75岁以上患者急性胆囊炎的 laparoscopic胆囊切除术与抗生素治疗:随机临床试验和回顾性队列研究
Antti Kivivuori1, Paulina Salminen2,3, Mika Ukkonen4
1Kuopio University Hospital Puijonlaaksontie 270210 Kuopio Finland.
概括
在患有急性胆囊炎的老年患者中,腹腔镜胆囊切除术 (LC) 可能是比抗生素更好的治疗方法. 这项研究发现LC的再入院人数较少,这表明该患者群体的治疗结果有所改善.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 老年医学 老年医学
背景情况:
- 在老年人群中,急性胆囊炎的患病率正在上升.
- 目前,老年人急性胆囊炎的治疗方案包括抗生素和手术.
研究的目的:
- 为了比较腹腔镜胆囊切除术 (LC) 与老年患者诊断为急性胆囊炎的抗生素治疗的疗效.
主要方法:
- 进行了一项过早终止的随机多中心临床试验 (n=42) 和一项回顾性队列研究 (n=630).
- 75岁以上患有急性结石胆囊炎的患者被随机分配给LC或抗生素.
- 评估结果包括发病率,死亡率,再入院率和住院时间.
主要成果:
- 在随机试验中,LC的并发症率为17%,抗生素的并发症率为33% (p=0.209).
- 在回顾性队列中,在LC (11%) 后的再入院明显低于抗生素 (32%) (p<0.001).
- 随机试验中没有观察到30天死亡率;回顾性队列中的总死亡率为6%.
结论:
- 在特定的老年患者中,腹腔镜胆囊切除术 (LC) 显示出对治疗急性胆囊炎的抗生素治疗的潜在优势.
- 降低的再接收率表明,LC可能为这一人口群体提供更好的长期结果.
- 进一步的研究可能是有必要的,以在更大的队列中证实这些发现.
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