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胆道结石的ERCP后清除:胆囊是否应该留在原位?

Cindy Siaw Lin Wong¹, Arya Krishnan², Naren Kumaran²

¹Department of General Surgery, Northampton General Hospital NHS Trust, Cliftonville, Northamptonshire, NN15BD, UK. lin_0702cindy@hotmail.com.

Surgical endoscopy

|January 9, 2025

概括

对于ERCP清除了普通胆道结石的患者,由于复发率较低,建议预防性胆囊切除而不是预期管理. 老年患者可能会从警等待中受益.

科学领域:

胃肠病学胃肠病学
胆道手术胆道手术
内镜手术进行内镜手术

背景情况:

内镜逆行胆血管细胞造影 (ERCP) 是常见胆道结石 (CBDS) 的标准.
腹腔镜胆囊切除术 (LC) 经常建议在ERCP后进行,但也可以使用预期管理 (EM).
对于CBDS的ERCP后的EM与预防性LC的结果需要评估.

研究的目的:

为了比较与胆道相关的并发症和预期管理和CBDSERCP后的预防性胆囊切除术之间的死亡率.
评估年龄对预期治疗或预防性胆囊切除术患者的结果的影响.

主要方法:

对接受ERCP治疗胆固醇胆病的患者的回顾性审查 (2017-2019).
分类为年轻人 (<60岁) 和老年人 (≥60岁) 组.
在EM和LC组之间,与胆道相关的并发症和全因死亡率的比较.

主要成果:

在预期治疗中,胆汁事件的复发率为20.6%,而在预防性胆囊切除组中为3.9%.
预期管理组的老年患者比例较高 (88.2%),所有原因死亡率为51.4%.
预防性胆囊切除组的整体并发症很低 (5.4%),没有手术后死亡率.

结论:

建议在ERCP清除常见胆道结石后进行预防性胆囊切除术.
预期管理可能适用于不适合手术的老年患者,推随访2年.
在ERCP后的老年患者中,对CBDS的警等待需要仔细考虑,因为死亡率很高.

关键词:

这是一块CBD石头.胆囊切除术是一种胆囊切除术.在 ERCP 里面,有很多 ERCP 项目.

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