常见胆道结石管理的变化:1980年至今
Ruth Stalnikowicz1, Jochanan Benbassat1
1Department of Medicine (retired), Hadassah University Hospital, Jerusalem, Israel.
Rambam Maimonides medical journal
|May 8, 2024
概括
laparoscopic-endoscopic sphincterotomy (ES) 约会是适合患者的普通胆道 (CBD) 石头的最佳选择. 对于患有CBD石头的老年人或高危人群的治疗选择仍然不确定.
科学领域:
- 胃肠病学 胃肠病学
- 手术内镜是指手术内镜.
- 胆道外科手术 胆道外科手术
背景情况:
- 常见胆管 (CBD) 结石是一个重大的临床挑战.
- 传统的治疗方法包括内镜缩切除术 (ES) 和外科探索.
- 聚会技术将ES与复杂病例的外科探索相结合.
研究的目的:
- 为了比较ES的疗效和安全性,手术探索和腹腔镜-ES聚会技术用于CBD石头去除.
- 评估治疗结果,包括石头清除率,死亡率和并发症率.
- 根据患者的特征,确定最佳的治疗策略.
主要方法:
- 现有医学文献的叙事审查.
- 对1991年之前和之后发表的队列研究和随机对照试验数据的分析.
- 对CBD石头不同治疗方式的结果进行比较.
主要成果:
- 1990年之前的研究表明,ES (92.0%) 和手术 (90.2%) 的石头清除率相似,死亡率相似.
- 1987年的RCT表明类似的疗效,但与手术相比,ES的并发症和死亡率更高.
- 1991年后的随机对照试验表明,腹腔镜-ES约会与单独的ES或手术一样有效,并发症更少,住院时间更短.
结论:
- 腹腔镜-ES约会是年轻,健康的患者常见胆道结石的首选治疗方法.
- 对于患有CBD石头的老年或高风险患者,最佳方法需要进一步调查.
- 在特定患者群体中,单独ES和腹腔镜-ES约会之间的选择仍然不确定.
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