Byfield Victoria L, Callahan Clark Julie E, Turek Bradley J, Bradley Charles W, Rondeau Mark P
1 Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, USA.
Current address: Mount Laurel Animal Hospital, Mount Laurel, NJ, USA.
J Feline Med Surg. 2017 Dec;19(12):1254-1260. doi: 10.1177/1098612X16689335. Epub 2017 Jan 27.
Objectives The objective was to evaluate the safety and diagnostic utility of percutaneous ultrasound-guided cholecystocentesis (PUC) in cats with suspected hepatobiliary disease. Methods Medical records of 83 cats with suspected hepatobiliary disease that underwent PUC were retrospectively reviewed. Results At the time of PUC, at least one additional procedure was performed in 79/83 cats, including hepatic aspiration and/or biopsy (n = 75) and splenic aspiration (n = 18). Complications were noted in 14/83 cases, including increased abdominal fluid (n = 11), needle-tip occlusion (n = 1), failed first attempt to penetrate the gall bladder wall (n = 1) and pneumoperitoneum (n = 1). There were no reports of gall bladder rupture, bile peritonitis or hypotension necessitating treatment with vasopressor medication. Blood products were administered to 7/83 (8%) cats. Seventy-two cats (87%) survived to discharge. Of the cats that were euthanized (9/83) or died (2/83), none were reported as a definitive consequence of PUC. Bacteria were identified cytologically in 10/71 samples (14%); all 10 had a positive aerobic bacterial culture. Bile culture was positive in 11/80 samples (14%). Of the cases with a positive bile culture, cytological description of bacteria corresponded to the organism cultured in fewer than 50% of cases. The most common cytologic diagnosis was hepatic lipidosis (49/66). The most common histopathologic diagnosis was cholangitis (10/21). Conclusions and relevance PUC was safe in this group of cats with suspected hepatobiliary disease. Complications were likely associated with ancillary procedures performed at the time of PUC. Bile analysis yielded an abnormal result in nearly one-third of cats with suspected hepatobiliary disease. Complete agreement between bile cytology and culture was lacking. Further evaluation of the correlation between bile cytology and bile culture is warranted.
目的 目的是评估经皮超声引导下胆囊穿刺术（PUC）在疑似肝胆疾病猫中的安全性和诊断效用。方法 回顾性分析83只接受PUC的疑似肝胆疾病猫的病历。结果 在进行PUC时，79/83只猫至少还进行了一项其他操作，包括肝脏穿刺抽吸和/或活检（n = 75）以及脾脏穿刺抽吸（n = 18）。14/83例出现并发症，包括腹腔积液增多（n = 11）、针尖堵塞（n = 1）、首次穿刺胆囊壁失败（n = 1）和气腹（n = 1）。未报告有胆囊破裂、胆汁性腹膜炎或需要使用血管升压药物治疗的低血压情况。7/83（8%）只猫接受了血液制品输注。72只猫（87%）存活至出院。在实施安乐死的猫（9/83）或死亡的猫（2/83）中，均未报告是PUC的直接后果。在71份样本中的10份（14%）细胞学检查发现细菌；所有10份样本需氧菌培养均为阳性。80份样本中的11份（14%）胆汁培养呈阳性。在胆汁培养阳性的病例中，细菌的细胞学描述与培养出的微生物相符的病例不到50%。最常见的细胞学诊断是肝脂肪变性（49/66）。最常见的组织病理学诊断是胆管炎（10/21）。结论及相关性 在这组疑似肝胆疾病的猫中，PUC是安全的。并发症可能与PUC时进行的辅助操作有关。胆汁分析在近三分之一的疑似肝胆疾病猫中得出异常结果。胆汁细胞学和培养之间缺乏完全一致性。有必要进一步评估胆汁细胞学和胆汁培养之间的相关性。
