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The Role of Magnesium in Acute Pancreatitis and Pancreatic Injury: A Systematic Review. 镁在急性胰腺炎和胰腺损伤中的作用:系统综述。
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-26 DOI: 10.1159/000540507
Ilaria Pergolini, Stephan Schorn, Helmut Friess, Ihsan Ekin Demir

Introduction: As natural calcium (Ca) antagonist, magnesium (Mg) seems to counteract Ca-signaling pathways involved in the intracellular protease activation leading to acute pancreatitis. We systematically reviewed the current literature to investigate the role of Mg in the pathogenesis of acute pancreatitis and its possible use in detecting, predicting, and preventing acute pancreatitis.

Methods: A systematic search was performed in PubMed/Scopus/Web of Science to identify in vivo and in vitro studies reporting data on Mg in acute pancreatitis.

Results: Twelve studies were included. Due to their heterogeneity, we conducted a review without the intent of inference. Mg deficiency in pancreatic acinar cells seems to be frequently associated with serum hypocalcemia and acute pancreatitis. Mg seems to contrast intracellular Ca accumulation which induces premature enzyme activation and acute pancreatitis. Several in vivo and in vitro experiments showed beneficial effects of Mg supplementation in counteracting Ca-signaling pathways and subsequent pathological events. Moreover, a recent randomized trial demonstrated the efficacy of Mg supplementation in reducing the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in high-risk patients.

Conclusion: Mg is a natural antagonist of Ca-signaling pathways and, when deficient, predisposes to acute pancreatitis. Mg supplementation may be useful to prevent acute pancreatitis in many contexts, such as post-ERCP or after pancreatic surgery. The heterogeneity of the included studies represents an important limitation that may hinder robust conclusions.

简介:作为天然的钙(Ca)拮抗剂,镁(Mg)似乎可以抵消参与细胞内蛋白酶激活导致急性胰腺炎的Ca信号通路。我们系统地回顾了目前的文献,以研究镁在急性胰腺炎发病机制中的作用,以及镁在检测、预测和预防急性胰腺炎中的可能用途:方法:在PubMed/Scopus/Web of Science中进行了系统性检索,以确定报道镁在急性胰腺炎中作用的体内和体外研究数据:结果:共纳入 12 项研究。由于这些研究存在异质性,我们在不进行推论的情况下进行了综述。胰腺针叶细胞的镁缺乏似乎经常与血清低钙血症和急性胰腺炎有关。镁似乎与细胞内的钙积累形成对比,而钙积累会诱发过早的酶激活和急性胰腺炎。一些体内和体外实验表明,补充镁对抵消钙信号通路和随后的病理事件有益。此外,最近的一项随机试验表明,补充镁能有效降低高危患者内镜逆行胰胆管造影术(ERCP)后胰腺炎的发病率:结论:镁是钙信号通路的天然拮抗剂,缺乏时易引发急性胰腺炎。在许多情况下,例如胃食管返流术后或胰腺手术后,补充镁可能有助于预防急性胰腺炎。纳入研究的异质性是一个重要的局限性,可能会妨碍得出可靠的结论。
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引用次数: 0
Gastroesophageal Reflux Disease: Still a Complex and Complicated Disease with Many Uncertainties and Challenges. 胃食管反流病:胃食管反流病:仍然是一种复杂的疾病,存在许多不确定性和挑战。
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-14 DOI: 10.1159/000540531
Joachim Labenz, Yves Borbély
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引用次数: 0
Effect of Early Removal of Urinary Catheter in Patients Undergoing Abdominal and Thoracic Surgeries with Continuous Thoracic Epidural Analgesia on Postoperative Urinary Retention. 接受腹部和胸部手术并持续胸腔硬膜外镇痛的患者尽早拔除导尿管对术后尿潴留的影响
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-27 DOI: 10.1159/000540740
Ahmed Alwali, Ernst Klar, Imad Kamaleddine, Aenne Glass, Matthias Leuchter, Clemens Schafmayer, Eberhard Grambow

Background: Postoperative continuous thoracic epidural analgesia (TEA) is an integral aspect of pain management after major abdominal and thoracic surgery. Under TEA, postoperative urinary retention (POUR) is frequently noted, prompting a common practice of maintaining the transurethral catheter (UC) until the cessation of TEA to avoid the necessity for reinsertion of the UC. This study analyzes the effect of an early bladder catheter removal during TEA on POUR incidence.

