Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Surg Res. 2013 Sep;184(1):84-8. doi: 10.1016/j.jss.2013.05.027. Epub 2013 May 31.
Although surgical management remains the mainstay of therapy for gallstone ileus, the optimal approach--enterolithotomy alone or combined with biliary-enteric fistula disruption--is controversial because of the reliance on small single-center series to describe outcomes. Using the American College of Surgeons' National Surgical Quality Improvement Program database, we sought to (1) review the outcomes of patients undergoing surgical management of gallstone ileus and (2) determine if cholecystectomy in addition to enterolithotomy increased morbidity or mortality rate.
We analyzed the demographics, comorbidities, acuity, operative time, postoperative hospitalization length, and 30-d morbidity and mortality rates of 127 patients from 2005 to 2010 who underwent a procedure for the relief of gallstone ileus. We identified a subset of 14 patients who underwent simultaneous cholecystectomy. We compared the "no cholecystectomy" and "cholecystectomy" groups using standard statistical methods.
The overall 30-d postoperative morbidity and mortality rate was 35.4% and 5.5%, respectively. Superficial surgical site infection and urinary tract infection were the most common complications. There was no significant difference in mortality rate between the no cholecystectomy and the cholecystectomy groups (5.3% versus 7.1%, respectively; P = 0.78), but the latter group did experience more minor complications, longer operations, and longer postoperative hospitalization.
Other recent studies on this topic have collected data or reviewed literature across several decades, making this study in particular one of the largest truly modern series. Perhaps reflecting changes in perioperative management, surgical treatment of gallstone ileus is less morbid than previously described, but there is still insufficient evidence to favor concurrent cholecystectomy.
尽管手术治疗仍然是治疗胆石性肠梗阻的主要方法，但由于依赖于小的单一中心系列来描述结果，单独进行取石术或联合胆肠瘘破裂的最佳方法——存在争议。使用美国外科医师学会国家手术质量改进计划数据库，我们旨在：(1) 回顾接受胆石性肠梗阻手术治疗的患者的结果；(2) 确定是否除取石术外行胆囊切除术会增加发病率或死亡率。
我们分析了 2005 年至 2010 年间 127 例接受手术缓解胆石性肠梗阻的患者的人口统计学、合并症、疾病严重程度、手术时间、术后住院时间以及 30 天发病率和死亡率。我们确定了 14 例同时行胆囊切除术的患者亚组。我们使用标准统计方法比较了“无胆囊切除术”和“胆囊切除术”两组。
总的 30 天术后发病率和死亡率分别为 35.4%和 5.5%。浅表手术部位感染和尿路感染是最常见的并发症。无胆囊切除术组和胆囊切除术组的死亡率无显著差异（分别为 5.3%和 7.1%；P = 0.78），但后者组确实经历了更多的轻微并发症、更长的手术时间和更长的术后住院时间。
该主题的其他近期研究在过去几十年中收集了数据或审查了文献，使得这项研究特别是最大的现代系列之一。也许反映了围手术期管理的变化，胆石性肠梗阻的手术治疗比以前描述的更不病态，但仍没有足够的证据支持同时行胆囊切除术。
