错过了腹腔镜常见胆道探索 (LCBDE) 的机会:我们可以做得更好
Tawni M Johnston1, Casey R Lamb2, Alice Jo1
1Department of Surgery, Dartmouth Hitchcock Medical Center (DHMC), Lebanon, NH, USA.
Surgical endoscopy
|September 11, 2025
概括
腹腔镜常见胆道探索 (LCBDE) 尚未得到充分利用,有37%的符合条件的病例错过了机会. 优化LCBDE的使用可以显著减少患者住院时间 (LOS).
科学领域:
- 最少侵入性的手术
- 胃肠病学 胃肠病学
- 外科教育的外科教育
背景情况:
- 腹腔镜常见胆管探测 (LCBDE) 提供较短的停留时间 (LOS) 比内镜逆行胆血管细胞造影 (ERCP) 加上腹腔镜胆囊切除术 (LC).
- 尽管LCBDE已被证明具有益处,但在临床实践中仍未得到充分利用.
- 自2021年以来,该机构已经实施了基于模拟的LCBDE培训.
研究的目的:
- 确定LCBDE的当前和潜在利用率.
- 为了识别 为了识别
- 错过的机会 错过的机会
- 在哪里ERCP执行而不是LCBDE.
主要方法:
- 在2023年至2024年期间,对87名接受LC的患者进行了LCBDE或ERCP的回顾性审查.
- 排除标准包括肝胆癌的LC和非胆结石病的ERCP.
- 定义的定义的定义
- 错过的机会 错过的机会
- 作为符合LCBDE条件的病例,但被ERCP处理.
主要成果:
- 在38%的病例中进行了LCBDE (LOS=2天),而在25%的病例中进行了ERCP (LOS=4.5天).
- 37%的病例被确定为严重的疾病.
- 错过的机会 错过的机会
- 对于LCBDE (LOS=3天).
- 错过机会的原因包括迟到的外科医生咨询,患者转移,缺乏外科医生培训和OR不可用.
结论:
- 潜在的LCBDE利用率为75%,表明增加采用的空间很大.
- 与LCBDE相比",错过的机会"的LOS明显更长 (3对2天,p=0.048).
- 优化ERCP/LC推模式,解决错失机会的原因,可以显著减少LOS.
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