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大肠直肠癌联合会议课件.ppt 28页

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EBM Journal Club 2012-08-28 GS 謝閔傑 題目 張先生今年42歲,他接受健康檢查時,腹部超音波發現有脂肪肝以及膽囊內有兩顆結石約1.5公分,他被轉介到外科門診諮詢,一般外科陳醫師向他說明了一些膽結石可能會碰到的併發症,包括急性膽囊炎,膽管炎和胰臟炎,甚至少數可能轉變成為膽囊癌,所以建議他在年輕力壯,身體健康良好的時候接受腹腔鏡膽囊切除手術,但是張先生聽了之後覺得很猶豫不決,因為他平時並沒有任何進食後上腹部不適或是消化不良的症狀出現,但是他又很害怕會不會如陳醫師所言,以後出現嚴重的併發症而導致不可收拾?他想上網找一些實證醫學資料作為參考,您可以提供他一些有用的意見(到底要不要接受膽囊切除手術的決定)嗎 ? 實證醫學的 5 個步驟 步驟1: 形成臨床問題 步驟2: 尋找証據 步驟3: 嚴謹評估証據 步驟4: 臨床應用 步驟5: 評估效果 步驟1: 形成臨床問題 Type of Questions (1) Background questions (2) Foreground questions Background questions Gallstone disease Complication of gallstone? Acute cholecystitis Choledocholithiasis Acute pancreatitis 發生率? Asymptomatic or silence gallstone or incidental gallstone Background Knowledge ( From Up to date database) The routine use of ultrasonography for the evaluation of abdominal pain, pelvic disease, and abnormal liver function tests has led to the identification of incidental gallstones in many patients The majority of these patients have no symptoms attributable to the gallstones approximately 20 percent will become symptomatic during up to 15 years of follow-up. The likelihood of continued symptoms or the development of other complications of gallstone disease (such as cholecystitis, pancreatitis, and choledocholithiasis) is substantially higher in patients who have developed symptomatic gallstones. In a landmark study, for example, the entire population of a town in Italy (Sirmione) was screened by ultrasound for the presence of gallstones or gallstone related disease. Of 132 subjects with gallstones who were identified, the following observations were made: The overall prevalence of gallstones was 7 percent, was higher in women than men (9 versus 5 percent), and increased with advancing age. Patients with gallstones were significantly more likely to suffer from biliary pain compared with patients without gallstones (22 versus 2 percent). Eighty-two percent of patients found to have gallstones were not aware of having gallstones prior to the study; 16 percent of these patie

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