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Issue Date
2015-06
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Choledocholithiasis after cholecystectomy at Landspítali - The National University Hospital of Iceland 2008-2011Citation
Læknablaðið 2015, 101(6):299-303Abstract
Inngangur: Einkenni gallsteina í gallrás geta komið fram eftir gallblöðrutöku. Ef þau koma fram innan tveggja ára er talið að steinn hafi verið til staðar við aðgerðina. Tilgangur rannsóknarinnar var að kanna þá sjúklinga sem greindust með gallrásarstein eftir að hafa farið í gallblöðrutöku á Landspítala á árunum 2008-2011. Efniviður og aðferðir: Afturskyggn rannsókn þar sem upplýsingum um sjúklinga var safnað úr sjúkraskrárkerfi Landspítala. Meðal þess sem var skráð voru lifrarpróf, niðurstöður myndgreininga, tími frá aðgerð, meðferð og fylgikvillar. Niðurstöður: Á rannsóknartímabilinu greindust 40 sjúklingar með gallrásarstein eftir gallblöðrutöku. Meðalaldur var 50 ár (20-89) og konur voru 24 (60%). Meðaltími frá aðgerð að greiningu gallrásarsteins voru 382 dagar. Greining var staðfest í 87,5% tilfella. Hjá 36 sjúklingum (90%) var brugðist við með röntgenrannsókn á gallvegum og brisgangi með holsjá. Gall-rásarmyndataka með ástungu gegnum kviðvegg og lifur var gerð hjá einum sjúklingi, einn fór í opna aðgerð en þremur sjúklingum batnaði án meðferðar. Þrír sjúklingar fengu fylgikvilla í kjölfar meðferðar. Gallrásarsteinn greindist innan við tveimur árum frá aðgerð hjá 31 sjúklingi (77,5%). Tíðni fyrri gallrásarsteina, gildi bílirúbíns og víkkun á gallgöngum án sjáanlegs steins var svipuð, hvort sem steinar greindust snemma eða seint. Ályktun: Nær alla er hægt að meðhöndla án skurðaðgerðar. Þó meirihluti steina greinist innan tveggja ára verður ekki séð að grunur um gallrásarstein hafi átt að vakna við sjálfa gallblöðrutökuna hjá meirihluta sjúklinga.Introduction: Symptoms of choledocholithiasis can appear after cholecystectomy. Stones diagnosed during the first two years following surgery are assumed to have been present at the time of surgery. The purpose of this study was to study patients who presented with choledocholithiasis at Landspitali - The National University Hospital of Iceland, during the period 2008-2011, who had previously undergone cholecystecomy and to assess whether cholodocholithiasis is underdiagnosed at the time of cholecystectomy. Material and methods: The study was retrospective, data was collected from medical records at Landspitali. Among recorded data were liver function tests, imaging results, time from surgery to diagnosis, treatment and complications. Results: Forty patients presented with choledocholithiasis after previous cholecystectomy. Mean age was 50 years (20-89) and women were 24 (60%). Mean time from surgery to diagnosis was 382 days. Diagnosis was confirmed with imaging in 35 (87.5% cases). Thirty six (90%) patients were treated with ERCP, one with PTC and one underwent open surgery. Three patients healed without treatment. Three patients developed complications from treatment. Thirty one (77.5%) had choledocholithiasis in the first 2 years following surgery. Incidence of previous choledocholithiasis, elevated bilirubin or widening of the choledochus without visible stones where similar for those diagnosed with choledocholithiasis in the first two years and those diagnosed later. Conclusion: Majority of patients are treated without surgery. Most stones are diagnosed during the first two years following surgery. For the majority of cases it can not be concluded that stones should have been suspected at time of cholecystectomy.
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