Venara A, Carretier V, Lebigot J, Lermite E
Service de chirurgie digestive et endocrinienne, CHU, 4, rue Larrey, 49933 Angers cedex, France.
Service de radiologie, CHU, 4, rue Larrey, 49933 Angers cedex, France.
J Visc Surg. 2014 Dec;151(6):435-9. doi: 10.1016/j.jviscsurg.2014.06.003. Epub 2014 Aug 29.
The gold standard in treatment of acute cholecystitis is cholecystectomy associated with antibiotics. In certain circumstances, percutaneous cholecystostomy is an interventional alternative. Percutaneous cholecystostomy is usually performed under local anesthesia by the radiologist using ultrasonographic or CT guidance. A drain can be inserted either through a trans-hepatic or a trans-peritoneal approach. Complications occur in nearly 10% of cases including hemorrhage, hemobilia, pneumothorax or bile leaks, depending on whether the approach was trans-hepatic or trans-peritoneal. The main indications for percutaneous cholecystostomy are resistance to medical treatment or severely-ill patients in intensive care. Drains should be maintained 3 to 6 weeks before removal. In patients with good general condition (ASA score I-II), secondary cholecystectomy can be recommended to avoid recurrence.
急性胆囊炎治疗的金标准是胆囊切除术联合使用抗生素。在某些情况下，经皮胆囊造瘘术是一种介入性替代方法。经皮胆囊造瘘术通常在局部麻醉下由放射科医生使用超声或CT引导进行。引流管可通过经肝或经腹途径插入。近10%的病例会出现并发症，包括出血、胆道出血、气胸或胆漏，这取决于采用的是经肝还是经腹途径。经皮胆囊造瘘术的主要适应证是对药物治疗无反应或重症监护病房中的重症患者。引流管应保留3至6周后再拔除。对于一般状况良好（美国麻醉医师协会评分I-II级）的患者，可建议进行二期胆囊切除术以避免复发。
