延迟内镜逆行性胆道血管细胞造影:在资源有限的环境中,对于急性胆道炎患者来说,这是一个改变游戏规则的方法
Nguyen Thi Hue1, Nguyen Thi Huyen Trang1, Nguyen Anh Tuan1
1Institute of Gastroenterology and Hepatology, 108 Military Central Hospital, Hanoi, Vietnam.
Therapeutic advances in gastroenterology
|April 29, 2025
概括
在资源有限的环境中复苏后,延迟内镜逆行性胆道管化图 (ERCP) 提供了与急性胆道炎 (AC) 早期ERCP相似的结果. 当医疗保健资源受到限制时,这种方法提供了一个可行的替代方案.
科学领域:
- 胃肠病学和肝病学
- 胆道疾病 胆道疾病
- 传染性疾病 传染性疾病
背景情况:
- 急性胆道炎 (AC) 是一种严重的胆道感染,通常由胆结石引起,可能导致败血症和器官衰竭.
- 2018年东京指导方针建议早期内镜逆行胆血管细胞造影 (ERCP) 适度至严重的AC.
- 对于AC在资源有限的环境中ERCP的最佳时机仍在调查中.
研究的目的:
- 为了比较早期ERCP (eERCP,在48小时内) 与延迟ERCP (dERCP,在48小时后) 的临床结果,患者患有胆结石诱导的AC.
- 在资源有限的环境中,评估不同ERCP时间的疗效,并发症和长期结果.
主要方法:
- 追溯队列研究涉及708名被诊断患有石头诱导的AC的患者.
- 根据ERCP时间,患者被分为两组:eERCP (≤48小时) 和dERCP (>48小时).
- 分析包括人口统计,临床表现,实验室数据,手术成功,并发症和患者结果.
主要成果:
- 在eERCP组有较高的严重胆管炎和高的炎症标志物,以及增加的ICU入院率 (3.1%对0.8%,p=0.02).
- 穿孔并发症在dERCP组中更频繁 (1.2%对0%,p=0.01),而石头治疗的成功率相似.
- 在eERCP组的住院时间较短 (6.5 vs 9.3天,p<0.05),但在团队之间没有观察到重新入院或1年死亡率的显著差异.
结论:
- 在资源有限的环境中,在初始复苏后的延迟ERCP (dERCP) 与急性胆道炎的早期ERCP (eERCP) 相似的结果.
- 当早期干预因资源限制而受到限制时,dERCP为AC提出了一种可行和有效的管理策略.
- 这项研究表明,初始复苏的策略,其次是dERCP,是管理资源有限的环境中AC的可行替代方案.
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