Karakayali Feza Y, Akdur Aydincan, Kirnap Mahir, Harman Ali, Ekici Yahya, Moray Gokhan
Department of General Surgery, Baskent University School of Medicine, Ankara, Turkey.
Hepatobiliary Pancreat Dis Int. 2014 Jun;13(3):316-22. doi: 10.1016/s1499-3872(14)60045-x.
In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy.
In 91 patients (American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis ≥72 hours at hospital admission and who did not respond to nonoperative treatment (48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at ≥4 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average (range 7-29).
Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19 (40%) vs 8 (19%); P=0.029], a frequency of intraoperative bleeding ≥100 mL [16 (33%) vs 4 (9%); P=0.006], a mean postoperative hospital stay (5.3+/-3.3 vs 3.0+/-2.4 days; P=0.001), and a frequency of complications [17 (35%) vs 4 (9%); P=0.003].
In patients with acute cholecystitis who presented to the hospital ≥72 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.
在对非手术治疗无反应的低风险急性胆囊炎患者中，我们前瞻性地比较了急诊腹腔镜胆囊切除术与经皮经肝胆囊造瘘术随后延迟行胆囊切除术的治疗效果。
91例患者（美国麻醉医师协会分级为I或II级）在入院时急性胆囊炎症状持续≥72小时且对非手术治疗（48小时）无反应，其中48例患者接受急诊腹腔镜胆囊切除术，43例患者在插入经皮经肝胆囊造瘘导管后≥4周接受延迟胆囊切除术。初始治疗后，患者平均随访23个月（范围7 - 29个月）。
与接受急诊腹腔镜胆囊切除术的患者相比，接受经皮经肝胆囊造瘘术和延迟胆囊切除术的患者转为开放手术的频率较低[19例（40%）对8例（19%）；P = 0.029]，术中出血≥100 mL的频率较低[16例（33%）对4例（9%）；P = 0.006]，术后平均住院时间较短（5.3±3.3天对3.0±2.4天；P = 0.001），并发症发生率较低[17例（35%）对4例（9%）；P = 0.003]。
对于症状发作后≥72小时入院且对48小时非手术治疗无反应的急性胆囊炎患者，经皮经肝胆囊造瘘术联合延迟腹腔镜胆囊切除术比急诊腹腔镜胆囊切除术效果更好且并发症更少。