Methods: The retrospective study was conducted on 71 patients undergoing elective abdominal and thoracic operations with TEA for postoperative pain control. Patients were divided into two groups based on the UC removal time in relation to the epidural catheter removal. In the early removal group (ERG), the UC was removed within 3 days of surgery, while in the standard group (SG), it was removed after completion of TEA. All patients in the ERG were still receiving TEA at the time of the UC removal. The primary outcome assessed was the incidence of POUR, while secondary outcomes included urinary tract infections (UTI), hospital length of stay (LOS), and patient's comfort.

Results: The overall prevalence of POUR was 7%, with five POUR cases - two (4.9%) of 41 patients in SG and three (10%) of 30 in ERG (p = 0.644). No significant difference was found in POUR occurrence between ERG and SG (p = 0.644). Additionally, no UTIs were observed in the study. The postoperative pain scores (visual analog scale [VAS]) 72 h and 96 h and the LOS (SG: 16.74 [±8.39] days; ERG: 14.53 [±6.99] days; p = 0.3) were similar between both study groups.

Conclusion: Based on our results, it can be concluded that the removal of UC in the early postoperative period, even during TEA, can be performed safely without significantly increasing the risk of recatheterization.

背景:术后连续胸硬膜外镇痛(TEA)是腹部和胸部大手术后疼痛治疗的一个重要方面。在 TEA 的作用下,术后尿潴留(POUR)经常出现,因此通常的做法是保留经尿道导尿管(UC)直到 TEA 停止,以避免重新插入 UC 的必要性。本研究分析了在 TEA 期间尽早拔除膀胱导尿管对 POUR 发生率的影响:这项回顾性研究针对 71 名接受择期腹部和胸部手术的患者进行,术后使用 TEA 控制疼痛。根据 UC 拔出时间与硬膜外导管拔出时间的关系,将患者分为两组。早期移除组(ERG)在手术后 3 天内移除 UC,而标准组(SG)则在完成 TEA 后移除 UC。在拔除 UC 时,ERG 组的所有患者仍在接受 TEA 治疗。评估的主要结果是POUR的发生率,次要结果包括尿路感染(UTI)、住院时间(LOS)和患者的舒适度:POUR的总发生率为7%,其中5例为POUR--41名SG患者中有2例(4.9%),30名ERG患者中有3例(10%)(P = 0.644)。ERG 和 SG 的 POUR 发生率无明显差异(p = 0.644)。此外,研究中未观察到尿毒症。两组患者术后 72 小时和 96 小时的疼痛评分(视觉模拟量表 [VAS])以及 LOS(SG:16.74 [±8.39] 天;ERG:14.53 [±6.99] 天;p = 0.3)相似:根据我们的研究结果,可以得出结论:在术后早期,即使是在 TEA 期间,也可以安全地切除 UC,而不会显著增加再次导管插入的风险。
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引用次数: 0
Endoscopic Resection of Neoplasia in the Lower GI Tract: A Clinical Algorithm. 下消化道肿瘤的内镜下切除术:临床算法。
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-26 DOI: 10.1159/000539219
Timothy O'Sullivan, Michael J Bourke

Background: Colorectal cancer is a highly prevalent malignancy and a significant driver of cancer mortality and health-related expenditure worldwide. Polyp removal reduces the incidence and mortality of colorectal cancer. In 2024, endoscopists have an array of resection modalities at their disposal. Each technique requires a unique skillset and has individual advantages and limitations. Consequently, resection in the colorectum requires an evidence-based algorithm approach that considers these factors.

