在等待胆囊切除术的患者中,在石头清除后插入胆道支架:系统性审查和元分析
Marco Valvano1,2, Daniele Balducci3, Antonio Vinci4
1Department of Health Sciences, University of L'Aquila Department of Health Sciences, L'Aquila, Italy.
Endoscopy international open
|May 16, 2025
概括
在内镜逆行胆道瘤学 (ERCP) 后,在普通胆道 (CBD) 中放置预防性支架并不能在等待胆囊切除术的患者中预防反复发生的胆道事件. 这次元分析没有发现任何益处,在推这种程序之前需要进一步的试验.
科学领域:
- 胃肠病学 胃肠病学
- 肝胆道手术 肝胆道手术
- 医疗干预 医疗干预
背景情况:
- 腹腔镜胆囊切除术是胆囊炎或胆结石常见胆道 (CBD) 清除后的标准.
- 一个顺序策略建议在ERCP后2周内进行胆囊切除术,以获得CBD清除.
- 在现实世界中,胆囊切除术的等待时间平均为ERCP后60-180天.
研究的目的:
- 评估CBD中预防性支架安置的临床理由.
- 为了确定支架是否可以防止在ERCP后等待胆囊切除术以获得CBD清除的患者中出现反复的胆汁事件.
主要方法:
- 根据预先设计的协议进行系统审查和元分析 (PROSPERO:CRD42024564804).
- 包括已发表的关于接受ERCP治疗CBD等待胆囊切除术的患者的研究.
- 分析了包括755名患者在内的四项全文研究.
主要成果:
- 在等待胆囊切除术的患者中,症状复发的几率比为0.74 (95% CI 0.30-1.79).
- 支架组中不良事件的综合几率比率为0.74 (95% CI 0.45-1.24).
- 在ERCP后发生胰腺炎和胆脉炎的风险分别为0.76 (95% CI 0.25-2.34) 和0.92 (95% CI 0.31-2.67).
结论:
- 在CBD清除后插入支架对等待延迟胆囊切除术的患者没有益处.
- 基于目前的证据,该程序不能被推.
- 需要进行更多的随机对照试验,使用更大的队列来最终评估潜在的益处.
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