Boggi U, Di Candio G, Campatelli A, Oleggini M, Pietrabissa A, Filipponi F, Bellini R, Mazzotta D, Mosca F
Dipartimento di Oncologia, Universita di Pisa, Italy.
Hepatogastroenterology. 1999 Jan-Feb;46(25):121-5.
BACKGROUND/AIMS: The aim of this study was to ascertain the therapeutic efficacy of percutaneous cholecystostomy in a selected group of high-risk patients who were physiologically unable to tolerate an open procedure.
We reviewed the hospital records of 11 critically ill patients who underwent percutaneous cholecystostomy for acute cholecystitis during the intensive care unit course of major underlying diseases.
Percutaneous cholecystostomy was easily performed in all cases (feasibility rate: 100%). No procedure-related death was recorded and minor complications occurred in 2 patients (18%). Percutaneous cholecystostomy led to resolution of the sepsis in all but 1 patient with gangrenous calcolous cholecystitis who required emergent cholecystectomy (success rate: 91%). Percutaneous cholecystostomy was the permanent treatment in all patients with acalcolous cholecystitis. Among patients with calcolous cholecystitis, 4 underwent delayed elective cholecystectomy, 1 required no further treatment, and 2 eventually died from the evolution of their underlying diseases. After a mean follow-up of 25 months (range: 12-32 months), none of the patients managed non-operatively required surgery or re-hospitalization.
Ease of performance, low complication rate, and high success rate make percutaneous cholecystostomy the procedure of choice for critically ill patients with acute cholecystitis. Whenever possible, percutaneous cholecystostomy should be followed by elective cholecystectomy. However, especially in acalcolous cholecystitis, it may constitute the definitive treatment.
背景/目的：本研究旨在确定经皮胆囊造瘘术对一组因生理原因无法耐受开放性手术的高危患者的治疗效果。
我们回顾了11例在患有严重基础疾病的重症监护病房期间因急性胆囊炎接受经皮胆囊造瘘术的重症患者的医院记录。
所有病例均轻松完成经皮胆囊造瘘术（成功率：100%）。未记录到与手术相关的死亡病例，2例患者（18%）出现轻微并发症。除1例患有坏疽性结石性胆囊炎且需要紧急胆囊切除术的患者外，经皮胆囊造瘘术使所有患者的败血症得到缓解（成功率：91%）。经皮胆囊造瘘术是所有无结石性胆囊炎患者的永久性治疗方法。在有结石性胆囊炎的患者中，4例行延期择期胆囊切除术，1例无需进一步治疗，2例最终因基础疾病进展而死亡。平均随访25个月（范围：12 - 32个月）后，所有非手术治疗的患者均无需手术或再次住院。
操作简便、并发症发生率低和成功率高使经皮胆囊造瘘术成为重症急性胆囊炎患者的首选治疗方法。只要有可能，经皮胆囊造瘘术后应行择期胆囊切除术。然而，特别是在无结石性胆囊炎中，它可能构成确定性治疗。
