Ransohoff D F, Miller G L, Forsythe S B, Hermann R E
Ann Intern Med. 1987 Jun;106(6):829-32. doi: 10.7326/0003-4819-106-6-829.
Prophylactic cholecystectomy has been recommended in patients who have diabetes and silent gallstones because of the reports of increased mortality resulting from acute cholecystitis in such patients. To assess recent mortality rates, we reviewed the course of acute cholecystitis in patients hospitalized between 1960 and 1981 at one hospital. Death occurred in 3 of 46 patients with diabetes and in 7 of 263 patients without the disease (p = 0.55). The age-adjusted estimate of the relative risk for death was 2.2 (95% confidence interval, 0.5 to 9.4) for diabetic compared with nondiabetic patients. All 3 diabetic patients who died had been diagnosed as having diabetes within 5 years of death, and only one had been taking insulin. Patients who had elevated blood urea nitrogen levels (greater than 20 mg/dL) were found to have an increased mortality rate when compared with patients with normal levels (27% compared with 2%; p less than 0.001). Results were similar for the outcome of serious complications. These results suggest the need for reconsideration of the recommendation for prophylactic cholecystectomy in diabetic patients with silent gallstones.
由于有报道称糖尿病合并无症状胆结石患者因急性胆囊炎导致死亡率增加，因此有人建议对这类患者进行预防性胆囊切除术。为了评估近期的死亡率，我们回顾了1960年至1981年间在一家医院住院的急性胆囊炎患者的病程。46例糖尿病患者中有3例死亡，263例非糖尿病患者中有7例死亡（p = 0.55）。与非糖尿病患者相比，糖尿病患者死亡的年龄调整相对风险估计值为2.2（95%置信区间，0.5至9.4）。所有3例死亡的糖尿病患者在死亡前5年内被诊断患有糖尿病，且只有1例使用胰岛素治疗。与血尿素氮水平正常的患者相比，血尿素氮水平升高（大于20mg/dL）的患者死亡率增加（分别为27%和2%；p<0.001）。严重并发症的结果相似。这些结果表明，对于患有无症状胆结石的糖尿病患者进行预防性胆囊切除术的建议需要重新考虑。
