Kim H J, Lee S K, Kim M H, Yoo K S, Lim B C, Seo D W, Min Y I
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Gastrointest Endosc. 2000 Nov;52(5):645-9. doi: 10.1067/mge.2000.107286.
The aim of the present study was to evaluate the diagnostic and therapeutic usefulness of percutaneous transhepatic cholecystoscopy in high-risk surgical patients with acute cholecystitis.
Between January 1992 and June 1998, there were 33 consecutive patients who underwent percutaneous transhepatic cholecystostomy and subsequent percutaneous transhepatic cholecystoscopy for the management of acute cholecystitis.
Percutaneous transhepatic cholecystostomy and subsequent percutaneous transhepatic cholecystoscopy were successfully accomplished in all 33 patients. During percutaneous transhepatic cholecystoscopy, minor complications (2 episodes of minor bleeding during electrohydraulic lithotripsy, 2 of tube dislodgement, and 1 of bile leakage to peritoneum) occurred in 5 patients. Percutaneous transhepatic cholecystoscopy revealed gallstones in 26 cases, sludge ball in 3, gallbladder carcinoma in 3, and 1 case of clonorchiasis related with acute cholecystitis. The 3 gallbladder cancers which were not identified radiologically were found incidentally during percutaneous transhepatic cholecystoscopy. For the 26 patients with gallstones, percutaneous transhepatic cholecystoscopy and concomitant stone removal were successful in 1 to 4 consecutive sessions (mean 2.2 sessions). Gallstones recurred in 3 of 22 patients (14%) during the mean follow-up period of 27 months. All of them remain asymptomatic.
Percutaneous transhepatic cholecystostomy may be justified in the management of acute cholecystitis in selected patients with high surgical risk.
本研究的目的是评估经皮经肝胆道镜检查在急性胆囊炎高危手术患者中的诊断和治疗价值。
1992年1月至1998年6月，连续有33例患者接受经皮经肝胆囊造瘘术及随后的经皮经肝胆道镜检查以治疗急性胆囊炎。
33例患者均成功完成经皮经肝胆囊造瘘术及随后的经皮经肝胆道镜检查。在经皮经肝胆道镜检查期间，5例患者出现轻微并发症（2例在液电碎石术中轻微出血、2例引流管移位、1例胆汁漏入腹腔）。经皮经肝胆道镜检查发现26例有胆结石，3例有胆泥球，3例有胆囊癌，1例为与急性胆囊炎相关的华支睾吸虫病。3例术前影像学未发现的胆囊癌在经皮经肝胆道镜检查时意外发现。对于26例有胆结石的患者，经皮经肝胆道镜检查及同期取石在1至4个连续疗程中成功（平均2.2个疗程）。22例患者中有3例（14%）在平均27个月的随访期内胆结石复发。他们均无症状。
对于部分手术风险高的急性胆囊炎患者，经皮经肝胆囊造瘘术可能是合理的治疗方法。
