老年人或合并症较多的患者在胆总管结石治疗后是否有必要进行胆囊切除术?

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS
Masahiro Shiihara, Yasuhiro Sudo, Norimasa Matsushita, Takeshi Kubota, Yasuhiro Hibi, Harushi Osugi, Tatsuo Inoue
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引用次数: 0

摘要

简介我们对胆总管结石内镜治疗后的预后进行了评估,尤其是对手术耐受性较差的患者。对于胆总管结石合并胆结石的患者,通常建议进行结石清除术和胆囊切除术,以防止胆道疾病复发。然而,对于手术耐受性不佳的患者,如老年人或合并症较多的患者,其胆总管结石治疗后的预后仍存在争议:我们回顾性分析了2012年1月至2021年12月期间在我院接受治疗的胆总管结石患者的数据。根据是否进行胆囊切除术,将接受内镜下括约肌切开术的患者分为胆囊切除术组(CHOLE)和保留胆囊组(CONS),并对他们的预后进行比较。此外,我们还对年龄调整后查尔森疾病指数(aCCI)评分较高的患者中导致胆道事件复发的因素进行了逻辑回归分析:在169名参与者中,110人患有胆结石,被分为CHOLE组(n=56)和CONS组(n=54)。CONS组患者明显有序,合并症较多,aCCI评分较高,而CHOLE组复发性胆道事件较少,但不明显(P= 0.122)。在胆道感染≥2级的复发率和胆道事件相关死亡率方面,两组间未观察到差异。在aCCI评分≥5分的患者中,不进行胆囊切除术而保留胆囊并不是胆道事件复发的独立风险因素:结论:胆总管结石治疗后进行胆囊切除术可预防复发性胆道事件,但对于 aCCI 评分较高的患者,不进行胆囊切除术而保留胆囊是一种可行的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is Cholecystectomy Necessary after Choledocholithiasis Treatment for the Elderly or Patients with Many Comorbidities?

Introduction: We evaluated the prognosis after endoscopic treatment for choledocholithiasis, particularly in patients with borderline tolerance to surgery. Stone removal and cholecystectomy are generally recommended for patients with choledocholithiasis combined with gallstones to prevent recurrent biliary events. However, the prognosis after choledocholithiasis treatment in patients with borderline tolerance to surgery, such as the elderly or those with many comorbidities, remains controversial.

Methods: We retrospectively analyzed data from patients with choledocholithiasis treated at our facility between January 2012 and December 2021. Patients who underwent endoscopic sphincterotomy were dichotomized into the cholecystectomy (CHOLE) and conservation (CONS) groups depending on whether cholecystectomy was performed, and their prognoses were subsequently compared. Furthermore, we performed a logistic regression analysis of the factors contributing to recurrent biliary events in patients with high age-adjusted Charlson Comorbidity Index (aCCI) scores.

Results: Of 169 participants, 110 had gallstones and were divided into the CHOLE (n = 56) and CONS (n = 54) groups. The CONS group was significantly ordered, had more comorbidities, and higher aCCI scores, whereas the CHOLE group had fewer recurrent biliary events, although not significant (p = 0.122). No difference was observed in the recurrent incidence of grade ≥2 biliary infections and mortality related to biliary events between the groups. In patients with aCCI scores ≥5, conservation without cholecystectomy was not an independent risk factor for recurrent biliary events.

Conclusion: Cholecystectomy after choledocholithiasis treatment prevents recurrent biliary events, but conservation without cholecystectomy is a feasible option for patients with high aCCI scores.

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来源期刊
ACS Applied Bio Materials
ACS Applied Bio Materials Chemistry-Chemistry (all)
CiteScore
9.40
自引率
2.10%
发文量
464
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