Kullman E, Dahlin L G, Hallhagen S, Segersvärdh R, Borch K
Department of Surgery, University Hospital of Linköping, Sweden.
Eur J Surg. 1994 Nov;160(11):605-11.
To assess time trends in the incidence, clinical findings, and outcome of conventional acute and elective cholecystectomy.
Single-institution time series analysis.
University hospital, Sweden.
A consecutive series of 2926 patients operated on for acute or chronic gallbladder disease in a defined Swedish population.
Changes in the incidence and outcome of acute and elective cholecystectomy.
From period I (1970-1978) to period II (1979-1986), the mean rate of acute operations increased from 10 to 30/100,000 inhabitants/year and that of elective operations decreased from 190 to 120/100,000 inhabitants/year. There was therefore a negative correlation between the rate of elective and acute operations (r = -0.58, p < 0.02). This was strongest when the rate of elective operations in any one year was correlated with the rate of acute operations two years later (r = -0.71, p < 0.01). In both groups the proportion of patients over 70 years old increased significantly. The female:male ratio decreased significantly for acute but not elective operations (mean 2.6 in period I and 1.0 in period II). The length of history and the number of previous admissions to hospital with gallstone disease decreased significantly for both groups, as did prevalence of common bile duct stones detected at cholecystectomy. Morbidity did not seem to change, though a general improvement may have been concealed, because patients were older in period II and postoperative mortality was lower than in period I. Complications were least common among patients with a short or no previous history of symptoms attributable to gallstones.
The rate of elective cholecystectomy seems to have some influence on the future rate of acute cholecystectomy. When symptoms of gallstone disease develop, treatment should not be delayed unnecessarily.
评估传统急性和择期胆囊切除术的发病率、临床发现及预后的时间趋势。
单机构时间序列分析。
瑞典大学医院。
瑞典特定人群中连续2926例因急性或慢性胆囊疾病接受手术的患者。
急性和择期胆囊切除术的发病率及预后变化。
从第一阶段（1970 - 1978年）到第二阶段（1979 - 1986年），急性手术的平均发生率从每年每10万居民10例增加到30例，择期手术的平均发生率从每年每10万居民190例降至120例。因此，择期手术率与急性手术率之间呈负相关（r = -0.58，p < 0.02）。当将任何一年的择期手术率与两年后的急性手术率进行关联时，这种相关性最强（r = -0.71，p < 0.01）。两组中70岁以上患者的比例均显著增加。急性手术的男女比例显著下降（第一阶段平均为2.6，第二阶段为1.0），而择期手术的男女比例未显著下降。两组患者胆石症病史的时长及既往住院次数均显著减少，胆囊切除术中发现的胆总管结石患病率也显著降低。尽管可能因第二阶段患者年龄较大且术后死亡率低于第一阶段而掩盖了总体改善情况，但发病率似乎并未改变。并发症在既往无或仅有短暂胆石症症状史的患者中最为少见。
择期胆囊切除术的发生率似乎对未来急性胆囊切除术的发生率有一定影响。当出现胆石症症状时，治疗不应不必要地延迟。
