对轻度胆结石胰腺炎 (PONCHO) 进行同剂量或间隔胆结囊切除:多中心随机对照试验
David W da Costa1, Stefan A Bouwense2, Nicolien J Schepers3
1Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands.
Lancet (London, England)
|October 14, 2015
概括
与间歇性手术相比,同剂量胆囊切除术显著减少了轻度胆结石胰腺炎患者的复发性胆结石并发症. 这种方法提供了一种安全有效的替代方案,
科学领域:
- 胃肠病学
- 外科瘤学
- 临床试验
背景情况:
- 轻度胆结石胰腺炎的治疗通常需要隔间胆囊切除术.
- 建议采用相同的胆囊切除术来减少反复发生的胆结石并发症,但缺乏可靠的证据.
- 有关同一入院胆囊切除术可能增加的外科并发症存在担忧.
研究的目的:
- 在轻微的胆结石胰腺炎中,比较同一剂量与间隔胆结囊切除的疗效和安全性.
- 为了确定相同的输入胆囊切除术是否会减少与胆结石相关的复发症.
- 评估同次胆囊切除是否会增加手术并发症的风险.
主要方法:
- 一个多中心,随机控制的优越性试验,涉及266名轻度胆结石胰腺炎患者.
- 患者被分配为同时接受 (3天内) 或间隔 (25-30天) 胆囊切除术.
- 主要终点是由于胆结石并发症或6个月内死亡的复合再入院,并根据治疗意图进行分析.
主要成果:
- 同时接受胆囊切除术导致主要终点的发生率显著降低 (6%对17%;RR 0.28, p=0. 002).
- 与胆结石相关的复发症的风险比率在同一个治疗组中显著降低.
- 手术并发症很少,并且在各组之间可比,没有与治疗相关的死亡.
结论:
- 同时接受胆囊切除术优于间隔胆囊切除术,可减少轻度胆囊结石相关并发症.
- 这种方法与胆囊切除相关并发症的风险非常低.
- 同时接受胆囊切除术是治疗轻度胆结石胰腺炎的安全有效策略.
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