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接受胆囊切除术的胆结石疾病患者的结局分析:一项基于人群的队列研究。

Outcome Analysis of Patients with Gallstone Disease Receiving Cholecystectomy: A Population-Based Cohort Study.

作者信息

Kiu Kee-Thai, Chen Hsiao-Lan, Huang Ming-Te, Sung Chih-Wei, Liaw Yung-Po, Chang Chun-Chao, Wang Yuan-Hung, Chen Hsin-An

机构信息

Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

出版信息

Digestion. 2017;95(2):132-139. doi: 10.1159/000455072. Epub 2017 Feb 7.

Abstract

BACKGROUND/AIMS: Cholecystectomy is generally performed to treat patients with gallstone disease (GSD) in clinical practice. The present study aimed to investigate whether type 2 diabetes mellitus (T2DM) may influence the overall survival of GSD patients.

METHODS

The National Health Insurance Research Database, a population-based registry data in Taiwan, was used to identify GSD patients from 2001 to 2008. The risk of cancers and effects of T2DM on the overall survival of GSD patients receiving cholecystectomy were estimated by hazards ratios (HRs) and 95% CIs using the Cox proportional hazard model.

RESULTS

Among 392,028 eligible GSD patients, 81,971 underwent cholecystectomy, whereas 310,057 did not. After cholecystectomy, the HR for developing cancer was 1.14. The HR for the overall survival was 0.74-fold lower for patients who underwent cholecystectomy than that for patients who did not. GSD patients without T2DM who underwent cholecystectomy (0.78-fold lower risk) had a longer survival, whereas those with T2DM had shorter survival (1.64-fold higher risk without cholecystectomy and 1.13-fold higher risk with cholecystectomy) compared with those without T2DM who did not undergo cholecystectomy.

CONCLUSIONS

Our major findings suggest that T2DM may worsen the prognosis of GSD patients after cholecystectomy, which provides useful insight into the treatment of T2DM among GSD patients in clinical settings.

摘要

背景/目的:在临床实践中,胆囊切除术通常用于治疗胆结石疾病(GSD)患者。本研究旨在调查2型糖尿病(T2DM)是否会影响GSD患者的总生存期。

方法

使用台湾基于人群的登记数据库——国民健康保险研究数据库,来识别2001年至2008年期间的GSD患者。采用Cox比例风险模型,通过风险比(HRs)和95%置信区间(CIs)估计接受胆囊切除术的GSD患者患癌风险以及T2DM对其总生存期的影响。

结果

在392,028例符合条件的GSD患者中,81,971例行胆囊切除术,310,057例未行该手术。胆囊切除术后,患癌的HR为1.14。接受胆囊切除术患者的总生存期HR比未接受手术的患者低0.74倍。与未行胆囊切除术的非T2DM的GSD患者相比,行胆囊切除术的非T2DM患者生存期更长(风险低0.78倍),而T2DM患者生存期较短(未行胆囊切除术风险高1.64倍,行胆囊切除术风险高1.13倍)。

结论

我们的主要研究结果表明,T2DM可能会使胆囊切除术后GSD患者的预后恶化,这为临床环境中GSD患者的T2DM治疗提供了有用的见解。

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