Summary: A literature review of endoscopic resection for colonic neoplasia was conducted. Best supporting scientific evidence was summarized for the endoscopic resection of diminutive polyps, large ≥20 mm lesions and polyps containing invasive cancer. Factors including resection modality, complications and lesion selection were explored to inform an algorithm approach to colorectal resection.

Key messages: Endoscopic resection in the colorectum is not a one-size-fits-all approach. Detailed understanding of polyp size, location, morphology and predicted histology are critical factors that inform appropriate endoscopic resection practice.

背景:结直肠癌是一种高发恶性肿瘤,也是全球癌症死亡率和健康相关支出的重要驱动因素。切除息肉可降低结直肠癌的发病率和死亡率。2024 年,内镜医师可以使用一系列切除方式。每种技术都需要独特的技能,并具有各自的优势和局限性。因此,结直肠切除术需要一种基于证据的算法方法来考虑这些因素。摘要:对结肠肿瘤的内镜切除术进行了文献综述。总结了内镜下切除微小息肉、≥20 毫米大病变和含有浸润性癌的息肉的最佳科学证据。研究还探讨了切除方式、并发症和病变选择等因素,为结肠直肠切除术的算法提供参考:关键信息:内窥镜结直肠切除术并非放之四海而皆准的方法。详细了解息肉的大小、位置、形态和预测组织学是指导内镜切除术实践的关键因素。
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引用次数: 0
Endoscopy First: The Best Choice to Optimize Outcomes for Early Gastrointestinal Malignancy. 先做内镜检查:优化早期胃肠道恶性肿瘤治疗效果的最佳选择。
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-01 Epub Date: 2024-06-03 DOI: 10.1159/000539178
Konstantinos Kouladouros, Michael J Bourke
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引用次数: 0
Hepatocellular Carcinoma: The Role of Surgery in Liver Cirrhosis. 肝细胞癌:手术在肝硬化中的作用。
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-01 Epub Date: 2024-01-03 DOI: 10.1159/000535782
Dominik T Koch, Fabian Horné, Matthias P Fabritius, Jens Werner, Matthias Ilmer

Background: Liver surgery is an essential component of hepatocellular carcinoma (HCC) treatment. Advances in surgical techniques and perioperative care have improved outcomes and have helped to expand surgical indications. However, liver fibrosis and cirrhosis still remain major problems for liver surgery due to the relevant impact on liver regeneration of the future liver remnant (FLR) after surgery. Especially in patients with clinically significant portal hypertension due to liver cirrhosis, surgery is limited. Despite recent efforts in developing predictive models, estimating the postoperative hepatic function remains difficult.

Summary: In this review, we focus on the role of surgery in the treatment of HCC in structurally altered livers. The importance of assessing FLR with techniques such as contrast-enhanced CT, e.g., with the help of artificial intelligence is highlighted. Moreover, strategies for increasing the FLR with approaches like portal vein embolization and liver vein deprivation prior to surgery are discussed. Patient selection, minimally invasive liver surgery including robotic techniques, and perioperative concepts like the Enhanced Recovery After Surgery (ERAS) guidelines are identified as crucial parts of avoiding posthepatectomy liver failure.

Key message: The need for ongoing research to optimize patient selection criteria and perioperative care and to develop innovative biomarkers for outcome prediction is emphasized.

背景:肝脏手术是肝细胞癌(HCC)治疗的重要组成部分。手术技术和围手术期护理的进步改善了治疗效果,并有助于扩大手术适应症。然而,肝纤维化和肝硬化仍然是肝脏手术的主要问题,因为这对术后未来残余肝脏(FLR)的肝脏再生有相关影响。特别是对于因肝硬化导致门静脉高压的患者,手术治疗更是受到限制。摘要:在这篇综述中,我们重点讨论了手术在治疗肝脏结构改变的 HCC 中的作用。我们强调了利用对比增强 CT 等技术(如人工智能)评估 FLR 的重要性。此外,还讨论了通过门静脉栓塞和手术前剥夺肝静脉等方法提高FLR的策略。患者选择、微创肝脏手术(包括机器人技术)以及围手术期概念(如术后增强恢复(ERAS)指南)被认为是避免肝切除术后肝功能衰竭的关键部分:强调有必要持续开展研究,以优化患者选择标准和围手术期护理,并开发创新的生物标志物来预测结果。
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引用次数: 0
The Challenge of Anticoagulation in Liver Cirrhosis. 肝硬化患者抗凝治疗的挑战。
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-21 DOI: 10.1159/000535438
Julia Carolin Eichholz, Heiner Wedemeyer, Benjamin Maasoumy

