在第三级护理中心治疗急性胆囊炎:我们是否遵循当前的指导方针?
Andrea Spota1, Amir Hassanpour2, Eran Shlomovitz3,4
1Department of Surgery, University Health Network, 200 Elizabeth St 10 Eaton North, Room 216, Toronto, ON, M5G 2C4, Canada. a.spota89@gmail.com.
Langenbeck's archives of surgery
|October 24, 2024
概括
建议对急性胆囊炎 (AC) 进行早期胆囊切除术,但许多患者接受非手术治疗 (NOM),违反指导方针. 遵守指导方针可以改善结果,并减少AC患者的并发症.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 临床实践指南 临床实践指南
背景情况:
- 2018年东京指南 (TG2018) 建议在急性胆囊炎 (AC) 时进行早期胆囊切除术.
- 证据支持早期手术干预,即使是在高风险患者.
- 这项研究评估了TG2018出版后的AC管理在高等中心.
研究的目的:
- 为了调查急性胆囊炎 (AC) 在三级护理中心的管理.
- 评估是否遵守AC管理的2018年东京指南 (TG2018).
- 为了比较AC的手术和非手术管理 (NOM) 之间的结果.
主要方法:
- 642名AC患者 (2018-2023) 的回顾性队列研究.
- 使用TG2018分级的AC严重程度;评估并发症和脆弱性 (CCI,5mFI).
- 分析了管理策略与TG2018的合规性以及结果 (手术与NOM).
主要成果:
- 57%的AC患者接受了胆囊切除术,43%接受了NOM.
- NOM与更长的停留时间,更多的并发症,死亡和再入院有关.
- 在70%的NOM病例中没有遵循TG2018,导致17%的手术延迟,而4%的手术延迟.
结论:
- 许多非手术治疗的AC患者可能会接受胆囊切除术,符合指南.
- 需要改进风险评估,以优化患者选择和手术结果.
- 在交流管理中遵守准则需要进一步关注.
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