内镜超声引导下胆囊引流与经皮胆囊造口术相比，可减少不适合胆囊切除术患者的不良事件。
Endoscopic ultrasound-guided gallbladder drainage reduces adverse events compared with percutaneous cholecystostomy in patients who are unfit for cholecystectomy.
机构信息
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
Department of Medicine, University Hospital Rio Hortega, Valladolid, Spain.
出版信息
Endoscopy. 2017 Feb;49(2):130-138. doi: 10.1055/s-0042-119036. Epub 2016 Nov 22.
There are no data comparing endoscopic ultrasound (EUS)-guided gallbladder drainage (EGBD) with percutaneous cholecystostomy as a treatment for patients with acute cholecystitis. This was a 1 : 1 matched cohort study of all patients who were unfit for cholecystectomy and underwent EGBD or percutaneous cholecystostomy instead for the treatment of acute cholecystitis. The outcomes were matched for age, sex, and American Society of Anesthesiologists grade. Outcome measures included the technical and clinical success rates, adverse events, hospital stay, the number of unplanned admissions, and mortality. Between November 2011 and August 2014, a total of 118 patients were included in the study (59 EGBD, 59 percutaneous cholecystostomy). Technical and clinical success rates were similar. In the EGBD group, significantly fewer patients suffered from overall adverse events (19 [32.2 %] vs. 44 [74.6 %]; < 0.001) and serious adverse events (14 [23.7 %] vs. 44 [74.6 %]; < 0.001) compared to the percutaneous cholecystostomy group. Patients in the EGBD group required fewer unplanned admissions (4 [6.8 %] vs. 42 [71.2 %]; < 0.001), which were due to problems related to the cholecystostomy tube in 95.2 %. The 30-day adverse event rates were similar between the groups (17 [28.8 %] vs. 10 [16.9 %]; = 0.13). For instance, recurrent acute cholecystitis occurred in 0 patients in the EGBD group and in 4 (6.8 %) patients in the percutaneous cholecystostomy group ( = 0.12). The 30-day mortality rates were non-significantly higher in the EGBD group (5 [8.5 %] vs. 1 [1.7 %]; = 0.21). EGBD and percutaneous cholecystostomy were both effective means of achieving gallbladder drainage. EGBD may be a promising alternative to percutaneous cholecystostomy for treatment of acute cholecystitis in patients who are unfit for surgery, provided that experienced endosonographers are available.
目前尚无内镜超声（EUS）引导下胆囊引流（EGBD）与经皮胆囊造口术治疗急性胆囊炎的疗效比较数据。这是一项 1:1 匹配队列研究，纳入了所有不适合行胆囊切除术且行 EGBD 或经皮胆囊造口术治疗的急性胆囊炎患者。匹配因素包括年龄、性别和美国麻醉医师协会（ASA）分级。观察指标包括技术成功率、临床成功率、不良事件、住院时间、非计划再入院次数和死亡率。2011 年 11 月至 2014 年 8 月，共有 118 例患者纳入研究（EGBD 组 59 例，经皮胆囊造口术组 59 例）。两组技术成功率和临床成功率相似。EGBD 组总体不良事件发生率（19[32.2%] vs.44[74.6%]；<0.001）和严重不良事件发生率（14[23.7%] vs.44[74.6%]；<0.001）均显著低于经皮胆囊造口术组。EGBD 组需要非计划再入院的患者更少（4[6.8%] vs.42[71.2%]；<0.001），这主要与胆囊造口管相关并发症有关（95.2%）。两组 30 天不良事件发生率相似（17[28.8%] vs.10[16.9%]；=0.13）。例如，EGBD 组无复发性急性胆囊炎患者，而经皮胆囊造口术组有 4 例（6.8%）（=0.12）。EGBD 组 30 天死亡率略高于经皮胆囊造口术组（5[8.5%] vs.1[1.7%]；=0.21）。EGBD 和经皮胆囊造口术都是有效的胆囊引流方法。对于不适合手术的急性胆囊炎患者，EGBD 可能是经皮胆囊造口术的一种有前途的替代方法，前提是有经验的超声内镜医生。
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