Patel M, Miedema B W, James M A, Marshall J B
Division of Gastroenterology, University of Missouri Hospital and Clinics, Columbia, USA.
Am Surg. 2000 Jan;66(1):33-7.
We sought to determine the safety, efficacy, and outcome of percutaneous cholecystostomy (PC) in all patients undergoing the procedure at our institutions. We reviewed 53 consecutive cases of acute cholecystitis seen at our hospitals over 5.5 years in which PC was performed at the initial treatment. Follow-up was obtained by chart review and telephone questionnaire. Acute cholecystitis was the primary admitting diagnosis in 18 cases. In the remaining 35, cholecystitis developed during hospitalization. All patients were considered high surgical risks on the basis of the presence of comorbid conditions. The gallbladder was successfully catheterized under radiologic guidance in all patients and with no immediate procedure-related morbidity. Acute cholecystitis resolved in 44 of 53 patients (83%), whereas nine patients (17%) did not improve clinically after PC and died during the same hospitalization. A total of 33 (62%) eventually survived hospitalization. Elective cholecystectomy was done in 25 patients with no mortality. After cholecystectomy, three of these patients subsequently died of other causes, whereas 22 are alive. Eight patients did not undergo cholecystectomy because of underlying medical conditions or because they had acalculous cholecystitis. These patients remained free of biliary problems after removal of their cholecystostomy tube, but two have subsequently died of nonbiliary conditions. Percutaneous cholecystostomy is a safe, effective treatment for high-risk patients with acute cholecystitis. Cholecystostomy can be followed by elective cholecystectomy at a later time if the patient's condition permits or by expectant conservative management in patients who have had acalculous cholecystitis or have a very high mortality risk with surgery.
我们试图确定在我们机构接受经皮胆囊造瘘术（PC）的所有患者的安全性、有效性及治疗结果。我们回顾了5.5年间在我们医院连续收治的53例急性胆囊炎患者，这些患者在初始治疗时接受了PC。通过查阅病历和电话问卷调查进行随访。18例患者以急性胆囊炎作为主要入院诊断。其余35例患者在住院期间发生胆囊炎。所有患者因存在合并症均被视为高手术风险患者。所有患者均在放射学引导下成功进行胆囊置管，且无即刻与操作相关的并发症。53例患者中有44例（83%）急性胆囊炎得以缓解，而9例患者（17%）在PC术后临床症状未改善，并在同一住院期间死亡。共有33例（62%）最终存活出院。25例患者接受了择期胆囊切除术，无死亡病例。胆囊切除术后，其中3例患者随后死于其他原因，而22例患者存活。8例患者因基础疾病或患有非结石性胆囊炎未接受胆囊切除术。拔除胆囊造瘘管后，这些患者未再出现胆道问题，但其中2例随后死于非胆道疾病。经皮胆囊造瘘术是治疗高危急性胆囊炎患者的一种安全、有效的方法。如果患者情况允许，胆囊造瘘术后可择期行胆囊切除术；对于患有非结石性胆囊炎或手术死亡风险极高的患者，可采取保守观察治疗。
