Giovannucci E, Colditz G A, Stampfer M J
Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Gastroenterology. 1993 Jul;105(1):130-41. doi: 10.1016/0016-5085(93)90018-8.
Over 60 studies have addressed the hypothesis that the risk of colorectal cancer is increased following cholecystectomy; these studies have yielded inconsistent findings. The aim of the present study was to quantitatively summarize the results from the collective studies.
A meta-analysis of the published studies addressing the relation between cholecystectomy and colorectal cancer was conducted.
The combined results from 33 case-control studies showed an association between cholecystectomy and risk of colorectal cancer (pooled relative risk [RR] = 1.34; 95% confidence interval [CI] = 1.14-1.57), particularly when limited to the proximal colon (RR = 1.88; 95% CI = 1.54-2.30). In most studies, the risk was stronger when the first 5-15 years following the surgery were excluded. The results from 6 cohort studies, with follow-up to approximately 15 years postcholecystectomy, were generally null (RR = 0.97; 95% CI = 0.82-1.14). A more limited body of evidence suggests that cholelithiasis is related to an elevated risk of proximal colon cancer.
Because the risks varied substantially by study design and because time since cholecystectomy or potentially confounding factors were often not considered, we could not firmly quantitate this risk. However, the findings are consistent with other evidence that suggests some characteristic of bile acid metabolism increases the risk of cancer of the proximal colon.
超过60项研究探讨了胆囊切除术后结直肠癌风险增加这一假说；这些研究结果并不一致。本研究的目的是对这些研究结果进行定量总结。
对已发表的关于胆囊切除术与结直肠癌关系的研究进行荟萃分析。
33项病例对照研究的综合结果显示胆囊切除术与结直肠癌风险之间存在关联（合并相对风险[RR]=1.34；95%置信区间[CI]=1.14-1.57），特别是局限于近端结肠时（RR=1.88；95%CI=1.54-2.30）。在大多数研究中，排除手术后最初5-15年时风险更强。6项队列研究的结果，随访至胆囊切除术后约15年，总体无关联（RR=0.97；95%CI=0.82-1.14）。更有限的证据表明胆结石与近端结肠癌风险升高有关。
由于风险因研究设计差异很大，且胆囊切除术后时间或潜在混杂因素常未被考虑，我们无法确切量化这一风险。然而，这些发现与其他证据一致，即胆汁酸代谢的某些特征会增加近端结肠癌的风险。
