GALLSTONE PANCREATITIS AND THE EFFECT OF CHOLECYSTECTOMY - A POPULATION-BASED COHORT STUDY
GALLSTONE PANCREATITIS AND THE EFFECT OF CHOLECYSTECTOMY - A POPULATION-BASED COHORT STUDY
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DOI：
10.1016/s0025-6196(12)65644-4
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发表时间：
1988-05-01
影响因子：
8.9
通讯作者：
DIMAGNO, EP
中科院分区：
文献类型：
--
作者：
MOREAU, JA;ZINSMEISTER, AR;DIMAGNO, EP
尽管胆结石和胰腺炎之间的关联已被认识了近 100 年，但胆结石患者患急性胰腺炎的风险以及胆囊切除术对这种风险的影响尚不清楚。对 1950 年至 1970 年间诊断出胆结石的明尼苏达州罗彻斯特 2,583 名居民的完整医疗记录进行了仔细审查，以检测急性胰腺炎的发展情况。仅 89 名受试者（占队列的 3.4%）出现急性胰腺炎； 然而，急性胰腺炎的相对风险（胆囊切除术前）男性增加 14 至 35 倍，女性增加 12 至 25 倍。胆囊切除术前队列成员的急性胰腺炎总发病率经年龄和性别调整后为每 1000 人年 6.3 至 14.8 例随访。对 1,560 名既往没有胰腺炎发作的患者进行胆囊切除术，将男性和女性的相对风险分别降低至 1.9 和 2.0。 58 例急性胰腺炎发作后接受胆囊切除术并在术后中位随访 15 年的患者中，只有 2 例再次发作急性胰腺炎，且两人胰腺炎的病因均与胆结石无关。总之，胆结石患者患急性胰腺炎的相对风险显着增加，无论之前是否发生过胰腺炎，胆囊切除术都能将这种风险降低到与普通人群几乎相同的水平。然而，由于胰腺炎的总体发病率较低，因此只有在急性胰腺炎已经发作时才需要进行胆囊切除术来预防胰腺炎。
Although an association between gallstones and pancreatitis has been recognized for almost 100 years, the risk of acute pancreatitis in patients with gallstones and the effect of cholecystectomy on this risk have been unknown. The complete medical records of the 2,583 residents of Rochester, Minnesota, who had gallstones diagnosed between 1950 and 1970 were carefully reviewed to detect the development of acute pancreatitis. Acute pancreatitis developed in only 89 subjects (3.4% of the cohort); however, the relative risk for acute pancreatitis (before cholecystectomy) was increased 14 to 35 times in men and 12 to 25 times in women. The overall age- and sex-adjusted incidence of acute pancreatitis of the members of the cohort before cholexystectomy was 6.3 to 14.8 per 1,000 person-years of follow-up. Cholecystectomy in 1,560 patients without a prior attack of pancreatitis reduced the relative risk to 1.9 and 2.0 for men and women, respectively. Of 58 patients who had a cholecystectomy after an attack of acute pancreatitis and underwent follow-up for a median of 15 years postoperatively, only 2 had another attack of acute pancreatitis, and the cause of the pancreatitis was unrelated to gallstones in both. In summary, patients with gallstones have a considerably increased relative risk for acute pancreatitis and, regardless of whether prior attacks of pancreatitis have occurred, cholecystectomy reduces this risk to almost the same level as in the general population. Because the overall incidence of pancreatitis is low, however, performance of cholecystectomy to prevent pancreatitis is indicated only if an attack of acute pancreatitis has already occurred.