等待政策或腹腔镜胆囊切除术后内镜膜切除术胆道结石:一个随机试验
Djemila Boerma1, Erik A J Rauws, Yolande C A Keulemans
1Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
Lancet (London, England)
|September 21, 2002
概括
不建议在胆管中去除结石后对胆囊结石采取等待方法. 大多数患者经历了反复的胆道症状,需要进行高转换率的手术,以开放程序.
科学领域:
- 胃肠病学 胃肠病学
- 肝胆道手术 肝胆道手术
- 临床试验 临床试验
背景情况:
- 患有常见胆管结石的患者经历了内镜缩切除术,并有残留的胆囊结石,通常会被转诊进行腹腔镜胆囊切除术.
- 然而,在没有胆囊切除术的患者中,很大一部分 (90%) 没有出现反复的胆道症状,这就质疑立即手术的必要性.
研究的目的:
- 评估"等待和观察"政策对患者的合理性,在内镜缩膜切除和常见胆道结石提取后残留胆囊结石.
主要方法:
- 一项前性,随机化,多中心试验,涉及120名患者 (18-80岁) 经过内镜膜切除后已证明胆囊结石.
- 患者被随机分配到"等待"组 (n=64) 或立即腹腔镜胆囊切除术 (n=56) 中.
- 主要结局是在2年的随访期内发生胆汁事件的复发;次要结局包括并发症和生活质量.
主要成果:
- "等待"政策导致47%的患者出现了复发的胆道症状,而在腹腔镜胆囊切除组中仅为2% (RR 22.42,p<0.0001).
- 在那些有复发症状的人中,81%最终需要胆囊切除术,通常是由于胆道疼痛或急性胆囊炎.
- 与立即腹腔镜胆囊切除组 (23%) 相比,最终接受手术的"等待和观察"组的转化率明显高 (55%).
结论:
- "等待和观察"的方法是不建议作为一种标准的治疗结合胆固醇胆固醇病在内透镜截切除术后.
- "等待和观察"组的高复发胆汁事件率 (47%) 和随后需要胆囊切除 (37%),以及高转化率,支持这一结论.
- 虽然没有发生重大胆道并发症,但需要手术的风险增加和更高的转化率凸显了预期管理的风险.
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