在老年人或患有许多并发症的患者治疗胆固醇结石病后是否需要胆固醇切除术?
Masahiro Shiihara1, Yasuhiro Sudo1, Norimasa Matsushita1
1Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan.
Digestive diseases (Basel, Switzerland)
|August 5, 2024
概括
胆道结石治疗胆道结石症的内镜治疗可以在有或没有胆囊切除术的情况下进行. 没有胆囊切除术的保存对于具有重大并发症的患者来说是一个可行的选择,特别是那些年龄调整后查尔森并发症指数得分高的患者.
科学领域:
- 胃肠病学 胃肠病学
- 肝胆道手术 肝胆道手术
背景情况:
- 胆管结石症 (胆管结石) 管理通常涉及结石切除和胆囊切除 (胆囊切除) 以防止复发.
- 在内镜治疗胆固醇胆病后的预后,特别是在具有临界外科耐受性 (老年人,并发病症) 的患者中,仍然存在争议.
研究的目的:
- 为了评估胆固醇胆病的内镜治疗后的预后.
- 为了比较经过胆囊切除术的患者与保存胆囊的患者之间的结果.
- 确定导致高并发症得分的患者反复发生胆汁事件的因素.
主要方法:
- 在2012-2021年期间接受治疗的169名胆固醇胆病患者的回顾性分析.
- 接受内镜缩膜切除术的患者被分为胆囊切除术 (CHOLE) 和保存 (CONS) 组.
- 后勤回归分析了高年龄调整的查尔森并发症指数 (aCCI) 评分的患者中复发性胆汁事件的因素.
主要成果:
- 在110名患有胆结石的患者中,56名在CHOLE,54名在CONS.
- 在CONS组有更多的并发症和更高的aCCI得分.
- 两组之间没有观察到复发性胆汁事件,胆汁感染 (等级≥2) 或死亡率的显著差异. 在没有胆囊切除术的情况下保存并不是在aCCI得分≥5.5的患者中复发胆道事件的独立风险因素.
结论:
- 胆囊切除术在胆固醇胆病治疗后有助于预防反复发生的胆汁事件.
- 没有胆囊切除术的保存对于具有高并发性得分 (aCCI ≥5) 的患者来说是一个可行的和安全的选择.
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