Rodríguez-Sanjuán J C, Casado F, Fernández M J, Morales D J, Naranjo A
Department of General and Digestive Surgery, University Hospital Marqués de Valdecilla, Santander, Spain.
Br J Surg. 1997 May;84(5):634-7.
The management of gallstone ileus is controversial. This study compared the results of simple enterolithotomy with those of enterolithotomy, cholecystectomy and fistula closure.
A retrospective analysis was made of 25 patients with a mean age of 75 (range 55-84) years. Enterolithotomy was performed in 16 patients (group 1) and cholecystectomy and fistula closure were added in nine patients (group 2).
The diagnosis was made before operation in 12 patients, and was associated with previous biliary disorder (P = 0.03) and pneumobilia (P < 0.001). Postoperative morbidity occurred in eight patients in group 1 and in six in group 2. Three patients died in each group; all but one of the deaths were unrelated to the surgical procedure. There was no relationship between age and mortality, and patients in American Society of Anesthesiologists (ASA) classes III and IV did not have higher rates of morbidity or mortality than those in ASA classes I and II.
Evidence from this study does not support one-stage enterolithotomy, cholecystectomy and fistula closure as the procedure of choice; simple enterolithotomy is appropriate in most patients. However, the one-stage procedure may be acceptable in patients at low risk.
胆石性肠梗阻的治疗存在争议。本研究比较了单纯肠石切除术与肠石切除术、胆囊切除术和瘘管闭合术的治疗结果。
对25例平均年龄75岁（范围55 - 84岁）的患者进行回顾性分析。16例患者行肠石切除术（第1组），9例患者加行胆囊切除术和瘘管闭合术（第2组）。
12例患者术前确诊，与既往胆道疾病（P = 0.03）和气腹（P < 0.001）有关。第1组8例患者发生术后并发症，第2组6例。每组各有3例患者死亡；除1例死亡外，其他死亡均与手术操作无关。年龄与死亡率之间无相关性，美国麻醉医师协会（ASA）分级为III级和IV级的患者，其并发症发生率和死亡率并不高于ASA分级为I级和II级的患者。
本研究证据不支持将一期肠石切除术、胆囊切除术和瘘管闭合术作为首选术式；大多数患者行单纯肠石切除术即可。然而，低风险患者行一期手术可能是可以接受的。
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