Ren Zuhai, Xu Yong, Zhu Shaihong
Department of General Surgery, Central South University, Changsha, China.
Hepatogastroenterology. 2012 Mar-Apr;59(114):329-31. doi: 10.5754/hge11424.
BACKGROUND/AIMS: To evaluate the safety and feasibility of percutaneous transhepatic cholecystostomy for choledocholithiasis with acute cholangitis in high-risk patients.
Six high-risk patients of choledocholithiasis complicated with moderate to severe acute cholangitis underwent percutaneous transhepatic cholecystostomy and subsequent interval open surgery from January, 2008 to October 2010. These patients, who were not suitable for both endoscopic and transhepatic biliary drainage, were reviewed retrospectively.
Percutaneous transhepatic cholecystostomy was performed uneventfully. One patient developed hemoperitoneum which was successfully controlled by conservative treatment. Biliary peritonitits occurred in two patients, one ceased to leak spontaneously, the other developed a biloma which was cured by repuncture. No procedure-related death occurred. Sepsis was relieved completely 3 to 4 days after procedure. Two patients underwent interval open exploration of the common bile duct. One patient who recovered from sepsis succumbed on day 12 post-cholecystostomy because of an acute cardiac infarct. The other 3 patients were cured of sepsis and discharged without further treatment.
The results showed that ultrasound-guided percutaneous transhepatic cholecystostomy is a safe and effective procedure for choledocholithiasis with moderate to severe acute cholangitis in highly selected high-risk surgical patients. It may deserve to become a definitive therapy for subsequent surgical management. Larger controlled studies are needed to further confirm our findings.
背景/目的：评估经皮经肝胆囊造瘘术治疗高危患者胆总管结石合并急性胆管炎的安全性和可行性。
回顾性分析2008年1月至2010年10月期间6例胆总管结石合并中重度急性胆管炎的高危患者，这些患者均接受了经皮经肝胆囊造瘘术及随后的择期开放手术。这些患者均不适合内镜和经肝胆汁引流，故对其进行回顾性研究。
经皮经肝胆囊造瘘术顺利完成。1例患者发生腹腔内出血，经保守治疗成功控制。2例患者发生胆汁性腹膜炎，1例自行停止渗漏，另1例形成胆汁瘤，经再次穿刺治愈。未发生与手术相关的死亡。术后3至4天败血症完全缓解。2例患者接受了胆总管择期开放探查。1例败血症康复患者在胆囊造瘘术后第12天因急性心肌梗死死亡。其他3例患者败血症治愈，无需进一步治疗即出院。
结果表明，超声引导下经皮经肝胆囊造瘘术对于高度选择的高危手术患者的胆总管结石合并中重度急性胆管炎是一种安全有效的手术。它可能值得成为后续手术治疗的确定性疗法。需要更大规模的对照研究来进一步证实我们的发现。
