Burdiles P, Csendes A, Diaz J C, Maluenda F, Avila S, Jorquera P, Aldunate M
Department of Surgery, Clinical Hospital Jose Joaquin Aguirre, University of Chile.
Hepatogastroenterology. 1989 Jun;36(3):136-9.
Chile is the country with the highest incidence of gallstone disease in the world. Nearly 44% of the women and 25% of the men over 20 years of age have gallstones. Biliary tract surgery accounts for about 35% of all the operations performed in Chilean general hospitals. The present paper aims at assessing the risk factors associated with a higher mortality in patients over 70 years of age subjected to elective or emergency surgery for gallstones or common bile duct stones. No specific factors of mortality were found in the group of elderly patients subjected to elective cholecystectomy. There was also no correlation between types of cholecystitis and postoperative mortality. However, acute suppurative cholangitis made the postoperative mortality rate increase almost 20-fold in patients with common bile duct stones. The mortality also shows a steep increase (up to 12%) if cholecystectomy is performed in acute cholecystitis. Cholecystostomy seems to be associated with a low mortality risk and hence should be appropriate in exceptionally high-risk patients, but is not considered useful by the authors in necrotic or gangrenous cholecystitis, or in cases with common bile duct stones and cholangitis. Postoperative mortality in patients submitted to cholecystectomy alone seems to depend exclusively on the concomitant presence of medical complications, mainly of a respiratory and cardiovascular nature. Septic complications are important causes of postoperative mortality in emergency cholecystectomy. Patients at high surgical risk are those suspected of cholangitis, those over 80 years of age, and those suffering from Charcot's triad, anemia, uremia, leukocytosis, hyperbilirubinemia or hypoprothrombinemia; in these, an endoscopic procedure could be chosen.
智利是世界上胆结石疾病发病率最高的国家。20岁以上的女性中近44%以及男性中25%患有胆结石。胆道手术约占智利综合医院所有手术的35%。本文旨在评估70岁以上因胆结石或胆总管结石接受择期或急诊手术患者中与较高死亡率相关的危险因素。在接受择期胆囊切除术的老年患者组中未发现特定的死亡因素。胆囊炎类型与术后死亡率之间也没有相关性。然而，急性化脓性胆管炎使胆总管结石患者的术后死亡率增加了近20倍。如果在急性胆囊炎时进行胆囊切除术，死亡率也会急剧上升（高达12%）。胆囊造口术似乎与低死亡风险相关，因此对于极高风险患者应该是合适的，但作者认为在坏死性或坏疽性胆囊炎、或伴有胆总管结石和胆管炎的病例中无用。仅接受胆囊切除术患者的术后死亡率似乎完全取决于是否同时存在主要为呼吸和心血管性质的内科并发症。脓毒症并发症是急诊胆囊切除术术后死亡的重要原因。手术高风险患者包括疑似胆管炎患者、80岁以上患者以及患有夏科氏三联征、贫血、尿毒症、白细胞增多、高胆红素血症或低凝血酶原血症的患者；对于这些患者，可以选择内镜手术。
