建議某些患者能於腹腔鏡胃繞道手術時一併切除膽囊


  April 24, 2007 (拉斯維加斯) — 一項追溯性回顧研究發現,於腹腔鏡胃繞道手術(laparoscopic Roux-en-Y gastric bypass,以下簡稱LRYGB)期間一併作膽囊切除,是安全、可行的方式,並能避免患者於後續再接受第二次手術,該項研究結果發表於美國腸胃暨內視鏡外科醫師學會年會中。
  
  根據研究人員的說法,於進行LRYGB時一併作例行性膽囊切除是具爭議性的;膽囊切除常用於病態性肥胖患者,膽石症(cholelithiasis)風險於快速減重期間升高,在胃繞道手術之後經口進入膽管的路徑即喪失。
  
  共有1696名患者被安排接受LRGYB,於手術前作超音波篩檢出膽囊病理反應;美國佛羅里達州Lauderdale堡克里夫蘭診所最低侵入性手術專家Olga Tucker醫師表示,我們想要研究到底在LRYGB期間一併作膽囊切除,能否降低將來的膽囊手術率;研究排除標準為先前做的膽囊切除、膽囊沉積物(結石)和小於1公分的息肉。
  
  有膽囊病理反應的205名患者中,有124名(60%)接受LRYGB合併膽囊切除(97%完成),之後不因膽囊病理反應而有死亡數或重大的發病率;然而,有膽囊病理反應的患者中,有82名並未同時接受膽囊切除,之後有16名(19%)有膽囊症狀,包括膽石絞痛(n = 8)、急性膽囊炎(n = 6),總膽管結結石(n = 2),需要後續接受膽囊切除;上述手術皆以腹腔鏡進行。
  
  研究中的1696名患者,有89名無手術前膽囊病理徵狀的患者(5.2%),在接受LRYGB(此群組中有69名患者隨後接受膽囊切除;有20名未接受)後惡化成膽石症。
  
  Tucker醫師指出,即使合併膽囊切除可能是沒必要的,但我們建議它應與LRYGB作選擇性的搭配使用。
  
  丹佛市科羅拉多大學的外科學教授Gregory Stiegmann醫師評論道,我認為這是個合理的結論,雖然(就研究中所排除的案例而論)小於1公分的(膽囊)息肉不常見,但這個問題應獲重視。
  
  Tucker醫師和Stiegmann醫師表示雙方無相關的財務關係。
  
  美國腸胃暨內視鏡外科醫師學會年度科學會議:摘要P010。2007年4月20日發表。

Concomitant Cholecystectomy Du

By Lexa W Lee, ND
Medscape Medical News

April 24, 2007 (Las Vegas) — Concomitant cholecystectomy during laparoscopic Roux-en-Y gastric bypass (LRYGB) for gallbladder pathology is safe, feasible, and avoids subjecting patients to a second surgical procedure later on. Findings of a retrospective review of patients undergoing LRYGB were presented here at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

Routine cholecystectomy during LRYGB is controversial, according to the researchers. Cholecystopathy is common in morbid obesity, the risk of cholelithiasis increases during rapid weight loss, and transoral access to the biliary tree is lost after gastric bypass.

A total of 1696 patients scheduled to undergo LRGYB were screened by ultrasound preoperatively for gallbladder pathology.  Olga Tucker, MD, a specialist of minimally invasive surgery at the Cleveland Clinic in Fort Lauderdale, Florida, said, "We wanted to investigate whether concomitant cholecystectomy during LRYGB reduced the need for further gallbladder surgery." Study exclusion criteria were previous cholecystectomy, gallbladder sludge, and polyps smaller than 1 cm.

Of 205 patients with gallbladder pathology, 124 (60%) underwent cholecystectomy concomitant with LRYGB (97% were completed laparoscopically), after which there was no mortality or significant morbidity due to gallbladder pathology. However, of the 82 patients with gallbladder pathology who did not undergo concomitant cholecystectomy, 16 (19%) later presented with gallbladder symptoms, including biliary colic (n = 8), acute cholecystitis (n = 6), and choledocolithiasis (n = 2), which required subsequent cholecystectomy; all were performed laparoscopically.

Of the total 1696 patients in the study, 89 (5.2%) without preoperative gallbladder pathology developed cholelithiasis after LRYGB (69 patients in this group subsequently had a cholecystectomy; 20 did not).

Dr. Tucker stated, "While routine concomitant cholecystectomy is probably unnecessary, we advocate its selective use with LRYGB."

Gregory Stiegmann, MD, professor of surgery at the University of Colorado in Denver, commented, "I think this is a sensible conclusion, although it should be pointed out [regarding exclusions to the study] that [gallbladder] polyps smaller than 1 cm can be a problem, just not a common one."

Dr. Tucker and Dr. Stiegmann report no relevant financial relationships.

SAGES 2007 Annual Scientific Session: Abstract P010. Presented April 20, 2007.

    



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