Jang Won Seok, Lim Jun Uk, Joo Kwang Ro, Cha Jae Myung, Shin Hyun Phil, Joo Sun Hyung
Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 134-727, Korea,
Surg Endosc. 2015 Aug;29(8):2359-64. doi: 10.1007/s00464-014-3961-4. Epub 2014 Dec 9.
Laparoscopic cholecystectomy (LC) is the treatment of choice for acute cholecystitis. However, the morbidity and mortality rates are high in elderly patients or in those with co-morbidities at the time of surgery. Percutaneous cholecystostomy (PC) is a safe treatment for acute inflammation of the gall bladder. This study aimed to evaluate the safety and efficacy of PC for acute cholecystitis and investigate the post-PC factors leading to subsequent LC.
Ninety-three patients with acute cholecystitis who underwent PC between August 2006 and December 2012 were retrospectively reviewed for clinical course, outcomes, and prognosis. We evaluated patient age, the presence of co-morbidities, American Society of Anesthesiologists (ASA) score, duration of drainage of the PC tube, performance of LC, conversion rate, hospital stay, recurrence, and 30-day mortality. We compared these characteristics in two study groups: 31 were treated with only conservative PC (group I) and 62 with PC followed by elective LC (group II).
Patients in group I were older than those in group II (80.38 ± 10.05 vs. 70.50 ± 11.81 years, p < 0.001). More group I patients had an ASA score of III or IV (deemed high risk for surgery) compared to group II patients (80.6 %, n = 25 vs. 37.0 %, n = 23, p = 0.0012). Age, ASA score, and cerebrovascular accident (CVA) were significantly correlated when analyzing factors used to decide surgery (R (2) = 0.15, p < 0.001; R (2) = 0.21, p < 0.001; R (2) = 0.05, p = 0.05, respectively). Two patients in group I died within 30 days. Six patients (19.3 %) in group I experienced recurrent cholecystitis after PC tube removal.
PC is a safe and effective therapeutic option in high-risk patients with acute cholecystitis, or for preoperative management. The decisive risk factors for surgery after PC were age, ASA score, and CVA.
腹腔镜胆囊切除术（LC）是急性胆囊炎的首选治疗方法。然而，老年患者或手术时伴有合并症的患者的发病率和死亡率较高。经皮胆囊造瘘术（PC）是胆囊急性炎症的一种安全治疗方法。本研究旨在评估PC治疗急性胆囊炎的安全性和有效性，并调查导致后续LC的PC术后因素。
回顾性分析2006年8月至2012年12月期间接受PC治疗的93例急性胆囊炎患者的临床病程、结局和预后。我们评估了患者年龄、合并症的存在情况、美国麻醉医师协会（ASA）评分、PC管引流持续时间、LC的实施情况、转化率、住院时间、复发情况和30天死亡率。我们在两个研究组中比较了这些特征：31例仅接受保守PC治疗（I组），62例接受PC治疗后择期行LC（II组）。
I组患者比II组患者年龄更大（80.38±10.05岁对70.50±11.81岁，p<0.001）。与II组患者相比，I组更多患者的ASA评分为III或IV级（被认为手术风险高）（80.6%，n = 25对37.0%，n = 23，p = 0.0012）。在分析用于决定手术的因素时，年龄、ASA评分和脑血管意外（CVA）显著相关（R（2）= 0.15，p<0.001；R（2）= 0.21，p<0.001；R（2）= 0.05，p = 0.05，分别）。I组有2例患者在30天内死亡。I组有6例患者（19.3%）在拔除PC管后发生复发性胆囊炎。
PC是高危急性胆囊炎患者或术前管理的一种安全有效的治疗选择。PC术后手术的决定性危险因素是年龄、ASA评分和CVA。
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