PROGNOSIS OF GALLSTONES WITH MILD OR NO SYMPTOMS - 25 YEARS OF FOLLOW-UP IN A HEALTH MAINTENANCE ORGANIZATION
PROGNOSIS OF GALLSTONES WITH MILD OR NO SYMPTOMS - 25 YEARS OF FOLLOW-UP IN A HEALTH MAINTENANCE ORGANIZATION
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DOI：
10.1016/0895-4356(89)90086-3
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发表时间：
1989-01-01
影响因子：
7.2
通讯作者：
FIREMAN, B
中科院分区：
文献类型：
--
作者：
FRIEDMAN, GD;RAVIOLA, CA;FIREMAN, B
298例伴有轻度或非特异性症状的胆结石患者，123例无症状胆结石患者，46例胆囊造影无功能和轻度或非特异性症状患者在诊断后的健康维护组织中随访长达25年。在生命表分析中，并发症（严重事件）发生在每年约1%的可见胆结石患者和约2%的无功能患者中。在诊断后的前5年中，所有严重和非严重事件（包括持续轻度症状的手术）发生在约6%伴有轻度症状的患者中，伴有胆结石或无功能，约4%无症状胆结石患者。所有事件的年概率随着随访时间的延长而趋于降低。在结石和轻度症状的患者中，女性比男性更容易发生任何事件（p = 0.02），肥胖患者比较瘦的患者更容易发生严重事件（p = 0.05）。本研究中的患者可能比以前研究预后的大多数群体更能代表大多数初级保健医生所见的胆结石门诊患者。他们的事件发生率与已发表的决策分析中使用的事件发生率非常相似，因此不应改变先前的结论，即早期择期胆囊切除术对胆结石患者的平均预期寿命几乎没有积极或消极影响。
Two-hundred ninety-eight patients with gallstones accompanied by mild or nonspecific symptoms, 123 with asymptomatic gallstones, and 46 with nonfunction on cholecystogram and mild or nonspecific symptoms were followed in the setting of a health maintenance organization for up to 25 years after diagnosis. In a life-table analysis, complications (severe events) developed in about 1% per year of patients with visualized gallstones and in about 2% per year of patients with nonfunction. During each of the first 5 years after diagnosis, all events, both severe and non-severe (including surgery for continuing mild symptoms) occurred in about 6% of the patients with mild symptoms accompanying either gallstones or nonfunction, and in about 4% of patients with asymptomatic gallstones. The annual probabilities for all events tended to decrease as length of follow-up increased. Among patients with stones and mild symptoms, women were more apt to develop any event than men (p = 0.02) and more obese patients were more likely to develop severe events than those who were thinner (p = 0.05). The patients in this study are probably more representative of outpatients with gallstones seen by most primary care physicians than are most groups investigated previously for prognosis. Their event rates are sufficiently similar to those used in published decision analyses, that they should not alter previous conclusions that early elective cholecystectomy will have little positive or negative effect on average life expectancy of patients with gallstones.