Demehri Farokh R, Alam Hasan B
Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
J Intensive Care Med. 2016 Jan;31(1):3-13. doi: 10.1177/0885066614554192. Epub 2014 Oct 15.
Gallstone-related disease is among the most common clinical problems encountered worldwide. The manifestations of cholelithiasis vary greatly, ranging from mild biliary colic to life-threatening gallstone pancreatitis and cholangitis. The vast majority of gallstone-related diseases encountered in an acute setting can be categorized as biliary colic, cholecystitis, choledocholithiasis, and pancreatitis, although these diagnoses can overlap. The management of these diseases is uniquely multidisciplinary, involving many specialties and treatment options. Thus, care may be compromised due to redundant tests, treatment delays, or inconsistent management. This review outlines the evidence for initial evaluation, diagnostic workup, and treatment for the most common gallstone-related emergencies. Key principles include initial risk stratification of patients to aid in triage and timing of interventions, early initiation of appropriate antibiotics for patients with evidence of cholecystitis or cholangitis, patient selection for endoscopic biliary decompression, and growing evidence in favor of early laparoscopic cholecystectomy for clinically stable patients.
胆石相关疾病是全球范围内最常见的临床问题之一。胆石症的表现差异很大，从轻微的胆绞痛到危及生命的胆石性胰腺炎和胆管炎。在急性情况下遇到的绝大多数胆石相关疾病可归类为胆绞痛、胆囊炎、胆总管结石和胰腺炎，尽管这些诊断可能相互重叠。这些疾病的管理具有独特的多学科性质，涉及许多专业和治疗选择。因此，由于重复检查、治疗延迟或管理不一致，护理可能会受到影响。本综述概述了最常见的胆石相关急症的初始评估、诊断检查和治疗的证据。关键原则包括对患者进行初始风险分层以帮助进行分诊和确定干预时机，对有胆囊炎或胆管炎证据的患者尽早开始使用适当的抗生素，选择患者进行内镜胆道减压，以及越来越多的证据支持对临床稳定的患者尽早进行腹腔镜胆囊切除术。
