Department of Radiology, Keimyung University, College of Medicine, Daegu 700-712, Korea.
Korean J Radiol. 2011 Mar-Apr;12(2):210-5. doi: 10.3348/kjr.2011.12.2.210. Epub 2011 Mar 3.
To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis.
Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique.
Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days).
Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis.
评估在高危手术患者中，在透视引导下经皮经肝胆囊结石切除术的技术可行性和临床疗效，这些患者患有急性胆囊炎。
63 例高危手术合并急性结石性胆囊炎患者在清醒镇静下接受经皮经肝胆囊结石取出术。在进行经皮胆囊造口术 3 天后，通过 12Fr 鞘在透视引导下使用 Wittich 镍钛合金取石篮取出结石。对于大的或硬的结石，使用套圈导丝技术或金属套管技术进行破碎。
63 例患者中有 59 例（94%）成功取出了胆囊结石。结石取出失败的原因包括 2 例患者无法抓取大结石，2 例患者因胆囊收缩而导致操作过程中丢失通道。急性胆囊炎患者的平均住院时间为 7.3 天，胆囊积脓患者为 9.4 天。有 2 例患者发生胆汁性腹膜炎，需要经皮引流。在随访期间无症状复发（平均 608.3 天）。
在高危手术患者中，使用 12Fr 鞘的透视引导下经皮胆囊结石取出术在技术上是可行的，在治疗急性胆囊炎方面具有临床疗效。
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