Sahlgrenska Academy, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Sahlgrenska Academy, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
HPB (Oxford). 2020 Jan;22(1):34-40. doi: 10.1016/j.hpb.2019.06.018. Epub 2019 Jul 18.
The aim was to analyse the risk for myocardial infarction (MI) after cholecystectomy.
The study is based on data from the Swedish Register for Gallstone Surgery (GallRiks) 2006-2014. The cohort was cross-linked with the Swedish Patient Register. Standardised incidence ratio (SIR) was calculated by dividing the observed incidence of MI within 30 days after surgery with the expected incidence of the background population.
Altogether 94,577 procedures were included. MI within 30 days postoperatively (30d-po) were registered in 87 cases (0.09%, SIR for MI 3.03; 95% CI 2.43-3.74). MI occurred more often in men (0.15% vs 0.06%), after open surgery (0.34% vs 0.04%), was age related (age >50 years OR 4.05 > 75 years OR 15.70) and occurred more frequently amongst those with gallstone complications and high ASA score (ASA 1; 0.02%, 2; 0.08%, ≥3; 0,64%). The risk for MI within 30d-po was 52.8% if the patient had suffered an infarct within 8 weeks preoperatively. Laparoscopy converted to open and primarily open surgery were independent risk factors (OR 3.05 vs 2.19). The mortality in the group with 30d-po MI was 11.5% vs 0.02%.
Delaying elective cholecystectomy for at least 8 weeks after a recent MI reduces the risk for postoperative MI.
目的是分析胆囊切除术后心肌梗死（MI）的风险。
该研究基于 2006 年至 2014 年瑞典胆囊结石手术登记（GallRiks）的数据。该队列与瑞典患者登记处进行了交叉链接。通过将术后 30 天内 MI 的观察发生率除以背景人群的预期发生率来计算标准化发病率比（SIR）。
共纳入 94577 例手术。术后 30 天内（30d-po）记录到 87 例 MI（0.09%，MI 的 SIR 为 3.03；95%CI 2.43-3.74）。MI 更常见于男性（0.15%比 0.06%），开腹手术（0.34%比 0.04%），与年龄相关（年龄>50 岁 OR 4.05>75 岁 OR 15.70），并且在伴有胆石并发症和高 ASA 评分的患者中更常见（ASA 1；0.02%，2；0.08%，≥3；0.64%）。如果患者在术前 8 周内发生过梗死，那么 30d-po 内发生 MI 的风险为 52.8%。腹腔镜转为开腹和单纯开腹手术是独立的危险因素（OR 3.05 比 2.19）。在 30d-po MI 组中，死亡率为 11.5%比 0.02%。
在近期心肌梗死后至少 8 周延迟择期胆囊切除术可降低术后 MI 的风险。
