Roslyn J J, Pitt H A, Mann L, Fonkalsrud E W, DenBesten L
Am J Surg. 1984 Jul;148(1):58-63. doi: 10.1016/0002-9610(84)90289-7.
Patients who receive long-term parenteral nutrition have an increased incidence of both calculous and acalculous cholecystitis. In an attempt to establish guidelines for the clinical management of patients with TPN-induced gallbladder disease, we have reviewed the records of 35 patients who have undergone cholecystectomy for this problem since 1976 at the UCLA Medical Center. The mean age of the 23 adult and 12 children who had cholecystectomy was 29.1 years. Forty percent of these patients required emergency cholecystectomy. The overall operative morbidity was 54 percent, and the hospital mortality was 11 percent. Significant factors contributing to this high rate of complications included a delay in diagnosis, especially in the young children, and increased operative difficulty due to extensive adhesions and intraoperative hemorrhage. Our analysis suggests that patients receiving long-term TPN should have a program of ultrasound surveillance for gallstone formation, elective cholecystectomy when stones first appear, and consideration of cholecystectomy at the time of laparotomy performed for other reasons. Whether TPN-induced gallstones can be prevented through daily stimulated gallbladder emptying awaits the results of future studies.
接受长期胃肠外营养的患者，结石性胆囊炎和非结石性胆囊炎的发病率均有所增加。为了制定TPN（全胃肠外营养）所致胆囊疾病患者临床管理的指南，我们回顾了自1976年以来在加州大学洛杉矶分校医学中心因该问题接受胆囊切除术的35例患者的记录。接受胆囊切除术的23名成人和12名儿童的平均年龄为29.1岁。这些患者中有40%需要急诊胆囊切除术。总体手术并发症发生率为54%，医院死亡率为11%。导致如此高并发症发生率的重要因素包括诊断延误，尤其是在幼儿中，以及由于广泛粘连和术中出血导致手术难度增加。我们的分析表明，接受长期TPN的患者应进行超声监测以观察胆结石形成情况，结石首次出现时进行择期胆囊切除术，以及在因其他原因进行剖腹手术时考虑行胆囊切除术。通过每日刺激胆囊排空是否可以预防TPN所致胆结石，有待未来研究结果。
