Department of Radiology, Stanford University, 300 Pasteur Dr, Stanford, CA 94305, USA.
J Vasc Interv Radiol. 2012 Jan;23(1):83-8.e1. doi: 10.1016/j.jvir.2011.09.030. Epub 2011 Nov 30.
To review the clinical course of patients with acute cholecystitis treated by percutaneous cholecystostomy, and to identify risk factors retrospectively that predict outcome.
A total of 106 patients diagnosed with acute cholecystitis were treated by percutaneous cholecystostomy during a 10-year period. Seventy-one (67%) presented to the emergency department (ED) specifically for acute cholecystitis, and 35 (23%) were inpatients previously admitted for other conditions. Outcomes of the two groups were compared with respect to severity of illness, leukocytosis, bile culture, liver function tests, imaging features, time intervals from onset of symptoms to medical and percutaneous intervention, and whether surgical cholecystectomy was later performed.
Overall, 72 patients (68%) showed an improvement clinically, whereas 34 (32%) showed no improvement or a clinically worsened condition after cholecystostomy. Patients who presented to the ED primarily with acute cholecystitis fared better (84% of patients showed improvement) than inpatients (34% showed improvement; P < .0001). Gallstones were identified in 54% of patients who presented to the ED, whereas acalculous cholecystitis was more commonly diagnosed in inpatients (54%). Patients with sepsis had worse outcomes overall (P < .0001). Bacterial bile cultures were analyzed in 95% of patients and showed positive results in 52%, with no overall effect on outcome. There was no correlation between the time of onset of symptoms until antibiotic therapy or cholecystostomy in either group. Long-term outcomes for both groups were better for those who later underwent cholecystectomy (P < .0001).
Outcomes after percutaneous cholecystostomy for acute cholecystitis are better when the disease is primary and not precipitated by concurrent illness.
回顾经皮胆囊造口术治疗急性胆囊炎患者的临床过程，并回顾性识别预测结局的风险因素。
在 10 年期间，共有 106 例被诊断为急性胆囊炎的患者接受了经皮胆囊造口术治疗。71 例（67%）因急性胆囊炎专门到急诊科就诊，35 例（23%）为先前因其他疾病住院的患者。比较两组患者的疾病严重程度、白细胞增多、胆汁培养、肝功能检查、影像学特征、从症状发作到医疗和经皮干预的时间间隔、以及是否随后进行胆囊切除术等方面的结果。
总体而言，72 例患者（68%）经胆囊造口术后临床症状改善，34 例（32%）症状无改善或恶化。因急性胆囊炎直接到急诊科就诊的患者预后较好（84%的患者症状改善），而住院患者（34%的患者症状改善；P <.0001）。到急诊科就诊的患者中有 54%的患者发现有胆囊结石，而住院患者中更常见的是无结石性胆囊炎（54%）。败血症患者的整体预后较差（P <.0001）。对 95%的患者进行了细菌胆汁培养，其中 52%的培养结果阳性，但对结局无总体影响。两组患者中，从症状发作到抗生素治疗或胆囊造口术的时间均无相关性。两组患者中，后来接受胆囊切除术的患者的长期结局均更好（P <.0001）。
急性胆囊炎经皮胆囊造口术后的结局在疾病为原发性且不是由合并疾病引发时更好。
