美国空军飞行员和领航员中无症状胆结石的航空医学风险。

Saboe G W, Slauson J W, Johnson R, Loecker T H

Clinical Sciences Division, Armstrong Laboratory, Brooks Air Force Base, TX 78235-5117, USA.

Aviat Space Environ Med. 1995 Nov;66(11):1086-9.

BACKGROUND

The U.S. Air Force (USAF) aeromedical policy regarding incidentally discovered, asymptomatic cholelithiasis required the aircrew to undergo cholecystectomy prior to being considered for return to flying duties.

HYPOTHESIS

The merit of continuing this USAF policy was evaluated at the request of the U.S. Air Force Surgeon General.

METHODS

A medical literature review of the natural history of cholelithiasis in the general population was completed. The USAF aircrew waiver file (1972-92) and the Ellingson Aerospace Medicine Consultation Service (ACS) data file (1955-92) were reviewed for cases of USAF pilots and navigators with a diagnosis of cholelithiasis or cholecystectomy. Pilot and navigator annual manpower data were obtained from the Air Force Military Personnel Center (1972-92) and used in calculations involving the USAF aircrew waiver file. Surgical morbidity and mortality information was obtained from the Division of Surgery, Wilford Hall Medical Center.

RESULTS

Literature review predicted a 1-4% annual rate of acute events in individuals with previous asymptomatic cholelithiasis. Based on KUB radiographs taken at ACS, the prevalence of asymptomatic cholelithiasis in USAF pilots and navigators was estimated to be 2-3%. Of 11,685 pilots and navigators evaluated at the ACS, 80 (0.7%) were diagnosed with cholelithiasis or cholecystectomy. Between 1972 and 1992, an estimated 16,232 man-years of pilot/navigator exposure to asymptomatic cholelithiasis occurred; however, only 50 cases with a diagnosis of cholecystectomy or cholelithiasis were reported in the USAF waiver file. Mortality and morbidity for cholecystectomy, whether performed by open or laparoscopic technique, were reported as 0.2% and 5%, respectively, in the general population.

CONCLUSION

The overall incidence of acute cholecystitis within USAF aircrew would not be changed by aeromedical cholecystectomy being performed on aviators with incidentally detected asymptomatic cholelithiasis.

背景

美国空军（USAF）关于偶然发现的无症状胆结石的航空医学政策要求机组人员在考虑恢复飞行任务之前接受胆囊切除术。

假设

应美国空军外科总长的要求，对继续执行这项美国空军政策的价值进行了评估。

方法

完成了对普通人群胆结石自然病史的医学文献综述。查阅了美国空军机组人员豁免档案（1972 - 92年）和埃林森航空航天医学咨询服务（ACS）数据档案（1955 - 92年），以获取诊断为胆结石或接受胆囊切除术的美国空军飞行员和导航员的病例。飞行员和导航员的年度人力数据来自空军军事人员中心（1972 - 92年），并用于涉及美国空军机组人员豁免档案的计算。手术发病率和死亡率信息来自威尔福德霍尔医疗中心外科。

结果

文献综述预测，既往无症状胆结石患者的急性事件年发生率为1 - 4%。根据在ACS拍摄的腹部平片，估计美国空军飞行员和导航员中无症状胆结石的患病率为2 - 3%。在ACS评估的11,685名飞行员和导航员中，80人（0.7%）被诊断为胆结石或接受了胆囊切除术。1972年至1992年期间，估计有16,232人年的飞行员/导航员暴露于无症状胆结石；然而，在美国空军豁免档案中仅报告了50例诊断为胆囊切除术或胆结石的病例。普通人群中，无论是采用开放手术还是腹腔镜手术进行胆囊切除术，死亡率和发病率分别报告为0.2%和5%。