Martínek L, Kostrouch D, Hoch J
Rozhl Chir. 2015 Sep;94(9):367-71.
Percutaneous cholecystostomy is considered to be an emergency treatment option when conservative treatment of acute cholecystitis fails in elderly and critically ill patients. The question is: to what extent is this technique still up-to-date or obsolete.
We retrospectively reviewed data of patients who underwent a computer tomography (CT) guided percutaneous cholecystostomy between 1/20101/2015. We analyzed the patient data, the success rate, complications of the procedure, short- and long-term outcomes.
30 patients undergoing CT-guided percutaneous cholecystostomy at the Department of Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital during the study period were enrolled. The study group included 21 females (70%) and 9 males (30%) with mean age of 78 years (SD±12.3), median 82 years (range 3493 years). Percutaneous cholecystostomy was indicated for patients with severe cholecystitis/empyema of the gallbladder not responding to conservative therapy who were poor candidates for operative cholecystectomy. Of these, 23 patients (77%) were successfully treated with initial percutaneous cholecystostomy whereas 7 patients (23%) experienced treatment failure - one was subsequently successfully treated with repeated percutaneous cholecystostomy and six underwent emergency cholecystectomy. The mean length of stay was 16.5 days (SD±8.2), median 15 days (7-49 days). The total 30-day mortality was 17%, and indication-related mortality was 10%. Three patients (10%) had a recurrence. One patient required repeated percutaneous drainage, the second recovered on conservative treatment and the third patient underwent acute cholecystectomy. Only one patient (3%) underwent delayed laparoscopic cholecystectomy without complications.
CT guided percutaneous cholecystostomy is a safe and effective therapeutic modality in patients unfit for surgery.
当老年和重症患者急性胆囊炎保守治疗失败时，经皮胆囊造瘘术被视为一种紧急治疗选择。问题在于：这项技术在多大程度上仍然适用或过时。
我们回顾性分析了2010年1月至2015年1月期间接受计算机断层扫描（CT）引导下经皮胆囊造瘘术患者的数据。我们分析了患者数据、手术成功率、并发症、短期和长期结果。
在研究期间，布拉格查理大学医学院第二附属医院和莫托尔大学医院外科有30例患者接受了CT引导下经皮胆囊造瘘术。研究组包括21名女性（70%）和9名男性（30%），平均年龄78岁（标准差±12.3），中位数82岁（范围34至93岁）。经皮胆囊造瘘术适用于患有严重胆囊炎/胆囊积脓且对保守治疗无反应、不适合进行手术胆囊切除术的患者。其中，23例患者（77%）初始经皮胆囊造瘘术治疗成功，而7例患者（23%）治疗失败——1例随后经重复经皮胆囊造瘘术成功治疗，6例接受了急诊胆囊切除术。平均住院时间为16.5天（标准差±8.2），中位数15天（7至49天）。30天总死亡率为17%，与适应症相关的死亡率为10%。3例患者（10%）复发。1例患者需要重复经皮引流，第2例经保守治疗康复，第3例患者接受了急性胆囊切除术。只有1例患者（3%）接受了延迟腹腔镜胆囊切除术，无并发症。
CT引导下经皮胆囊造瘘术对于不适合手术的患者是一种安全有效的治疗方式。
