观察与干预在手术内胆道结石的偶然常见胆道结石:一个系统的审查
J Crichton1,2, S Cox2, C Tong2
1Department of General Surgery, Te Whatu Ora Waitaha Canterbury, Christchurch Hospital, Christchurch, New Zealand.
ANZ journal of surgery
|June 29, 2023
概括
常见胆道结石 (CBDS) 的自然史尚不清楚. 虽然一些无症状的石头可能会自发地通过,但需要进一步的研究来确认预期的管理是否安全.
科学领域:
- 胃肠病学 胃肠病学
- 肝胆道手术 肝胆道手术
背景情况:
- 偶然发生的普通胆道结石 (CBDS) 的自然史仍然不太清楚.
- 关于自发通过与无症状CBDS常规移除的必要性存在相互矛盾的证据.
- 目前的指导方针经常建议干预,尽管对预期管理的数据有限.
研究的目的:
- 系统地审查在手术胆道血管学中检测到的CBDS的预期管理结果.
- 为了比较随机CBDS的观察与干预结果.
- 评估自发石头通道,管道清除成功率和并发症率.
主要方法:
- 在MEDLINE,Embase和CINAHL数据库中进行系统搜索.
- 包括通过手术内胆血管学 (IOC) 确定的CBDS的成年患者.
- 预期管理 (观察) 与ERCP和胆道探索等干预措施的比较.
主要成果:
- 包括8项具有严重偏差风险的非随机研究.
- 在观察到的患者中,有20.9%的患者出现了有症状的保留结石.
- 接受ERCP的患者中有50.6%患有持续的CBDS;自发通过与石头大小无关.
结论:
- 需要进一步的证据来最终推对偶然的CBDS进行观察.
- 无症状的CBDS可能会被安全地观察到.
- 当胆道干预风险较高时,可以考虑采取保守的方法.
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