Macchini Daniele, Degrate Luca, Oldani Massimo, Leni Davide, Padalino Pietro, Romano Fabrizio, Gianotti Luca
School of Medicine and Surgery, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy -
Minerva Chir. 2016 Dec;71(6):415-426. Epub 2016 Jun 9.
Percutaneous cholecystostomy (PC) is an effective procedure to treat moderate or severe acute cholecystitis (AC) in high-risk patients. The ideal timing of the drainage removal is argued. The aim of this study is to analyze our experience and perform a systematic review about the ideal timing of a percutaneous cholecystostomy (PC) tube removal.
A web-based literature search was performed and studies reporting the length of the catheter maintenance were analyzed. A regression analysis between the timing of tube removal and morbidity, mortality and disease recurrence was performed. Patients who underwent PC as definitive treatment of moderate or severe acute cholecystitis at our institution between 2011 to 2015 were analyzed. Clinical and technical success, morbidity, mortality and recurrence rates were retrospectively retrieved from a perspective database.
The systematic review yield to analyze 50 studies. None of them focused exclusively on outcome measures in relation to PC tube duration. The timing of the drain removal varied from 2 to 193 days. Regression analyses showed no correlation between length of tube maintenance and the considered outcomes. We studied 35 patients. The median age was 78 (range 52-94) and 88.5% had an ASA score ≥3. P-POSSUM estimated morbidity was 68.7% (range 34.3-99.0) and mortality was 15.8% (range 1.9-80.2). Clinical success was 97.1%. Procedure-related morbidity was 34.3%: 2 abscess, 1 bleeding, 1 biloma and 8 tube dislodgment. Biliary leakage was not observed. The observed 30-day overall mortality was 11.4%. The median follow-up was 16 months. Recurrence rate was 12.1%.
PC is an effective procedure in high-risk patients with moderate or severe AC. At the moment there is no evidence whether the duration of PC tube may affect outcome.
经皮胆囊造瘘术（PC）是治疗高危患者中度或重度急性胆囊炎（AC）的有效方法。关于引流管拔除的理想时机存在争议。本研究的目的是分析我们的经验，并对经皮胆囊造瘘术（PC）引流管拔除的理想时机进行系统评价。
进行了基于网络的文献检索，并分析了报告导管留置时间的研究。对拔管时机与发病率、死亡率和疾病复发率之间进行了回归分析。分析了2011年至2015年期间在我们机构接受PC作为中度或重度急性胆囊炎确定性治疗的患者。从一个前瞻性数据库中回顾性获取临床和技术成功率、发病率、死亡率和复发率。
系统评价共分析了50项研究。没有一项研究专门关注与PC管留置时间相关的结局指标。引流管拔除时间从2天到193天不等。回归分析显示管留置时间与所考虑的结局之间无相关性。我们研究了35例患者。中位年龄为78岁（范围52 - 94岁），88.5%的患者ASA评分≥3。P-POSSUM估计发病率为68.7%（范围34.3 - 99.0），死亡率为15.8%（范围1.9 - 80.2）。临床成功率为97.1%。与手术相关的发病率为34.3%：2例脓肿、1例出血、1例胆汁瘤和8例引流管移位。未观察到胆漏。观察到的30天总死亡率为11.4%。中位随访时间为16个月。复发率为12.1%。
PC对于中度或重度AC的高危患者是一种有效的治疗方法。目前尚无证据表明PC管的留置时间是否会影响治疗结局。
