在预测严重的急性胆结石胰腺炎 (APEC) 中,急性内镜逆行胆结核造影与保守治疗:多中心随机对照试验
Nicolien J Schepers1, Nora D L Hallensleben1, Marc G Besselink2
1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands; Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands.
Lancet (London, England)
|July 20, 2020
概括
在没有胆管炎的严重胆结石胰腺炎中,紧急ERCP并没有改善结果. 建议采取保守的方法,将ERCP保留给胆管炎或持续胆管病的病例.
科学领域:
- 胃肠病学
- 肝病学
- 外科创新
背景情况:
- 没有胆结炎的胆结石胰腺炎在紧急ERCP的必要性方面存在治疗困境.
- 在没有胆管炎的严重胆结石胰腺炎中,早期内逆行胆管瘤学 (ERCP) 的疗效尚不确定.
研究的目的:
- 在没有胆管炎的预测严重的急性胆结石胰腺炎患者中,比较紧急ERCP与缩切除治疗的结果.
主要方法:
- 一个多中心,随机控制的优越性试验,涉及232名预计患有严重胆结石胰腺炎但没有胆结炎的患者.
- 患者被分配到紧急ERCP与膜切除 (在24小时内) 或保守治疗.
- 主要终点是6个月内死亡率或重大并发症的复合值,根据治疗意图进行分析.
主要成果:
- 紧急ERCP没有显著降低死亡率或重大并发症的复合终点 (38%对44%,RR0. 87;p=0. 37).
- 然而,紧急ERCP显著降低了胆炎的发病率 (2%对10%,RR0. 18;p=0. 010).
- 在主要终点或整体不良事件的其他单个组成部分中没有发现显著差异.
结论:
- 在没有胆管炎的预测严重胆结石胰腺炎中,紧急ERCP并不能改善结果.
- 支持一种保守的治疗策略,ERCP主要用于胆管炎或持续性胆管炎.
相关概念视频
01:26Endoscopic Procedures V: ERCP
1.9K
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
Patient...
1.9K
01:29Chronic Pancreatitis II: Collaborative Care
206
The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
Assessment:
206
01:30Acute Pancreatitis II: Clinical Manifestations and Management
594
Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
594