Department of General and Digestive Surgery, Hospital Universitario de la Princesa, Madrid, Spain.
Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Scand J Surg. 2020 Sep;109(3):205-210. doi: 10.1177/1457496919832147. Epub 2019 Feb 21.
BACKGROUND & AIMS: The prevalence of gallstone disease increases with age, being early cholecystectomy the most accepted treatment in the vast majority of patients in order to prevent complications and recurrence. The aim of this study is to determine the recurrence rate and its possible predictors after initial non-operative management.
We reviewed a consecutive series of patients, older than 65 years, admitted for a gallstone-related disease and treated with a non-operative management between January 2010 and December 2013. We analyzed comorbidities, clinical data, diagnosis, management, recurrence, and its treatment. Median follow-up after the discharge was 2 years. Recurrence was analyzed by a Kaplan-Meier survival curve. Possible recurrence's predictors were analyzed.
The study included 226 patients. Mean age was 80.4 ± 7.2 years, 127 (56%) were female. The main causes of index hospitalization were acute cholecystitis (58%) and biliary pancreatitis (18.1%). After 2 years of follow-up, the recurrence rate was 39.8%; mean time to recurrence was 255.2 ± 42.1 days, 81% of patients recurred within 1 year. Bile duct disease implied a higher recurrence rate than the gallbladder disease group (52% vs 33%, < 0.001). Subjects with two or more diagnoses during index admission presented higher recurrence rate (32% vs 49%, < 0.001).
More than a third of elderly patients could present a recurrence within 2 years after initial non-operative management. Early cholecystectomy should be considered at index admission in order to prevent recurrence.
胆石病的患病率随着年龄的增长而增加，在绝大多数患者中，早期胆囊切除术是最被接受的治疗方法，以预防并发症和复发。本研究旨在确定初次非手术治疗后复发的发生率及其可能的预测因素。
我们回顾了 2010 年 1 月至 2013 年 12 月期间因胆石症相关疾病入院并接受非手术治疗的年龄大于 65 岁的连续患者系列。我们分析了合并症、临床数据、诊断、治疗、复发及其治疗。出院后中位随访时间为 2 年。采用 Kaplan-Meier 生存曲线分析复发情况。分析了可能复发的预测因素。
该研究纳入了 226 例患者。平均年龄为 80.4 ± 7.2 岁，127 例（56%）为女性。指数住院的主要原因是急性胆囊炎（58%）和胆源性胰腺炎（18.1%）。2 年后的随访中，复发率为 39.8%；平均复发时间为 255.2 ± 42.1 天，81%的患者在 1 年内复发。胆管疾病的复发率高于胆囊疾病组（52%比 33%，<0.001）。指数入院时存在两种或两种以上诊断的患者复发率更高（32%比 49%，<0.001）。
初次非手术治疗后 2 年内，超过三分之一的老年患者可能会出现复发。在指数入院时应考虑早期胆囊切除术，以预防复发。
