内镜鼻胆道排水与内镜胆道支架用于恶性胆道阻塞患者的术前胆道排水:倾向性得分匹配的多中心比较研究
Hirotoshi Ishiwatari1, Takanori Kawabata2, Hiroki Kawashima3
1Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
概括
对于恶性状胆道阻塞,内镜胆道排水 (ENBD) 和内镜胆道支架 (EBS) 在手术前显示出类似的不良事件率,如胆道炎. 这项研究表明,这两种方法在这些患者的手术前胆汁排水中是可比的.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 干预性内镜检查是干预性的内镜检查.
背景情况:
- 目前的指导方针建议在恶性状胆道阻塞 (MHBO) 中进行内鼻胆道疏通 (ENBD) 进行术前胆道疏通 (PBD).
- 这项建议是基于对手术前内镜胆道支架 (EBS) 胆道炎风险更高的担忧.
- 支持这一准则的证据有限.
研究的目的:
- 为了比较MHBO患者手术前ENBD与EBS的结果.
- 评估与每个排水方法相关的不良事件,特别是胆管炎.
主要方法:
- 在13个中心 (2014-2018) 进行了355名MHBO患者的回顾性分析,这些患者在ENBD或EBS后接受了彻底手术.
- 1:1倾向分数匹配为ENBD和EBS组 (每组63名患者) 创建了可比的队列.
- 比较侧重于胆管炎,排水后的不良事件 (AE),胆管炎的时间,术后的AE和住院死亡率.
主要成果:
- 在内镜胆道排水 (EBD) 后胆道炎的发病率在ENBD和EBS组之间相似 (20.6%对25.4%,P=0.67).
- 在这两种排水方法之间,在两种排水方法之间发生胆管炎的时间方面没有发现显著差异.
- 手术后的不良事件,包括手术部位感染,胆汁泄漏和住院死亡率,在各组之间是可比的.
结论:
- 使用ENBD或EBS进行手术前的胆管排水会导致MHBO手术前出现类似的不良事件,包括胆管炎.
- 这些发现挑战了目前有利于ENBD的指导方针,因为人们认为EBS的风险更高.
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