Haas Ilana, Lahat Elon, Griton Ygal, Shmulevsky Pavel, Shichman Stanislav, Elad Guy, Kammar Chagay, Yaslovich Ori, Kendror Shai, Ben-Ari Anat, Paran Haim
Department of Surgery A, Meir Medical Center, 59 Tschernihovsky St., 44281, Kfar Sava, Israel.
Department of Radiology, Meir Medical Center, Kfar Sava, Israel.
Surg Endosc. 2016 May;30(5):1948-51. doi: 10.1007/s00464-015-4419-z. Epub 2015 Jul 23.
Urgent laparoscopic cholecystectomy has been established as the best treatment for acute cholecystitis. However, conservative treatment is advocated for high-risk patients. Failure of conservative treatment can result in high-risk operations with relatively high rates of operative morbidity. Percutaneous cholecystostomy is a good option for these patients. Recently, percutaneous aspiration of the gall bladder without drain has been described.
A protocol of initial conservative management in high-operative-risk patients admitted with acute cholecystitis was prospectively assessed. Patients who did not respond to antibiotics were treated with percutaneous trans-hepatic aspiration of the gall bladder under ultrasound guidance. Following discharge, the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary.
Between January 2011 and December 2012, 33 patients with persistent clinical and sonographic signs of acute cholecystitis after failure of initial antibiotic treatment underwent gall bladder aspiration under ultrasound guidance. No complications related to the procedure were reported. In 25 patients (76 %), the procedure was successful and they were discharged. Seven patients needed repeated aspiration. Eight patients (24 %) who did not improve underwent percutaneous cholecystostomy and were discharged with a drain and later reevaluated for elective surgery. The mean hospital stay of patients with successful aspiration was 3 days. During the follow-up period, 23 patients underwent elective interval laparoscopic cholecystectomy. Two were converted to open surgery (8.7 %).
Conservative treatment and delayed operation is an acceptable option for acute cholecystitis. Percutaneous gall bladder aspiration is a simple and effective procedure, with a high success rate and low morbidity. Laparoscopic cholecystectomy after drainage of the gall bladder has low morbidity with a relatively low conversion rate.
急诊腹腔镜胆囊切除术已被确立为急性胆囊炎的最佳治疗方法。然而，对于高危患者，提倡采用保守治疗。保守治疗失败可能导致高风险手术，手术发病率相对较高。经皮胆囊造瘘术是这些患者的一个不错选择。最近，有人描述了不放置引流管的经皮胆囊抽吸术。
对因急性胆囊炎入院的高手术风险患者采用初始保守治疗方案进行前瞻性评估。对抗生素治疗无反应的患者在超声引导下进行经皮经肝胆囊抽吸术。出院后，患者在门诊就诊，必要时考虑并安排择期腹腔镜胆囊切除术。
2011年1月至2012年12月期间，33例初始抗生素治疗失败后仍有持续临床和超声急性胆囊炎体征的患者在超声引导下接受了胆囊抽吸术。未报告与该操作相关的并发症。25例患者（76%）手术成功并出院。7例患者需要重复抽吸。8例（24%）病情未改善的患者接受了经皮胆囊造瘘术，带引流管出院，随后接受择期手术的重新评估。抽吸成功患者的平均住院时间为3天。在随访期间，23例患者接受了择期腹腔镜胆囊切除术。2例转为开放手术（8.7%）。
保守治疗和延迟手术是急性胆囊炎可接受的选择。经皮胆囊抽吸术是一种简单有效的手术，成功率高，发病率低。胆囊引流后行腹腔镜胆囊切除术发病率低，转化率相对较低。
Zotero 插件