Department of Surgery, Aga Khan University, Stadium road, P.O.Box 3500, Karachi, Pakistan.
Int J Surg. 2011;9(6):456-9. doi: 10.1016/j.ijsu.2011.04.008. Epub 2011 Jun 6.
Acute cholecystitis is a frequent cause of general surgical admissions with a mortality risk that is related to the age of the patient. Percutaneous cholecystostomy (PC) has been used as a bridging technique while awaiting resolution of sepsis. We evaluated the outcome of our study population following percutaneous cholecystostomy for acute cholecystitis due to benign etiologies.
Retrospective review of patients undergoing PC from January 1988 to December 2008. Patients were reviewed for demographic features, co-morbidity, resolution of symptoms, hospital stay, outcome, complications and ASA class.
62 patients underwent PC for acute cholecystitis. 49 patients had calculous cholecystitis. 61% (n = 38) were ≥ 60 years old. 92% had resolution of symptoms within 48 h, and 8% had partial or no resolution. 84% had a decline in total leucocyte counts. The mean hospital stay was 10.6 days and 30-day mortality was 15%. 69% patients had no post-procedure complication. Of the remainder, 1 patient had post-procedure hemorrhage and the remaining developed complications that included pneumonia, hypotension and vasovagal reactions. The duration of drainage ranged from 1 to 3 months. 3 patients underwent emergency cholecystectomy during the same admission, 20 patients underwent interval cholecystectomy. 22 patients had no further intervention and had no recurrent symptoms, of these 73% (n = 16) had calculous cholecystitis. In this sub-group of non-operated patients, 76% were ASA III & IV.
PC is a low risk management option for high risk patients with acute cholecystitis. It can be used as a temporizing measure while awaiting resolution of sepsis and optimization of co-morbidities, or as a definitive therapeutic option for acalculous cholecystitis. We also conclude that it has a good potential to be used as a definitive therapy for high risk (ASAIII & IV) patients with acute calculous cholecystitis.
评估我们研究人群经皮胆囊造口术（PC）治疗良性病因引起的急性胆囊炎的结果。
回顾性分析 1988 年 1 月至 2008 年 12 月期间接受 PC 的患者。患者的人口统计学特征、合并症、症状缓解、住院时间、结果、并发症和 ASA 分级进行了回顾。
62 例患者因急性胆囊炎接受 PC。49 例为结石性胆囊炎。61%（n=38）年龄≥60 岁。92%（n=60）的患者在 48 小时内症状缓解，8%（n=5）部分或无缓解。84%（n=52）的白细胞总数下降。平均住院时间为 10.6 天，30 天死亡率为 15%。69%（n=43）患者无术后并发症。其余患者中，1 例发生术后出血，其余患者发生并发症，包括肺炎、低血压和血管迷走神经反应。引流时间为 1 至 3 个月。3 例患者在同一入院期间行急诊胆囊切除术，20 例患者行择期胆囊切除术。22 例患者未进一步干预，无复发症状，其中 73%（n=16）为结石性胆囊炎。在未手术的患者亚组中，76%（n=16）为 ASA III 或 IV 级。
PC 是高危急性胆囊炎患者的低风险治疗选择。它可作为等待脓毒症缓解和合并症优化的临时措施，或作为非结石性胆囊炎的确定性治疗选择。我们还得出结论，PC 具有作为高危（ASA III 和 IV 级）患者急性结石性胆囊炎的确定性治疗的良好潜力。
