McSherry C K
Department of Surgery, Beth Israel Medical Center, New York, New York 10003.
Am J Surg. 1989 Sep;158(3):174-8. doi: 10.1016/0002-9610(89)90246-8.
There were 14,232 patients operated on for non-malignant biliary tract disease at a single medical center from 1932 through 1984. During this period, there were 237 postoperative deaths. Of the total number of patients, 10,749 underwent cholecystectomy with 60 postoperative deaths. Cholecystostomy was performed in 599 patients with 60 deaths. Cholecystectomy or cholecystostomy in conjunction with common duct exploration was performed in 2,226 patients with 89 deaths. Choledochotomy alone as a secondary procedure to search for stones was performed in 374 patients with 21 deaths. Procedures for strictures and miscellaneous conditions were performed in 284 patients with 21 deaths. Cholecystectomy for chronic cholecystitis was performed in 8,910 patients with 38 deaths. The data from the last 6 years of this study disclosed 30 postoperative deaths; only one of these patients might have been a candidate for lithotripsy or bile acid dissolution therapy. Nonsurgical alternative therapies for gallstone disease are unlikely to decrease the mortality from calculous biliary tract disease. Furthermore, stone recurrence will continue to be the major limiting factor for those techniques that fail to remove the gallbladder.
1932年至1984年期间，在一家医疗中心有14232例患者接受了非恶性胆道疾病手术。在此期间，有237例术后死亡病例。在所有患者中，10749例行胆囊切除术，术后死亡60例。599例行胆囊造瘘术，死亡60例。2226例行胆囊切除术或胆囊造瘘术并胆总管探查术，死亡89例。374例单独行胆总管切开术作为寻找结石的二次手术，死亡21例。284例因狭窄和其他情况行手术，死亡21例。8910例行慢性胆囊炎胆囊切除术，死亡38例。该研究最后6年的数据显示有30例术后死亡；这些患者中只有1例可能是碎石术或胆汁酸溶解疗法的候选者。胆结石疾病的非手术替代疗法不太可能降低结石性胆道疾病的死亡率。此外，结石复发仍将是那些未能切除胆囊的技术的主要限制因素。
