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Panminerva Medica 1999 September;41(3):243-6

lingua: Inglese

Predictive fac­tors for cho­lel­i­thi­a­sis com­pli­ca­tions

Tri­ta­pepe R., Piro D., Anno­ni F., Sega­la M.*

From the Chair of Surgical Gastroenterology University of Milan School of Medicine
* Institute of Emergency Surgery, University of Milan, Italy


Background. Cholelithiasis is a ­benign dis­ease ­that is ­very fre­quent­ly encoun­tered through­out the ­world. Its sur­gi­cal mor­tal­ity is usu­al­ly min­i­mal (0.1%), but the ­risk is con­sid­er­ably great­er (2-10%) in ­patients devel­op­ing com­pli­ca­tions par­tic­u­lar­ly if ­they are eld­er­ly. The iden­tifi­ca­tion of pos­sible pre­dic­tive ­signs of com­pli­ca­tions is there­fore cru­cial for the indi­ca­tion of pre­ven­tive sur­gery.
Methods. The ­present ­study ret­ro­spec­tive­ly exam­ined 490 ­patients admit­ted to hos­pi­tal ­because of com­pli­cat­ed and uncom­pli­cat­ed cho­lel­i­thi­a­sis in ­order to estab­lish the exis­tence of pre­vi­ous (clin­i­cal or instru­men­tal) symp­toms ­that may be pre­dic­tive of the ­course of the dis­ease. The anal­y­sis of ­some var­i­ables (age, sex, preg­nan­cy, ­diet, eth­a­nol con­sump­tion, smok­ing, pre­vi­ous/con­com­i­tant dis­eas­es, and ­blood chem­is­try and instru­men­tal ­test ­results) and the spe­cif­ic symp­toms of cho­lel­i­thi­a­sis ­made it pos­sible to iden­ti­fy two poten­tial ­risk fac­tors: an age of ­more ­than 60 ­years and the ­onset of bil­iary col­ic.
Results. The ­risk of devel­op­ing com­pli­ca­tions is 3.2 ­times great­er in ­patients ­aged ­more ­than 60 ­years ­than in ­those who are young­er, and 3.3 ­times great­er in symp­to­mat­ic ­than in asymp­to­mat­ic ­patients. Statistical anal­y­sis ­also ­revealed ­that the ­risk of com­pli­ca­tons is ­about ten ­times great­er in ­patients ­with ­both ­risk fac­tors ­than in ­those ­with nei­ther.
Conclusions. In con­clu­sion, the indi­ca­tion for sur­gery ­must be con­sid­ered abso­lute in symp­to­mat­ic ­patients ­aged ­more ­than 60 ­years and rel­a­tive to young­er symp­to­mat­ic ­patients.

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