Ermolov A S, Guliaev A A, Ivanov P A, Samsonov V T, Rogal' M L, Timerbaev V Kh, Trofimova E Iu, Kudriashova N E, Tlibekova M A
Khirurgiia (Mosk). 2014(8):4-8.
The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.
一项回顾性研究展示了769例入院时手术及麻醉风险高的急性结石性胆囊炎患者的治疗结果。高风险由明显的合并症、疾病病程、急性胆囊炎的并发症、年龄（大多数情况下超过60岁）来判定。根据合并症的严重程度及其纠正的可能效果，将患者分为2组。第一组包括617例适合行胆囊切除术的患者。第二组包括152例不适合行此手术的患者。第一组采用分期治疗概念，包括在超声引导下经皮经肝微胆囊造瘘术对胆囊进行初步减压。在合并症、急性胆囊炎并发症得到纠正且必要时通过内镜对肝外胆管进行重新调整后，行胆囊切除术。587例患者成功进行了腹腔镜胆囊切除术。11例进行了开腹胆囊切除术。19例因中转而进行了胆囊切除术。第二组在局部麻醉下通过微创进行胆囊造瘘并取出结石，以达到减压及确定性治疗的目的。采用这种策略，未观察到手术及麻醉风险高的患者死亡。术后1.7%的患者出现并发症，但均成功解决。
