Edward C.s. Lai;Francis P.t. Mok;Eliza S.y. Tan;Chung Mau lo;上达 范;Kok Tjang You;John Wong
University of Hong Kong;China Association for Science and Technology
发表时间:1992-6-11
期 刊:New England Journal of Medicine
语 言:English
U R L: http://www.scopus.com/inward/record.url?scp=0026692895&partnerID=8YFLogxK
Emergency surgery for patients with severe acute cholangitis due to choledocholithiasis is associated with substantial morbidity and mortality. Because recent results suggested that emergency endoscopic drainage could improve the outcome of such patients, we undertook a prospective study to determine the role of this procedure as initial treatment. During a 43-month period, 82 patients with severe acute cholangitis due to choledocholithiasis were randomly assigned to undergo surgical decompression of the biliary tract (41 patients) or endoscopic biliary drainage (41 patients), followed by definitive treatment. Hospital mortality was analyzed with respect to the use of endoscopic biliary drainage and other clinical and laboratory findings. Prognostic determinants were studied by linear discriminant analysis. Complications related to biliary tract decompression and subsequent definitive treatment developed in 14 patients treated with endoscopic biliary drainage and 27 treated with surgery (34 vs. 66 percent, P>0.05). The time required for normalization of temperature and stabilization of blood pressure was similar in the two groups, but more patients in the surgery group required ventilatory support. The hospital mortality rate was significantly lower for the patients who underwent endoscopy (4 deaths) than for those treated surgically (13 deaths) (10 vs. 32 percent, P<0.03). The presence of concomitant medical problems, a low platelet count, a high serum urea nitrogen concentration, and a low serum albumin concentration before biliary decompression were the other independent determinants of mortality in both groups. Endoscopic biliary drainage is a safe and effective measure for the initial control of severe acute cholangitis due to choledocholithiasis and to reduce the mortality associated with the condition. (N Engl J Med 1992;326:1582–6.), THE use of endoscopic papillotomy and nasobiliary drainage, either alone or in combination, is a satisfactory alternative to emergency exploration of the common bile duct in the treatment of patients with acute cholangitis due to choledocholithiasis.1 2 3 4 5 6 Although surgery has been the conventional treatment for these patients, remarkably low mortality rates of 4.7 and 7.6 percent have been reported in patients treated by endoscopy.1 , 4 Since these encouraging results of endoscopy were obtained in retrospective or prospective but uncontrolled studies, the advantage of endoscopic drainage remains unproved. Indeed, in a selected group of patients who had emergency surgery, we found a mortality…
医学与生命科学
Scopus度量
年份 | CiteScore | SJR | SNIP |
---|---|---|---|
1996 | |||
1997 | |||
1998 | |||
1999 | 7.361 | 10.989 | |
2000 | 8.367 | 10.43 | |
2001 | 8.571 | 10.65 | |
2002 | 9.315 | 11.39 | |
2003 | 10.407 | 13.878 | |
2004 | 11.349 | 13.963 | |
2005 | 9.888 | 12.13 | |
2006 | 10.173 | 11.886 | |
2007 | 10.481 | 11.853 | |
2008 | 11.386 | 11.487 | |
2009 | 11.765 | 11.932 | |
2010 | 13.149 | 11.382 | |
2011 | 56 | 13.674 | 12.685 |
2012 | 60.2 | 13.984 | 13.287 |
2013 | 58 | 14.796 | 14.706 |
2014 | 57.3 | 16.259 | 13.935 |
2015 | 57.4 | 16.591 | 13.011 |
2016 | 61.1 | 18.009 | 12.685 |
2017 | 67.2 | 19.476 | 12.908 |
2018 | 73.1 | 19.524 | 13.73 |
2019 | 66.1 | 18.291 | 13.212 |
2020 | 67.6 |
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