长期胆道支架在2010年代的结石的结果:小心胆囊切除!
Jamal Ahmed1, Priyanka Prakash2, Gney Mehta2
1Royal Gwent Hospital, Newport, UK.
Frontline gastroenterology
|March 15, 2024
概括
对于常见的胆道结石 (CBDS),在内镜逆行性胆道松造影 (ERCP) 后永久插入支架是高风险患者的可行选择. 这种方法在选定的个体中显示出可接受的胆道连续病例和死亡率.
科学领域:
- 胃肠病学 胃肠病学
- 肝胆道手术 肝胆道手术
- 干预性内镜检查是干预性的内镜检查.
背景情况:
- 内镜逆行胆血管细胞造影 (ERCP) 是常见胆道结石 (CBDS) 的标准.
- 在初始ERCP期间并不总能达到完整的导管清除,尤其是在患有并发症的老年患者中.
- 重复的手术对这些高危人群构成风险.
研究的目的:
- 为了评估经过永久支架插入 (PSI) 无法恢复的CBDS的患者在单次ERCP与膜切除后的结果.
- 识别与不良结果相关的因素,包括胆道后果和死亡率.
主要方法:
- 2010年2月至2020年1月期间对ERCP进行的回顾性分析.
- 鉴定一个因最初无法恢复的CBDS而获得PSI的队列.
- 随访至2023年,以评估胆道后果,进一步干预或死亡.
主要成果:
- 114名患者符合PSI标准,103人在初次住院后进行了随访. 24%的人患有晚期胆汁连续病,18%的人需要重复ERCP,8%的人死于胆汁原因.
- 在ERCP前的胆囊切除术和周边脉冲分泌器与增加的不良结果有关.
- 尽管出现并发症,72%的患者不需要进一步的ERCP.
结论:
- 长期胆道支架 (PSI) 是对某些具有不可逆转的CBDS患者的有效策略,这些患者有重复手术的高风险.
- 仔细的患者选择对于优化结果至关重要.
- 这种方法可以避免重复干预高风险患者的很大一部分.
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