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我们是否过度治疗了患者?无症状胆总管结石治疗后内镜逆行胰胆管造影术胰腺炎风险大幅增加

[Do we overtreat patients? Heavily increased risk for ERCP pancreatitis after treatment for asymptomatic common bile duct stones].

作者信息

Videhult Per

机构信息

Kirurgkliniken, Västmanlands sjukhus - Västerås, Sweden Kirurgkliniken, Västmanlands sjukhus - Västerås, Sweden.

出版信息

Lakartidningen. 2019 Aug 23;116:FRY7.

Abstract

Common bile duct stones (CBDS) as well as ERCP treatment may cause jaundice, pancreatitis and cholangitis. More than half of the patients with asymptomatic CBDS found on intraoperative cholangiography pass all of their stones spontaneously. The ERCP treatment of asymptomatic common bile duct stones seems to carry a fivefold increased risk for complications, especially pancreatitis. It is unclear what carries the highest complication risk, untreated asymptomatic CBDS or ERCP treatment. The high risk for life-threatening complications combined with high rate of spontaneous stone passage raises the question of whether routine treatment of asymptomatic CBDS is justified.

摘要

胆总管结石(CBDS)以及内镜逆行胰胆管造影术(ERCP)治疗可能会导致黄疸、胰腺炎和胆管炎。术中胆管造影发现的无症状胆总管结石患者中,超过一半会自行排出所有结石。对无症状胆总管结石进行ERCP治疗似乎会使并发症风险增加五倍,尤其是胰腺炎。目前尚不清楚哪种情况并发症风险最高,是未经治疗的无症状胆总管结石还是ERCP治疗。危及生命的并发症高风险以及结石自行排出的高发生率,引发了对于无症状胆总管结石进行常规治疗是否合理的质疑。

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