Chopra S, Dodd G D, Mumbower A L, Chintapalli K N, Schwesinger W H, Sirinek K R, Dorman J P, Rhim H
Department of Radiology, Mail Code 7800, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
AJR Am J Roentgenol. 2001 Apr;176(4):1025-31. doi: 10.2214/ajr.176.4.1761025.
This study was performed to compare the clinical outcome after gallbladder aspiration with that after percutaneous cholecystostomy in non-critically ill patients with acute cholecystitis who were at high risk from surgery.
Medical records of 53 consecutive non-critically ill, high-surgical-risk patients admitted with acute cholecystitis between July 1995 and July 1999 were reviewed. Thirty-one had gallbladder aspiration and 22 had percutaneous cholecystostomy. The primary outcome measure of clinical response within 72 hr and the secondary outcome measures of overall positive response rate, complication rate, time to resolution, and rate of recurrence of acute cholecystitis were compared between the two groups.
Gallbladder aspiration and percutaneous cholecystostomy were technically successful in 30 (97%) and 21 (97%) patients, respectively; of these, 23 (77%) and 19 (90%) patients responded clinically within 72 hr (p > 0.2). Complications occurred in three patients (12%) after percutaneous cholecystostomy and in none after gallbladder aspiration (p < 0.05). No significant difference was noted in the other secondary outcome measures of the two groups.
We found no significant difference in the clinical outcomes of gallbladder aspiration and percutaneous cholecystostomy in the treatment of acute cholecystitis in high-surgical-risk patients who are not critically ill. However, we found gallbladder aspiration to be significantly safer. Therefore, gallbladder aspiration should be the procedure of choice in high-risk patients with acute cholecystitis who are not critically ill, and percutaneous cholecystectomy should be reserved as a salvage procedure if gallbladder aspiration is technically or clinically unsuccessful.
本研究旨在比较胆囊穿刺抽吸术与经皮胆囊造瘘术在手术风险高的非危重症急性胆囊炎患者中的临床疗效。
回顾了1995年7月至1999年7月期间连续收治的53例非危重症、手术风险高的急性胆囊炎患者的病历。31例行胆囊穿刺抽吸术，22例行经皮胆囊造瘘术。比较两组患者72小时内临床反应的主要结局指标以及总体阳性反应率、并发症发生率、症状缓解时间和急性胆囊炎复发率等次要结局指标。
胆囊穿刺抽吸术和经皮胆囊造瘘术在技术上分别成功应用于30例（97%）和21例（97%）患者；其中，23例（77%）和19例（90%）患者在72小时内出现临床反应（p>0.2）。经皮胆囊造瘘术后3例患者（12%）发生并发症，胆囊穿刺抽吸术后无并发症发生（p<0.05）。两组的其他次要结局指标无显著差异。
我们发现胆囊穿刺抽吸术和经皮胆囊造瘘术在治疗非危重症、手术风险高的急性胆囊炎患者时，临床疗效无显著差异。然而，我们发现胆囊穿刺抽吸术明显更安全。因此，对于非危重症急性胆囊炎的高危患者，胆囊穿刺抽吸术应作为首选方法；如果胆囊穿刺抽吸术在技术上或临床上不成功，经皮胆囊造瘘术应留作挽救性手术。
