Reisner R M, Cohen J R
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York 10042.
Am Surg. 1994 Jun;60(6):441-6.
Although rare in the general population, gallstone ileus accounts for 25 per cent of nonstrangulated small bowel obstructions in those over the age of 65. While mortality has declined over the years, it remains high at 15-18 per cent. This is largely due to the patient population, with comorbid medical conditions contributing to mortality. The proper extent of surgery continues to be actively debated. Proponents of minimal surgery feel that relief of the obstruction is all that is required. Others argue that the gallbladder and biliary-enteric fistula must be removed to prevent future recurrence (a one-stage procedure). The one-stage procedure carries an associated mortality of 16.9 per cent, compared to 11.7 per cent for simple enterolithotomy. Morbidity after enterolithotomy is low. The recurrence rate of gallstone ileus was less than 5 per cent, and only 10 per cent of patients required reoperation for continued symptoms related to the biliary tract. Simple enterolithotomy is both safe and effective in dealing with a patient with gallstone ileus.
虽然在普通人群中罕见，但胆石性肠梗阻在65岁以上人群的非绞窄性小肠梗阻中占25%。尽管多年来死亡率有所下降，但仍高达15% - 18%。这主要归因于患者群体，合并的内科疾病导致了死亡。手术的适当范围仍在积极争论中。支持微创手术的人认为解除梗阻就足够了。其他人则认为必须切除胆囊和胆肠瘘以防止未来复发（一期手术）。一期手术的相关死亡率为16.9%，而单纯肠石切除术为11.7%。肠石切除术后的发病率较低。胆石性肠梗阻的复发率低于5%，只有10%的患者因与胆道相关的持续症状需要再次手术。单纯肠石切除术在治疗胆石性肠梗阻患者时既安全又有效。
