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[择期胆囊切除术前行常规食管胃十二指肠镜检查的价值]

[Value of routine preoperative oesophagogastroduodenoscopy before elective cholecystectomy].

作者信息

Dimitriou I, Reckmann B, Nephuth O, Betzler M

机构信息

Alfried Krupp Krankenhaus, Klinik für Allgemeine Chirurgie, Unfallchirurgie, Gefäßchirurgie, Essen, Deutschland.

出版信息

Zentralbl Chir. 2012 Feb;137(1):38-42. doi: 10.1055/s-0030-1247365. Epub 2010 May 25.

Abstract

BACKGROUND

Symptomatic gallstones and inflammatory diseases of the gastroduodenum are common causes of upper abdominal pain. PATIENTS / MATERIAL AND METHODS: We evaluated the data of 766  patients who underwent pre-operative oesophagogastroduodenoscopy before elective surgical treatment of cholelithiasis between January  1, 2003 and March 31, 2008.

RESULTS

Pathological findings of an inflammatory nature were seen in 43.1 % (330 / 766), 25.2 % (197 / 766) of the patients had a chronic gastritis, 14.9 % (114 / 766) an acute gastritis and 3 % (54 / 766) a gastroduodenal ulcer. Non-specific upper abdominal pain was not significantly related to an inflammatory gastroduodenal dis-ease (p = 0.0755). Independent of the history (p = 0.1065), the therapy concept had to be -changed in favour of a primary non-surgical therapy in 16.3 % (125 / 766) of the examined patients due to relevant gastroscopic findings.

CONCLUSIONS

The case history is not sufficient for identifying gastroduodenal disease requiring treatment in patients with symptomatic gall-stones. Therefore, contrary to the current leading concepts, preoperative oesophagogastroduodenoscopy should be discussed as a matter of -routine in patients undergoing elective cholecystectomy in order to treat pathological gastroduodenal findings.

摘要

背景

有症状的胆结石和胃十二指肠炎性疾病是上腹部疼痛的常见原因。患者/材料与方法:我们评估了2003年1月1日至2008年3月31日期间766例在择期手术治疗胆结石前接受术前食管胃十二指肠镜检查的患者的数据。

结果

43.1%(330/766)的患者有炎症性质的病理发现,25.2%(197/766)的患者患有慢性胃炎,14.9%(114/766)患有急性胃炎,3%(54/766)患有胃十二指肠溃疡。非特异性上腹部疼痛与胃十二指肠炎性疾病无显著相关性(p = 0.0755)。与病史无关(p = 0.1065),由于相关的胃镜检查结果,16.3%(125/766)的受检患者的治疗方案不得不改为首选非手术治疗。

结论

病史不足以识别有症状胆结石患者中需要治疗的胃十二指肠疾病。因此,与当前的主流观念相反,对于接受择期胆囊切除术的患者,应常规讨论术前食管胃十二指肠镜检查,以便治疗胃十二指肠的病理发现。

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