Schmidt J H, Hocking M P, Rout W R, Woodward E R
Department of Surgery, University of Florida, College of Medicine, Gainesville 32610.
Am Surg. 1988 May;54(5):269-72.
The pre and postoperative incidence of cholelithiasis were investigated in patients undergoing bariatric surgery at the University of Florida. The first part of the study was retrospective and revealed a pre and 24-month postoperative incidence of cholelithiasis of 30 and 40 percent respectively. Age and postoperative interval were not predictive of cholelithiasis. Patients with cholelithiasis had a significantly greater weight loss (130 +/- 61.0 lbs) than those without stones (109 +/- 59.9 lbs) P = 0.04. Men had a significantly greater weight loss than women (160 +/- 15 lbs SEM versus 99 +/- 7 lbs SEM) as well as a higher incidence of cholelithiasis (53 and 24%, respectively). In the second, prospective part of the study, cholecystectomy was performed in 73 consecutive patients concomitant with their bariatric procedure. Ninety six per cent of removed gallbladders had gross or histologic abnormalities including cholelithiasis in 27 per cent and cholesterolosis/cholecystitis in 69 per cent. The incidence of cholelithiasis was higher than that found in the retrospective series by preoperative ultrasound. The bariatric surgical patient is clearly at risk for the development of postoperative cholelithiasis and cholecystitis. The risk appears to be related to the amount of weight loss. In addition, some gallstones may remain undetected at the time of surgery. We therefore recommend prophylactic cholecystectomy at the time of bariatric surgery.
对在佛罗里达大学接受减肥手术的患者，研究了胆石症的术前和术后发病率。研究的第一部分为回顾性研究，结果显示胆石症术前发病率为30%，术后24个月发病率为40%。年龄和术后时间间隔不能预测胆石症的发生。有胆石症的患者体重减轻幅度（130±61.0磅）显著大于无胆石症的患者（109±59.9磅），P = 0.04。男性体重减轻幅度显著大于女性（平均标准误分别为160±15磅和99±7磅），胆石症发病率也更高（分别为53%和24%）。在研究的第二部分前瞻性研究中，73例连续患者在进行减肥手术的同时接受了胆囊切除术。切除的胆囊中有96%存在肉眼或组织学异常，其中27%有胆石症，69%有胆固醇沉着症/胆囊炎。术前超声检查显示胆石症发病率高于回顾性研究系列中的发病率。减肥手术患者显然有术后发生胆石症和胆囊炎的风险。这种风险似乎与体重减轻量有关。此外，一些胆结石在手术时可能未被发现。因此，我们建议在减肥手术时进行预防性胆囊切除术。
