在急性胆囊炎的排水程序后进行间隔胆囊切除术:通过皮肤通过肝脏或通过内镜通过胆囊的胆囊排水
Morihiro Katsura1, Kazuhide Matsushima2, Takashi Kato3
1Department of Surgery, Okinawa Chubu Hospital, Okinawa, Japan; Department of Surgery, University of Southern California, Los Angeles, CA, United States.
概括
针对急性胆囊炎 (AC) 的内透皮胆囊支架 (ETGBS) 导致更复杂的间隔胆囊切除术,而不是皮肤透肝胆囊排水 (PTGBD). 在ETGBS后,腹腔镜次总胆囊切除术对于高风险患者来说是一个可行的选择.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 最少侵入性的手术
背景情况:
- 胆囊排水对于急性胆囊炎 (AC) 患者具有较高的外科风险至关重要.
- 经皮切经肝胆囊排水 (PTGBD) 已确立,但内透皮胆囊支架 (ETGBS) 对AC的数据有限.
- 这项研究比较了ETGBS和PTGBD后的间隔胆囊切除术.
研究的目的:
- 在AC患者中比较ETGBS和PTGBD后间隔胆囊切除术的特征.
- 评估ETGBS作为胆囊排水程序的可行性和有效性.
- 为了确定两个排水方法之间的手术技术和结果的差异.
主要方法:
- 对接受ETGBS和/或PTGBD,随后进行间隔胆囊切除 (2018-2023) 的AC患者的回顾性分析.
- 患者人口统计,手术技术和术后并发症的比较.
- 统计分析以确定ETGBS和PTGBD组之间的显著差异.
主要成果:
- 包括14名ETGBS和45名PTGBD患者.
- ETGBS组的胆囊切除术间隔显著更长 (64 vs. 16天) 和操作时间更长.
- 在ETGBS组中,由于囊性导管结合困难,次总胆囊切除术更频繁地需要关闭 (75%vs28%).
结论:
- 在ETGBS之后的间隔胆囊切除术在技术上比PTGBD后更具挑战性.
- 在ETGBS后的 laparoscopic 亚总胆囊切除术是高风险患者的潜在选择.
- 意识到囊管结合的挑战对于计划ETGBS后胆囊切除术至关重要.
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