Background: Advanced liver diseases are characterized by a number of changes in the hemostatic system. Due to the occurrence of bleeding events in patients with liver cirrhosis, there seems to be a hesitance to the administration of anticoagulant medications. This review summarizes challenges, recommendations, and current developments of anticoagulation in the cirrhotic patient.

Summary: The risk of thrombotic events in patients with liver cirrhosis is at least as high as in patients with healthy liver function if not even higher. Standard laboratory markers do not truly reflect the complexity of changes that take place in the coagulative system and therefore cannot be used as a reference for risk of thrombosis or hemorrhage. Potential options for anticoagulant therapy are heparins, vitamin K antagonists, and direct-acting oral anticoagulants which come with differences in safety, application, possible side effects, and data availability for the patient cohort.

Key message: The administration of anticoagulation can be beneficial in patients with liver disease if the indication is present and bleeding prophylaxis has been established. Direct-acting oral anticoagulants appear to be a promising new approach with many improvements compared to conventional substances. Nevertheless, there is a need for further data and prospective trials on the use in patients with liver cirrhosis.

背景:晚期肝病的特点是止血系统发生一系列变化。由于肝硬化患者会发生出血事件,因此在使用抗凝药物时似乎有些犹豫不决。摘要:肝硬化患者发生血栓事件的风险至少与肝功能健康的患者一样高,甚至更高。标准实验室指标不能真实反映凝血系统发生的复杂变化,因此不能作为血栓形成或出血风险的参考。抗凝疗法的潜在选择包括肝素、维生素 K 拮抗剂和直接作用口服抗凝剂,这些药物在安全性、应用、可能的副作用以及患者群体的数据可用性方面存在差异:关键信息:如果肝病患者有适应症并已确立出血预防措施,服用抗凝药对患者有益。直接作用口服抗凝剂似乎是一种很有前景的新方法,与传统药物相比有很多改进。然而,在肝硬化患者中使用这种药物还需要更多的数据和前瞻性试验。
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引用次数: 0
Baseline Interleukin-6 as a Preoperative Biomarker for Liver Fibrosis. 作为肝纤维化术前生物标志物的基线白细胞介素-6
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-27 DOI: 10.1159/000535627
Dominik Thomas Koch, Dionysios Koliogiannis, Moritz Drefs, Malte Schirren, Viktor von Ehrlich-Treuenstätt, Hanno Nieß, Bernhard Renz, Matthias Ilmer, Joachim Andrassy, Markus O Guba, Jens Werner, Florian Kühn

Introduction: Liver (hepatic) fibrosis (LF) is characterized by impaired function and regenerative capacity of the liver and can lead to significantly increased morbidity and mortality in the context of surgical liver resection (LR). For this reason, it is crucial to identify the extent of LF preoperatively. Interleukin-6 (IL-6) is known to play a key role in the pathogenesis of LF, but its exact value as a preoperative marker is unknown. This study aimed to investigate the correlation between preoperatively determined IL-6 and the presence of LF.

Methods: In this prospective study, IL-6 was determined in 134 consecutive patients undergoing LR. Patients with liver cirrhosis (LC) and patients with clinical or laboratory signs of inflammation were excluded. LF was graded by a blinded pathologist with regard to the degree of LF according to the Desmet classification (0-4). Baseline IL-6 and degree of LF were correlated.

