急性 胆 炎: レビュー
Jared R Gallaher1, Anthony Charles1
1Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill.
JAMA
|March 8, 2022
まとめ
早期の腹腔鏡による胆囊切除は,急性胆囊炎の推奨治療法であり,患者のアウトカムを大幅に改善し,合併症を軽減します. この早期の手術は 遅延した治療と比較して より良い結果をもたらします
科学分野:
- 胃腸内科
- 外科 革新
- 診断用イメージング
背景:
- 急性胆炎は,米国で毎年20万人に罹患し,しばしば胆石の阻害によって引き起こされます.
- 結腸炎は5〜10%の症例で,典型的には重症患者で起こります.
- 典型的な症状は 右上部の痛み 発熱 吐き気
研究 の 目的:
- 急性胆囊炎の早期の腹腔鏡胆囊切除と遅延治療の有効性を評価する.
- 妊婦や高齢者を含む特定の集団でのアウトカムを評価する.
- 高リスク患者の皮膚経結腸切除と腹腔鏡経結腸切除を比較する.
主な方法:
- 診断は超音波検査と肝胆スシンチグラフィで確認された.
- 腹腔鏡による胆管切除のタイミングに基づく患者のアウトカムの分析 (早期 vs. 遅刻).
- 腹腔鏡による胆囊切除と経皮胆囊切除の結果の比較
主要な成果:
- 早期の腹腔鏡切除 (1~3日) は,合併症の減少 (11. 8% 対 34. 4%),入院の短縮 (5. 4 対 10. 0 日),およびコストの減少を示した.
- 妊娠中,早期手術は母子合併症を減少させた (1. 6% vs 18. 4%).
- 65歳以上の患者では,早期手術により2年後の死亡率が低下しました (15. 2% vs 29. 3%). 経皮排水による合併症の発生率は高かった (65%対12%).
結論:
- 早期の腹腔鏡による胆管切除は,急性胆管炎の治療法として好ましい結果をもたらします.
- 妊婦や高齢者を含めて 患者様を対象に 適切なタイミングで介入することが重要です
- 経皮胆小胞口手術は,重症患者のための一時的な治療法です.
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