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资料来源：
Am J Gastroenterol. 2005 Aug;100(8):1813-20
胆囊切除术与结肠癌发生关系
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网址：http://370.daifumd.com 译者:周太成
目的：胆囊切除术是结直肠癌的可能危险因素;但两者之间的联系尚缺乏其相关性的临床证据,机制也不清楚。
为此,我们利用英国全科医师研究数据库(GPRD)资料,评估胆囊切除术后病人的结直肠癌发病危险。
方法：回顾性定群研究包括GPRD中全部≥40岁的病人,但不包括随访期<1年和胆囊切除术后1年内患结直肠癌的病人。
采用Poisson回归分析方法确定粗发病率比(IRR)和校正IRR。
结果：在接受胆囊切除术的55960例病人中,结直肠癌发病率为119例/10万人年;
在未接受胆囊切除术的574668例病人中,结直肠癌发病率为86例/10万人年。对各种已知的和怀疑的结直肠癌危险因素进行校正后,上述关系没有改变。
在所检查的协变量中,仅性别和年龄是有意义的混杂变量,已对其进行校正。
胆囊切除术组病人的校正结直肠癌IRR为1.32,胆囊切除术与结肠癌呈正相关(校正IRR为1.51),但与直肠癌无正相关关系(校正IRR为1.00)。男性与女性的相关类型相似。
通过观察，结肠癌与胆石症也有类似的相关关系。
结论：胆囊切除与结肠癌有关，但与直肠癌无关。
机制可能与具有促结石形成特性的胆汁有关。
以上为美国宾夕法尼亚大学医学院Shao等最近报告,胆囊切除术与结肠癌危险轻度增加相关,但不增加直肠癌发病危险。
Cholecystectomy and the risk of colorectal cancer.Shao T, Yang YX.
Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
OBJECTIVES: Cholecystectomy has been implicated as a possible risk factor for colorectal cancer. However, the clinical evidence and the underlying mechanism for this association are still inconclusive. We conducted a population-based study to further clarify this association. METHODS: We conducted a retrospective cohort study among all patients aged 40 yr or older in the General Practice Research Database from the United Kingdom. We excluded patients with <1 yr of colorectal cancer-free database follow-up as well as those patients who developed colorectal cancer within 1 yr after their cholecystectomies. Crude and adjusted incidence rate ratios (IRRs) were determined using Poisson regression. RESULTS: The incidence rate of colorectal cancer among cholecystectomy patients (n = 55,960) was 119 (95% CI: 106-133) per 100,000 person-years, compared to 86 (95% CI: 83-90) per 100,000 person-years among patients without a cholecystectomy (n = 574,668). Among the covariates examined, only sex and age were significant confounders and were included in the adjusted analyses. The adjusted IRR of colorectal cancer associated with cholecystectomy was 1.32 (95% CI: 1.16-1.48, p < 0.001). The positive association was present for colon cancer (adjusted IRR 1.51, 95% CI: 1.30-1.74, p < 0.001), but not for rectal cancer (adjusted IRR 1.00, 95% CI: 0.85-1.17, p= 0.99). The pattern of association was similar in men versus women. A similar association with colon cancer was observed for cholelithiasis. CONCLUSIONS: Cholecystectomy is associated with a modestly increased risk of colon cancer but not for rectal cancer. Lithogenic bile could be the underlying mechanism.
PMID: 16086719 [PubMed - indexed for MEDLINE]
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