J Gastroenterology:无症状胆管结石的自然病史以及内镜治疗与临床结局的关系

2020-02-06 不详 MedSci原创

由于进行腹部CT的机会越来越多,偶而被诊断出没有任何症状的胆管结石的现象也越来越多。然而,关于无症状胆管结石的治疗尚无共识。因此,研究人员对此进行了一项回顾性纵向队列研究,以根据内窥镜切除的时机调查无症状胆管结石的自然病史和临床结局。

背景
由于进行腹部CT的机会越来越多,偶而被诊断出没有任何症状的胆管结石的现象也越来越多。然而,关于无症状胆管结石的治疗尚无共识。因此,研究人员对此进行了一项回顾性纵向队列研究,以根据内窥镜切除的时机调查无症状胆管结石的自然病史和临床结局。

方法
研究人员纳入了诊断为无症状的胆总管结石的患者,并将其分为原位结石随访的患者(观望组)和内镜下结石早期切除的患者(干预组)。估计并比较两组之间胆道并发症的累积发病率。

结果
本项研究共纳入了191例患者(观望组为114例,干预组为77例)。在观望组中,胆道并发症的累积发生率在1年时为6.1%,在3年时为11%,在5年时为17%。22例患者(19%)观察到结石无症状消失。25例(32%)患者(其中4例(5.2%)患有严重的胰腺炎观察到了无症状结石的早期内镜下结石清除的手术相关不良事件。胆道并发症的累积发病率功能因治疗策略而无差异(P = 0.55)。

结论
无症状性胆管结石患者中有很大一部分发生胆道并发症,但早期内镜下摘除似乎对预防进一步的胆道并发症影响不大。鉴于存在与手术相关的胰腺炎的风险,“静观其变”的策略可能成为无症状结石的治疗选择。

原始出处:

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    2020-03-28 许安
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  6. 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  7. 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  8. 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