Department of Radiology, Abdominal Imaging Section, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215, USA.
AJR Am J Roentgenol. 2012 Dec;199(6):W753-60. doi: 10.2214/AJR.11.8445.
The purpose of this article is to compare the complication rate for ultrasound-guided percutaneous cholecystostomy in patients with coagulopathy to the rate in patients with normal coagulation.
We performed a database search for patients who underwent ultrasound-guided percutaneous cholecystostomy from January 2000 through December 2010. Patients were divided into those with normal coagulation and those with coagulopathy, as documented by abnormal laboratory values (international normalized ratio ≥ 1.5 and platelet count ≤ 50 × 10(9)/L) or history of anticoagulant medication in the preceding 5 days. Medical records were reviewed, and complication rates and subsequent treatment was recorded. Statistical analysis was performed using the Fisher exact and chi-square tests.
Two hundred forty-two patients underwent ultrasound-guided percutaneous cholecystostomy (132 men and 110 women; mean [± SD] age, 73.9 ± 15.9 years; range, 22-104 years). One hundred thirty-two patients were coagulopathic and 110 had normal coagulation. Major complications related to ultrasound-guided percutaneous cholecystostomy were rare (4/242 cases [1.7%]) and included hemorrhage requiring transfusion (n = 1), death directly related to the procedure (n = 1), sepsis related to the procedure (n = 1), and abscess or biloma formation (n = 1). All of these occurred in the group with normal coagulation. Fourteen additional deaths (5.8%) that occurred within 30 days of the procedure were related to comorbidities. Minor catheter-related complications (15/242 [6.2%]) were due to catheter dislodgement (n = 11 [4.5%]), failure of placement (n = 1 [0.4%]), and hemorrhage not requiring transfusion (n = 3 [1.2%]). Two of the minor hemorrhagic complications were seen in the coagulopathic group and one in the normal coagulation group (p = 0.599).
There is no difference in the complication rate for ultrasound-guided percutaneous cholecystostomy in patients who are coagulopathic compared with those who have normal coagulation.
本文旨在比较凝血功能异常患者与凝血功能正常患者行超声引导下经皮胆囊穿刺引流术的并发症发生率。
我们对 2000 年 1 月至 2010 年 12 月期间行超声引导下经皮胆囊穿刺引流术的患者进行了数据库检索。根据异常实验室值（国际标准化比值≥1.5 和血小板计数≤50×109/L）或在过去 5 天内使用抗凝药物的病史，将患者分为凝血功能正常组和凝血功能异常组。回顾病历资料，记录并发症发生率和后续治疗情况。采用 Fisher 确切概率法和卡方检验进行统计学分析。
共 242 例行超声引导下经皮胆囊穿刺引流术患者（男 132 例，女 110 例；平均年龄[±标准差]73.9±15.9 岁；年龄范围 22~104 岁）。132 例患者凝血功能异常，110 例患者凝血功能正常。与超声引导下经皮胆囊穿刺引流术相关的主要并发症较为少见（4/242 例[1.7%]），包括需要输血的出血（1 例）、直接与手术相关的死亡（1 例）、与手术相关的脓毒症（1 例）和脓肿或胆汁瘤形成（1 例）。所有这些并发症均发生在凝血功能正常的患者中。术后 30 天内发生的另外 14 例死亡（5.8%）与合并症有关。少数与导管相关的并发症（15/242[6.2%]）是由导管移位（11 例[4.5%]）、置管失败（1 例[0.4%]）和无需输血的出血（3 例[1.2%]）引起的。凝血功能异常组中有 2 例轻微出血并发症，凝血功能正常组中有 1 例（p=0.599）。
凝血功能异常患者行超声引导下经皮胆囊穿刺引流术的并发症发生率与凝血功能正常患者无差异。
