Viste Asgaut, Jensen Dag, Angelsen Jon Helge, Hoem Dag
Department of Acute and Gastrointestinal surgery, Haukeland University Hospital, N-5021, Bergen, Norway.
Department of Clinical Medicine K1, University of Bergen, Bergen, Norway.
BMC Surg. 2015 Mar 8;15:17. doi: 10.1186/s12893-015-0002-8.
The purpose of this study was to evaluate the clinical course and possible benefit of a percutaneous cholecystostomy in patients with acute cholecystitis.
Retrospective study of 104 patients with severe cholecystitis or cholecystitis not responding to antibiotic therapy treated with percutaneous drainage of the gall bladder (PC) during the period 2007 - 2013. Primary outcome was relief of cholecystitis, complications following the procedure and need for later cholecystectomy.
There were 57 men and 47 women with a median age of 73,5 years (range 22 - 96). 43% of the patients were ASA III or IV and 91% had cholecystitis Grade 2 or 3. About 60% of the patients had severe comorbidity (cardiovascular disease or active cancer). Drain insertion was successful in all but one patient and complications were mild, apart from two patients that needed percutaneous drainage of intraabdominal fluid collection due to bile leakage. The drain was left in place for 1 - 75 days (median 6,5). When evaluated clinically and by blood tests (CRP and white blood cell counts) we found resolution of symptoms in 101 patients (97,2%), whereas 2 patients had no obvious effect of drainage. Four patients died within 30 days, no deaths were related to the drainage procedure. Follow-up after drainage was median 12 months (range 0 - 78). During that time cholecystectomy was performed in 30 patients and 24 patients had died. Following cholecystectomy, two had died, both from cancer and more than one year after the operation.
Patients with acute cholecystitis were promptly relieved from their symptoms following PC. There were only minor complications following the procedure and only about 30% of the patients had a later cholecystectomy.
本研究旨在评估经皮胆囊造瘘术对急性胆囊炎患者的临床病程及可能的益处。
对2007年至2013年期间104例患有严重胆囊炎或对抗生素治疗无反应的胆囊炎患者进行经皮胆囊引流术（PC）的回顾性研究。主要结局指标为胆囊炎缓解情况、术后并发症以及后期是否需要行胆囊切除术。
患者共104例，其中男性57例，女性47例，中位年龄73.5岁（范围22 - 96岁）。43%的患者美国麻醉医师协会（ASA）分级为III或IV级，91%的患者胆囊炎分级为2级或3级。约60%的患者有严重合并症（心血管疾病或活动性癌症）。除1例患者外，其余所有患者引流管插入均成功，并发症轻微，仅有2例患者因胆汁漏需要经皮引流腹腔积液。引流管留置时间为1 - 75天（中位时间6.5天）。经临床评估及血液检查（CRP和白细胞计数）发现，101例患者（97.2%）症状缓解，2例患者引流效果不明显。4例患者在30天内死亡，无死亡与引流操作相关。引流术后中位随访时间为12个月（范围0 - 78个月）。在此期间，30例患者接受了胆囊切除术，24例患者死亡。胆囊切除术后，2例患者死亡，均死于癌症，且术后超过1年。
急性胆囊炎患者经皮胆囊造瘘术后症状迅速缓解。术后仅有轻微并发症，仅约30%的患者后期接受了胆囊切除术。
