对急性胆囊炎患者的管理进行全面审查,这些患者无法接受手术
Todd H Baron1, Irving Jorge2, Ali Husnain3
1Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC.
Annals of surgery
|April 21, 2025
概括
在非手术患者中,急性胆囊炎的治疗方法包括穿皮胆囊整形术 (PC) 和内超声波引导胆囊排水 (EUS-GBD). 需要进一步的研究来优化这些微创方法.
科学领域:
- 胃肠病学 胃肠病学
- 干预性放射学 干预性放射学
- 手术瘤学手术瘤学
背景情况:
- 胆囊切除术是急性胆囊炎 (AC) 的标准治疗方法.
- 非手术候选人通常需要穿皮或内镜干预.
- 新出现的数据支持内镜超声波引导胆囊排水 (EUS-GBD) 和穿皮技术.
研究的目的:
- 对非手术候选人进行AC治疗的当前文献进行审查.
- 为这种患者群体提供管理指南.
主要方法:
- 专家小组对当前文献进行了审查.
- 基于推评估,发展和评价 (GRADE) 框架的推.
主要成果:
- 对于那些不适合使用光体安置金属支架 (LAMS) 或患有可逆性疾病的患者,建议进行皮肤胆囊静脉切除术 (PC).
- 带有LAMS的EUS-GBD是符合条件,从未手术的候选人患有性AC的推疗法.
- 当手术不可行时,应考虑采用皮肤穿胆固醇 - 石 / 石切除术和胆固醇 - 双管腺支架等绝对治疗方法.
结论:
- 非手术患者中AC的管理具有挑战性,并且因机构而异.
- 建议制定一项协议,将穿皮和内镜方法与多学科合作相结合.
- 进一步的研究是必要的,以评估这些不断发展的技术,由于有限的当前文献.
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