Chang L, Moonka R, Stelzner M
Surgical Service, Veterans Administration Puget Sound Health Care System, Department of Surgery, University of Washington, Seattle, Washington 98108, USA.
Am J Surg. 2000 Sep;180(3):198-202. doi: 10.1016/s0002-9610(00)00476-1.
Surgical cholecystostomy has been shown to carry a significantly higher mortality rate at Veterans Administration (VA) hospitals than at non-federal hospitals in the past.
A retrospective outcomes study was undertaken at a large VA medical center with a policy favoring radiologic over surgical cholecystostomy over the past 9 years. Records of 24 consecutive patients with acute cholecystitis were reviewed to evaluate the effectiveness of the procedure.
Cholecystostomy was performed radiologically in 22 patients and surgically in 2 patients. Most (78%) of patients improved within 48 hours. The periprocedural mortality was 25%. The majority of these patients died from unrelated illnesses. Four patients developed complications, none of which required operative intervention.
Comorbidities are the most important mortality factor for cholecystostomies in VA patients. Radiologic tube placement is effective and uncomplicated in most cases.
过去研究表明，在退伍军人事务部（VA）医院进行外科胆囊造口术的死亡率显著高于非联邦医院。
在一家大型VA医疗中心进行了一项回顾性结局研究，该中心在过去9年中有一项倾向于采用放射学方法而非外科手术进行胆囊造口术的政策。回顾了连续24例急性胆囊炎患者的记录，以评估该手术的有效性。
22例患者通过放射学方法进行胆囊造口术，2例通过外科手术进行。大多数（78%）患者在48小时内病情改善。围手术期死亡率为25%。这些患者大多死于无关疾病。4例患者出现并发症，但均无需手术干预。
合并症是VA患者胆囊造口术最重要的死亡因素。在大多数情况下，放射学置管有效且操作简单。
