ERCP的发现进一步证明了在胆固醇胆病中采取"手术优先"的心态的理由
Gloria Sanin1, Gabriel Cambronero2, James Patterson2
1Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA. gsanin@wakehealth.edu.
Surgical endoscopy
|July 31, 2023
概括
大多数接受ERCP的怀疑胆固醇胆病患者的发现可以通过简单的腹腔镜常见胆道探索 (LCBDE) 来治疗. 对于许多胆结石患者来说,先进行手术的方法可能更有效.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 胆道疾病管理 胆道疾病管理
背景情况:
- 胆固醇胆病通常通过两步的方法来管理:ERCP,其次是LC.
- 一个单阶段的手术第一方法 (LCBDE) 提供了减少住院时间和可比结果.
- 目前的转诊模式有利于ERCP,可能会忽视更简单的手术干预.
研究的目的:
- 评估胆固醇胆病患者的比例,其内镜检查结果可以接受基本的腹腔镜普通胆道探索 (LCBDE) 操作.
- 为了挑战怀疑胆固醇胆病的占主导地位的ERCP-第一途径.
- 为了支持更广泛地采用手术第一的方法.
主要方法:
- 对294名接受手术前ERCP治疗的成年患者进行了回顾性审查,他们怀疑患有胆固醇胆病.
- 排除ERCP失败,胆管炎,先前胆囊切除术或手术禁忌的患者.
- 石头大小的分类:小 (0-4毫米),中等 (5-7毫米) 和大 (≥8毫米).
主要成果:
- 74.3%的患者发现了污泥,小到中型石头 (0-7毫米) 或负的ERCP结果.
- 37.1%的污泥只含有污泥或含有石头的污泥.
- 超过四分之一的患者有负面的ERCP发现,污泥或小石头,可以通过基本操作来治疗.
结论:
- 大多数怀疑患有胆固醇胆固醇病的患者在LCBDE期间通过简单的手术内干预来管理结果.
- 需要先进技术的大型石头代表了一小部分患者.
- 对于大多数患者来说,手术为首要的胆固醇结石病的策略是有效的替代方案.
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