胆囊切除术后的阳性胆道损伤:内镜管理的新兴作用
Mohamed H Emara1, Mohammed Hussien Ahmed2, Mohamed I Radwan3
1Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt. emara_20007@yahoo.com.
World journal of gastrointestinal surgery
|January 15, 2024
概括
胆囊手术后发生的阳性胆道损伤 (IBDIs) 是常见的,特别是在腹腔镜检查后. 管理因伤害类型而异,内逆行胆板造影 (ERCP) 为许多病例提供了不那么侵入性的选择.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 患者的治疗结果.
背景情况:
- 催生性胆道损伤 (IBDIs) 是胆囊切除术后的一个显著并发症,腹腔镜方法与开放手术相比显示出更高的发病率.
- 这些伤害给患者,医疗保健提供者和系统带来了巨大的负担,并且可能危及生命,表现为腹痛,胆汁泄漏,发烧和黄等症状.
研究的目的:
- 审查目前对胆囊切除术后的阳性胆道损伤 (IBDIs) 的理解和管理策略.
- 突出显示内镜逆行胆胰腺学 (ERCP) 的作用,作为管理这些损伤的范式转变,并讨论最佳时间和技术.
主要方法:
- 对临床表现,诊断工具 (超声波,MRCP) 和胆囊切除术后IBDIs的治疗干预措施的审查.
- 对手术与内镜管理的比较有效性和指示的分析,特别是ERCP.
主要成果:
- 腹腔镜胆囊切除术的IBDIs发病率高于开放手术.
- 对于许多IBDIs来说,ERCP已经成为成功的,具有成本效益的,不那么病态的外科手术替代方案.
- 管理策略,包括ERCP的时间和技巧,如杆切除和支架,应根据特定的损伤类型进行量身定制.
结论:
- 在IBDI管理中ERCP的最佳时机仍在争论中,但对于高流量泄漏和缩水,早期干预是最受欢迎的,而对于低流量泄漏,保守的管理先于ERCP.
- 完整的胆管绑定需要迅速的手术干预,因为内镜没有任何好处.
- 干预放射学为复杂病例和失败的内镜修复提供了一个有希望的替代方案.
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