Bragg L E, Thompson J S
Surgical Service, Omaha Veterans Administration Medical Center, NE.
Arch Surg. 1989 Apr;124(4):460-2. doi: 10.1001/archsurg.1989.01410040070016.
The outcome of 68 patients with asymptomatic cholelithiasis undergoing laparotomy for other conditions was reviewed to determine those most likely to become symptomatic postoperatively. Thirty-seven patients (54%) became symptomatic postoperatively. Eight patients (22%) required cholecystectomy within 30 days of operation or within the same hospitalization. These patients fasted for a longer period of time postoperatively (15 +/- 21 vs 4 +/- 3 days) than those undergoing later cholecystectomy. Significantly more of these patients required transfusion (38% vs 7%), mechanical ventilation (50% vs 11%), and total parenteral nutrition (50% vs 18%). Cholelithiasis frequently becomes symptomatic after laparotomy for other intra-abdominal conditions. Patients who require mechanical ventilation, transfusions, and parenteral nutrition and who are slow to resume enteral nutrition are more likely to require early cholecystectomy. Concomitant cholecystectomy adds minimal morbidity to other procedures and should be undertaken unless specific contraindications exist, particularly in this high-risk group.
回顾了68例因其他疾病接受剖腹手术的无症状胆结石患者的预后情况，以确定哪些患者术后最有可能出现症状。37例患者（54%）术后出现症状。8例患者（22%）在术后30天内或同一住院期间需要行胆囊切除术。这些患者术后禁食时间比后期行胆囊切除术的患者更长（15±21天对4±3天）。这些患者中需要输血的比例（38%对7%）、机械通气的比例（50%对11%）以及全胃肠外营养的比例（50%对18%）明显更高。对于其他腹腔内疾病行剖腹手术后，胆结石常出现症状。需要机械通气、输血和胃肠外营养且肠内营养恢复缓慢的患者更有可能需要早期行胆囊切除术。同期行胆囊切除术给其他手术增加的并发症极少，除非存在特定禁忌证，否则应进行，尤其是在这个高危人群中。
