Department of Surgery, Faculty of Clinical and Experimental Medicine, Linköping University Hospital, Linköping, Sweden.
HPB (Oxford). 2009 May;11(3):183-93. doi: 10.1111/j.1477-2574.2009.00052.x.
Percutaneous cholecystostomy (PC) is an established low-mortality treatment option for elderly and critically ill patients with acute cholecystitis. The primary aim of this review is to find out if there is any evidence in the literature to recommend PC rather than cholecystectomy for acute cholecystitis in the elderly population.
In April 2007, a systematic electronic database search was performed on the subject of PC and cholecystectomy in the elderly population. After exclusions, 53 studies remained, comprising 1918 patients. Three papers described randomized controlled trials (RCTs), but none compared the outcomes of PC and cholecystectomy. A total of 19 papers on mortality after cholecystectomy in patients aged >65 years were identified.
Successful intervention was seen in 85.6% of patients with acute cholecystitis. A total of 40% of patients treated with PC were later cholecystectomized, with a mortality rate of 1.96%. Procedure mortality was 0.36%, but 30-day mortality rates were 15.4 % in patients treated with PC and 4.5% in those treated with acute cholecystectomy (P < 0.001).
There are no controlled studies evaluating the outcome of PC vs. cholecystectomy and the papers reviewed are of evidence grade C. It is not possible to make definitive recommendations regarding treatment by PC or cholecystectomy in elderly or critically ill patients with acute cholecystitis. Low mortality rates after cholecystectomy in elderly patients with acute cholecystitis have been reported in recent years and therefore we believe it is time to launch an RCT to address this issue.
经皮胆囊造口术（PC）是一种成熟的低死亡率治疗选择，适用于患有急性胆囊炎的老年和重症患者。本综述的主要目的是在文献中寻找证据，以确定在老年人群中，对于急性胆囊炎患者，PC 是否优于胆囊切除术。
2007 年 4 月，我们就 PC 和老年人群中的胆囊切除术这一主题进行了系统的电子数据库检索。排除后，共有 53 项研究纳入 1918 例患者。其中 3 篇论文描述了随机对照试验（RCT），但没有一项比较了 PC 和胆囊切除术的结果。共确定了 19 篇关于 >65 岁患者胆囊切除术后死亡率的论文。
急性胆囊炎患者中，有 85.6%的患者成功接受了干预。接受 PC 治疗的患者中，有 40%后来接受了胆囊切除术，死亡率为 1.96%。该操作的死亡率为 0.36%，但接受 PC 治疗的患者 30 天死亡率为 15.4%，而接受急性胆囊切除术治疗的患者死亡率为 4.5%（P<0.001）。
没有对照研究评估 PC 与胆囊切除术的结果，所审查的论文为 C 级证据。因此，对于患有急性胆囊炎的老年或重症患者，无法对 PC 或胆囊切除术的治疗做出明确的推荐。近年来，有研究报道老年急性胆囊炎患者的胆囊切除术后死亡率较低，因此我们认为现在是时候开展 RCT 来解决这个问题了。
