Saeed Shaista Afzal, Masroor Imrana
Department of Radiology, The Aga Khan University Hospital, Stadium Road, Karachi.
J Coll Physicians Surg Pak. 2010 Sep;20(9):612-5.
To determine the role of ultrasound-guided percutaneous cholecystostomy (PC) regarding complications and outcome in the management of acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management.
Observational case series.
The study was carried out at The Aga Khan University Hospital, Karachi, from January 2003 to December 2007.
The study included patients admitted with acute cholecystitis considered unfit for immediate surgery but not responding to conservative management. Percutaneous cholecystostomy was conducted under ultrasound guidance. The studied variables included patients' demographics, co-morbid, ultrasound findings of biliary tree, indication for percutaneous cholecystostomy, its route, complication during or after procedure, patient's clinical outcome (upto 48 hours) and 30 days follow-up. Those with incomplete medical record and follow-up were excluded. Data were analyzed and results compiled using SPSS 16.0 version. Mean and standard deviation for quantitative variable like age was derived. Proportions were computed for complications and patient's clinical outcome.
Forty one patients with complete medical record were studied including 15 (37%) males and 26 (63%) females. Mean age was 65 +/-13.5 years. Indications for PC included calculus cholecystitis in 25, acalculous cholecystitis in 10, empyema in 04 and gallbladder perforation in 02 patients. No complication was seen during or after procedure in 31 (75%) patients. Complications occurred in 10 (25%) patients including vagal reaction, pain during procedure, tube blockage, catheter dislodgement and bile leakage. Favourable clinical response (improvement in clinical symptoms) was noted in 34 (83%) patients. Seven (17%) patients did not show any improvement in clinical condition after the procedure. On 30 days follow-up, 9 patients had undergone cholecystectomy, 5 (12%) patients expired due to underlying clinical conditions and the rest were settled without requiring an immediate cholecystectomy. There was no direct procedure-related mortality.
Imaging guided PC is a safe and effective procedure for immediate management of non-resolving acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management.
确定超声引导下经皮胆囊造瘘术（PC）在手术和麻醉高风险且对保守治疗无反应的急性胆囊炎患者管理中有关并发症和结局方面的作用。
观察性病例系列。
本研究于2003年1月至2007年12月在卡拉奇的阿迦汗大学医院进行。
该研究纳入了因急性胆囊炎入院但不适合立即手术且对保守治疗无反应的患者。在超声引导下进行经皮胆囊造瘘术。研究变量包括患者的人口统计学、合并症、胆道树的超声检查结果、经皮胆囊造瘘术的指征、其途径、手术期间或术后的并发症、患者的临床结局（长达48小时）以及30天随访。那些病历和随访不完整的患者被排除。使用SPSS 16.0版本对数据进行分析并汇总结果。得出年龄等定量变量的均值和标准差。计算并发症和患者临床结局的比例。
研究了41例病历完整的患者，其中男性15例（37%），女性26例（63%）。平均年龄为65±13.5岁。经皮胆囊造瘘术的指征包括25例结石性胆囊炎、10例非结石性胆囊炎、4例积脓和2例胆囊穿孔。31例（75%）患者在手术期间或术后未出现并发症。10例（25%）患者出现并发症，包括迷走神经反应、手术期间疼痛、导管堵塞、导管移位和胆汁渗漏。34例（83%）患者有良好的临床反应（临床症状改善）。7例（17%）患者术后临床状况未显示任何改善。在30天随访时，9例患者接受了胆囊切除术，5例（12%）患者因基础疾病死亡，其余患者无需立即进行胆囊切除术即可康复。无直接与手术相关的死亡。
影像引导下的经皮胆囊造瘘术是一种安全有效的方法，可用于立即处理手术和麻醉高风险且对保守治疗无反应的非缓解性急性胆囊炎。
