急性胆囊炎:一个回顾
Jared R Gallaher1, Anthony Charles1
1Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill.
JAMA
|March 8, 2022
概括
早期腹腔镜胆囊切除术是急性胆囊炎的推治疗方法,可显著改善患者的治疗结果并减少并发症. 这种及时的手术方法在不同患者群体中提供了比延迟治疗更好的结果.
科学领域:
- 胃肠病学
- 外科创新
- 诊断成像
背景情况:
- 在美国,急性胆囊炎每年影响20万人,通常是由胆结石阻塞引起的.
- 在5-10%的病例中发生结核性胆囊炎,通常发生在危急病患者中.
- 典型的症状包括右上象限疼痛,发烧和恶心.
研究的目的:
- 评估早期腹腔镜胆囊切除术与急性胆囊炎延迟治疗的疗效.
- 评估特定人群的结果,包括孕妇和老年患者.
- 通过皮肤进行胆囊切除术与腹腔镜胆囊切除术在高危患者中进行比较.
主要方法:
- 通过超声波和肝胆扫描证实了诊断.
- 基于腹腔镜胆囊切除术时间 (早期与晚期) 的患者结局分析.
- 透皮胆囊切除术与腹腔镜胆囊切除术结果的比较.
主要成果:
- 早期腹腔镜胆囊切除术 (1-3天) 显示并发症较少 (11.8% vs 34.4%),住院时间较短 (5.4 vs 10.0天),费用较低.
- 在怀孕期间,早期手术减少了母胎并发症 (1.6%对18.4%).
- 在65岁以上的患者中,早期手术降低了2年死亡率 (15. 2% vs 29. 3%). 通过皮肤排水的并发症率较高 (65%对12%).
结论:
- 早期腹腔镜胆囊切除术是急性胆囊炎的首选治疗方法,
- 及时干预对于包括孕妇和老年人在内的不同患者群体至关重要.
- 透皮胆囊管切除术仅适用于危急病患者的临时措施.
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