Hawkyard S J, Walker S J, Holt S
Department of Surgery, Whiston District General Hospital, Liverpool.
Br J Clin Pract. 1990 Dec;44(12):593-5.
We have studied retrospectively 27 patients undergoing cholecystostomy for acute cholecystitis over the past decade. The mean age of the patients was 60 years, and 17 were female. 'Difficult dissection' was the reason given for cholecystostomy in 18 cases and in the remainder the patients were deemed unfit for cholecystectomy. An operative cholangiogram was performed in only two cases, and none of the patients had a primary common bile duct exploration. Post-operative cholangiograms in 14 patients revealed common bile duct stones in three (21%). Three elderly patients (mean age 79) died in hospital. At a mean follow-up of one year, 26% of patients had come to elective cholecystectomy, and there had been a further three unrelated deaths. We conclude that under difficult circumstances, cholecystostomy may be a safe alternative to cholecystectomy. These patients have a high incidence of choledocholithiasis, and thus we would recommend operative cholangiograms in all patients. However, early ERCP and sphincterotomy may be a safe alternative if this service becomes more widely available.
我们回顾性研究了过去十年中接受胆囊造口术治疗急性胆囊炎的27例患者。患者的平均年龄为60岁，其中17例为女性。18例胆囊造口术的原因是“解剖困难”，其余患者被认为不适合进行胆囊切除术。仅2例患者进行了术中胆管造影，且无一例患者进行了原发性胆总管探查。14例患者的术后胆管造影显示3例（21%）有胆总管结石。3例老年患者（平均年龄79岁）死于医院。平均随访一年时，26%的患者接受了择期胆囊切除术，另有3例与手术无关的死亡。我们得出结论，在困难情况下，胆囊造口术可能是胆囊切除术的一种安全替代方法。这些患者胆总管结石的发生率很高，因此我们建议对所有患者进行术中胆管造影。然而，如果更广泛地提供早期内镜逆行胰胆管造影（ERCP）和括约肌切开术，可能是一种安全的替代方法。
