在印度的资源有限的环境中,用于管理常见胆道结算的实用算法
Vinay Gangadhar Mehendale1, Manoj S Kamdar2, Sharad Narayan Shenoy2
1Department of Surgery, Medico Surgical Clinic and Hospital, Mumbai, Maharashtra, India.
Journal of minimal access surgery
|April 1, 2024
概括
在资源有限的环境中,建议对常见胆道 (CBD) 结石进行内镜逆行胆道瘤造影 (ERCP),然后进行腹腔镜胆囊切除术. 如果ERCP失败,使用随时可用的刚性视野镜进行胆固醇显微镜的开放CBD探索是有效和成本高效的.
科学领域:
- 胃肠病学 胃肠病学
- 肝胆道手术 肝胆道手术
- 最少侵入性的手术
背景情况:
- 常见的胆管 (CBD) 结石的管理通常需要内镜逆行胆血管细胞造影 (ERCP).
- 由于ERCP失败,需要对CBD进行探索,最好是通过胆固醇镜检查.
- 专门的胆道镜是昂贵的,在某些地区稀缺,特别是在印度.
研究的目的:
- 在ERCP失败的情况下,评估开放CBD探索的有效性,使用可访问的硬硬范围进行胆固醇镜检查.
- 提出一个具有成本效益的算法,用于在资源有限的环境中管理CBD计算.
主要方法:
- 从1991年3月开始,对8866名胆病患者进行了回顾性分析.
- 862名患者接受了ERCP; 96名CBD清除失败的患者进行了开放的CBD探索.
- 胆道镜检查使用易于使用的刚性透视镜 (囊囊镜,儿科囊囊镜,阴道镜或5毫米腹腔镜望远镜) 进行.
主要成果:
- 在96名患者中,95名患者获得了完整的CBD清除.
- 一名患者在囊上有一个受影响的结石.
- 探索后的手术包括胆固醇双管切除术,T管放置或胆固醇切除术 suturing,没有观察到残留结石.
结论:
- 倡导一个序列式的方法:ERCP,其次是腹腔镜胆囊切除术,用于CBD计算.
- 在ERCP失败的情况下,使用任何合适的刚性范围进行胆固醇显微镜的开放CBD探索是一种可行的和成功的策略.
- 这种方法消除了昂贵的专用胆固醇镜的需求,在资源有限的环境中提供了具有成本效益的解决方案.
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