在中度和重度急性胆炎后胆囊切除术的时间
Marcello Di Martino1, Benedetto Ielpo2, Francesco Pata3,4
1Division of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, Naples, Italy.
JAMA surgery
|August 23, 2023
概括
在严重的急性胆道胰腺炎 (ABP) 中,早期胆囊切除术 (EC) 会增加死亡率和发病率. 建议在这些患者中仔细考虑EC,特别是那些患有严重并发症或并发症的患者.
科学领域:
- 胃肠病学 胃肠病学
- 外科手术的结果
- 临床流行病学临床流行病学
背景情况:
- 在急性胆管胰腺炎 (ABP) 中胆囊切除术的最佳时间仍在争论中,特别是在中度严重和严重的病例中.
- 基于证据的指导方针存在,但现实世界的遵守和结果需要进一步调查.
研究的目的:
- 为了评估早期胆囊切除术 (EC) 与延迟胆囊切除术 (DC) 的结果,在被诊断为中度严重和严重的急性胆道胰腺炎 (ABP) 的患者中.
主要方法:
- 使用MANCTRA-1数据集进行的回顾性队列研究,包括3696名接受胆囊切除术的ABP患者.
- 分析涉及单变量和多变量后勤回归,以确定死亡率和发病率的预后因素.
- 在入院后14天内,EC被定义为胆囊切除术.
主要成果:
- 与延迟胆囊切除术 (DC) 相比,早期胆囊切除术 (EC) 与术后死亡率 (1.4%对0.1%) 和发病率 (7.7%对3.7%) 的显著增加有关.
- 在中度重度至重度ABP患者中,EC显示死亡率 (15.6%与1.2%) 和发病率 (30.3%与10.3%) 与DC相比增加.
- 患者年龄和美国麻醉学会得分与死亡率有关;严重的ABP并发症显著增加了死亡率和发病率.
结论:
- 早期胆囊切除术 (EC) 在中度严重和严重的急性胆道胰腺炎 (ABP) 患者中与术后风险增加有关.
- 在这种患者群体中,应谨慎使用EC,特别是在老年人或患有严重并发症的人群中.
- 延迟胆囊切除术 (DC) 可能为管理严重的ABP提供更安全的替代方案.
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