Results: A total of 134 patients were prospectively included prior to LR. For 104 patients, LF was graded and inflammatory parameters were available. Thirty-five of these patients showed LC (Desmet 4), and another 33 patients showed preoperatively elevated inflammatory markers. Two of the remaining patients were liver transplant patients. These patients were excluded from the final analysis. According to Desmet, the remaining 34 patients had LF grade 0 or 1 (none or minimal LF) in 26 cases and LF grade 2 or 3 (moderate-to-severe LF) in 8 cases. Correlation of LF with preoperatively determined IL-6 yielded significantly higher IL-6 levels in the group of patients with moderate-to-severe LF (Desmet 2 or 3) compared to the group with none or minimal LF (Desmet 0 or 1; p = 0.0495).

Conclusion: In the context of LR, our results showed a correlation of preoperatively determined IL-6 with the extent of LF present. Higher serum baseline IL-6 concentrations were associated with a higher degree of LF, whereas no other blood parameter or score was that predictive for LF. Our results suggest that baseline IL-6 might serve as a valuable parameter to assess LF prior to LR. More patients need to be analyzed to further evaluate and confirm the predictive accuracy of IL-6 for LF.

导言:肝(肝)纤维化(LF)的特点是肝脏功能和再生能力受损,可导致手术肝切除(LR)的发病率和死亡率显著增加。因此,术前确定肝纤维化的程度至关重要。众所周知,白细胞介素-6(IL-6)在肝纤维化的发病机制中起着关键作用,但其作为术前标志物的确切价值尚不清楚。本研究旨在探讨术前测定的 IL-6 与 LF 存在之间的相关性:在这项前瞻性研究中,对 134 名连续接受 LR 的患者进行了 IL-6 测定。排除了肝硬化(LC)患者和有临床或实验室炎症迹象的患者。LF由盲法病理学家根据Desmet分类法(0-4)对LF程度进行分级。基线IL-6与LF程度相关:结果:共有 134 名患者在 LR 前接受了前瞻性研究。其中 104 例患者的 LF 已分级,炎症参数也已获得。其中 35 例患者出现低密度脂蛋白血症(Desmet 4),另有 33 例患者术前炎症指标升高。其余两名患者为肝移植患者。这些患者被排除在最终分析之外。根据 Desmet 的数据,其余 34 例患者中,26 例患者的 LF 等级为 0 或 1(无或轻度 LF),8 例患者的 LF 等级为 2 或 3(中度至重度 LF)。LF 与术前测定的 IL-6 的相关性显示,中重度 LF 患者组(Desmet 2 或 3)的 IL-6 水平明显高于无 LF 或轻度 LF 患者组(Desmet 0 或 1;P = 0.0495):我们的研究结果表明,在 LR 的情况下,术前测定的 IL-6 与 LF 的存在程度相关。较高的血清基线 IL-6 浓度与较高的 LF 程度相关,而其他血液参数或评分均不能预测 LF。我们的研究结果表明,基线 IL-6 可能是在 LR 之前评估 LF 的一个有价值的参数。需要对更多患者进行分析,以进一步评估和确认 IL-6 对 LF 的预测准确性。
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引用次数: 0
Microbiota Manipulation as an Emerging Concept in Cancer Therapy 操纵微生物群是癌症治疗的新概念
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-12 DOI: 10.1159/000534810
M. Spalinger, Michael Scharl
Background: The human body is colonized by billions of bacteria that provide nutrients to the host, train our immune system, and importantly affect our heath. It has long been suggested that microbes might play a role in tumor pathogenesis; however, compelling evidence was only provided in the past decades when novel detection methods that do not depend on culturing techniques had been developed. Summary: The microbiome impacts tumor development and anti-tumor therapies on various levels. Bacteria can promote or suppress tumor growth via direct interactions with cancer cells, production of metabolites that promote or inhibit tumor growth, and via stimulation or suppression of the local and systemic immune response. Cancer patients harbor a distinct microbiome when compared to healthy controls, which could potentially be employed to detect, identify, and treat cancer. Manipulation of the microbiome either via supplementation of single strains, bacterial