Yeo Charleen Shan Wen, Tay Vivyan Wei Yen, Low Jee Keem, Woon Winston Wei Liang, Punamiya Sundeep J, Shelat Vishal G
Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Hepatobiliary Pancreat Sci. 2016 Jan;23(1):65-73. doi: 10.1002/jhbp.304. Epub 2015 Dec 10.
Percutaneous cholecystostomy (PC) is an established treatment for high surgical risk patients with acute cholecystitis. This paper studies factors predictive of mortality and eventual cholecystectomy.
A retrospective review of all patients who underwent PC from March 2005 to March 2015 was performed. Patient demographics, clinical features, comorbidity profile, grade of cholecystitis, interval between cholecystitis diagnosis and PC, and method of PC were studied. Length of stay, complications, readmission rate, mortality and eventual cholecystectomy were studied. For patients with eventual cholecystectomy, operative data and perioperative outcomes were studied.
One hundred and three patients with median age of 80 years (range 43-105) underwent PC. Median interval to PC was 2 days (range 0-15). 9.7% of patients had complications. Median length of stay was 19 days (range 3-206). 41% underwent eventual cholecystectomy. 30-day mortality rate was 10.7%. Higher APACHE II scores (P = 0.004), higher Charlson comorbidity index (CCI) (P = 0.009), and longer interval from diagnosis to PC (P = 0.037) were associated with in-hospital mortality. Younger age (P = 0.015), lower APACHE II scores (P = 0.043) and lower CCI (P = 0.002) were associated with eventual cholecystectomy.
Percutaneous cholecystostomy is safe and effective in treatment of acute cholecystitis. Prompt PC improves survival in high risk surgical patients. Comorbidity severity is associated with mortality. Patients with lesser comorbidity are likely to receive eventual cholecystectomy.
经皮胆囊造瘘术（PC）是治疗急性胆囊炎手术风险高的患者的一种既定疗法。本文研究了预测死亡率和最终胆囊切除术的因素。
对2005年3月至2015年3月期间接受PC的所有患者进行回顾性研究。研究了患者的人口统计学特征、临床特征、合并症情况、胆囊炎分级、胆囊炎诊断与PC之间的间隔时间以及PC方法。研究了住院时间、并发症、再入院率、死亡率和最终胆囊切除术。对于最终接受胆囊切除术的患者，研究了手术数据和围手术期结果。
103例患者接受了PC，中位年龄为80岁（范围43 - 105岁）。至PC的中位间隔时间为2天（范围0 - 15天）。9.7%的患者出现并发症。中位住院时间为19天（范围3 - 206天）。41%的患者最终接受了胆囊切除术。30天死亡率为10.7%。较高的急性生理与慢性健康状况评分系统II（APACHE II）评分（P = 0.004）、较高的查尔森合并症指数（CCI）（P = 0.009）以及从诊断到PC的间隔时间较长（P = 0.037）与院内死亡率相关。年龄较小（P = 0.015）、较低的APACHE II评分（P = 0.043）和较低的CCI（P = 0.002）与最终胆囊切除术相关。
经皮胆囊造瘘术治疗急性胆囊炎安全有效。及时进行PC可提高高风险手术患者的生存率。合并症严重程度与死亡率相关。合并症较少的患者可能最终接受胆囊切除术。
