = 1.98 (CI: 1.13-3.46).
Gallstone ileus is a rare surgical disease affecting mainly the elderly female population. Mortality rates appear to be lower than previously reported in the literature. Enterotomy with stone extraction alone appears to be associated with better outcomes than more invasive techniques.
胆石性肠梗阻是一种机械性肠梗阻，由源自胆肠瘘的胆石引起。由于报道的病例数量有限，因此治疗的最佳手术方法一直是争论的主题。
对 2004 年至 2009 年全国住院患者样本进行回顾性分析，对通过单纯肠切开取石术（ES）、肠切开和胆囊切除术加瘘管闭合术（EF）、单纯肠切除术（BR）和肠切除术加瘘管闭合术（BF）治疗的胆石性肠梗阻病例进行治疗。报告患者人口统计学、医院因素、合并症和术后结果。进行多变量分析，比较不同手术类型的死亡率、发病率、住院时间和总费用。
在 2004 年至 2009 年估计的 3452536 例机械性肠梗阻病例中，有 3268 例（0.095%）是由胆石性肠梗阻引起的-发病率低于先前的报告。大多数患者是老年女性（>70%）。ES 是最常进行的手术（62%的患者），其次是 EF（19%的病例）。19%的患者需要进行肠切除术。最常见的并发症是急性肾功能衰竭（30.44%的病例）。院内死亡率为 6.67%。多变量分析显示，EF 和 BR 与 ES 相比，死亡率更高（比值比[OR] = 2.86；置信区间[CI]：1.16-7.07）和（OR = 2.96；CI：1.26-6.96）。BR 还与更高的并发症发生率相关，OR = 1.98（CI：1.13-3.46）。
胆石性肠梗阻是一种罕见的外科疾病，主要影响老年女性人群。死亡率似乎低于文献中的先前报道。单纯肠切开取石术似乎比更具侵袭性的技术具有更好的结果。