consortia, fecal microbiota transfer or the use of pre- and probiotics has been suggested as therapeutic approach to directly target tumor growth or to enhance the efficacy of current state-of-the-art treatment options. Key Messages: (1) Bacteria have a tremendous impact on anti-cancer immune responses. (2) Cancer patients harbor a distinct microbiome when compared to healthy controls. (3) The microbiome seems to be cancer-type specific. (4) Exploitation of bacteria to promote anti-tumor therapy is a novel, very promising venue in cancer treatment.
背景:人体内有数十亿个细菌,它们为宿主提供营养,训练我们的免疫系统,并对我们的健康产生重要影响。长期以来,人们一直认为微生物可能在肿瘤发病机制中发挥作用;然而,直到过去几十年中,不依赖培养技术的新型检测方法被开发出来,才提供了令人信服的证据。摘要:微生物组在不同层面上影响着肿瘤的发展和抗肿瘤疗法。细菌可通过与癌细胞的直接相互作用、产生促进或抑制肿瘤生长的代谢物以及刺激或抑制局部和全身免疫反应来促进或抑制肿瘤生长。与健康对照组相比,癌症患者体内的微生物组截然不同,这有可能被用来检测、识别和治疗癌症。有人建议通过补充单一菌株、细菌联合体、粪便微生物群转移或使用预益生菌和益生菌来操纵微生物群,作为直接针对肿瘤生长或提高当前最先进治疗方案疗效的治疗方法。关键信息:(1)细菌对抗癌免疫反应有巨大影响。(2)与健康对照组相比,癌症患者体内的微生物组截然不同。(3)微生物组似乎具有癌症类型特异性。(4)利用细菌促进抗肿瘤治疗是癌症治疗中一个非常有前景的新领域。
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引用次数: 0
The Role of Open-Pore Film Drainage Systems in Endoscopic Vacuum Therapy: Current Status and Review of the Literature 开孔膜引流系统在内窥镜真空治疗中的作用:现状与文献综述
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-11 DOI: 10.1159/000535029
Konstantinos Kouladouros, Dörte Wichmann, Gunnar Loske
Background: Endoscopic vacuum therapy (EVT) is an increasingly popular endoscopic technique used for the treatment of wall defects in the gastrointestinal tract. Open-pore film drainage (OFD) systems are a new addition to the armamentarium of EVT and have shown encouraging results in a wide spectrum of applications. The aim of this review is to summarize the current literature on the applications of OFD systems in the gastrointestinal tract. Summary: Open-pore film drainage (OFD) systems have been used for the treatment of several defects of the gastrointestinal tract. The small size and easy placement of these devices make them very useful, particularly for the treatment of defects that are small in size or difficult to reach. OFDs have been successfully used for both perforations and anastomotic leaks in various locations, with most reports focusing on the treatment of duodenal defects, although successful applications in the esophagus, stomach, and colon have also been reported. Lately, the role of OFDs in preemptive EVT has also been explored. Key Messages: OFD systems are easy to use, particularly for small defects and challenging localizations. The current literature, consisting mainly of small case series and case reports, shows encouraging results, but further prospective studies are needed to explore and verify the indications and technical aspects of this innovative method.
背景:内窥镜真空治疗(EVT)是一种日益流行的内窥镜技术,用于治疗胃肠道壁缺损。开孔膜引流(OFD)系统是 EVT 的新成员,在广泛的应用中取得了令人鼓舞的效果。本综述旨在总结目前有关胃肠道开孔膜引流系统应用的文献。摘要:开孔薄膜引流系统(OFD)已被用于治疗多种胃肠道缺损。这些设备体积小、易于放置,因此非常有用,尤其是在治疗体积小或难以触及的缺损时。OFD 已成功用于治疗不同部位的穿孔和吻合口漏,大多数报道都集中在十二指肠缺损的治疗上,但也有成功应用于食道、胃和结肠的报道。最近,人们还探索了 OFD 在先期 EVT 中的作用。关键信息:OFD 系统易于使用,尤其适用于小缺损和具有挑战性的定位。目前的文献主要由小型病例系列和病例报告组成,显示了令人鼓舞的结果,但还需要进一步的前瞻性研究来探索和验证这种创新方法的适应症和技术方面。
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引用次数: 0
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Visceral Medicine
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