Department of Surgery, The University of Florida, Gainesville, FL, USA.
The Malcom Randall Veterans Affairs Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608, USA.
Surg Endosc. 2017 Nov;31(11):4568-4575. doi: 10.1007/s00464-017-5517-x. Epub 2017 Apr 13.
Data regarding long-term outcomes following percutaneous cholecystostomy (PC) are limited, and comparisons to cholecystectomy (CCY) are lacking. We hypothesized that chronic disease burden would predict 1-year mortality following PC, and that outcomes following PC and CCY would be similar when controlling for preprocedural risk factors.
We performed a 10-year retrospective cohort analysis of patients with acute cholecystitis managed by PC (n = 114) or CCY (n = 234). Treatment response was assessed by systemic inflammatory response syndrome (SIRS) criteria at PC/CCY and 72 h later. Logistic regression identified predictors of 30-day and 1-year mortality following PC. PC and CCY patients were matched by age, Tokyo Guidelines (TG13) cholecystitis severity grade, and VASQIP calculator predicted mortality (n = 42/group).
The presence of SIRS at 72 h following PC was associated with 30-day mortality [OR 8.9 (95% CI 2.6-30)]. SIRS at 72 h was present in and 21.4% of all PC patients, significantly higher than unmatched CCY patients (4.7%, p = 0.048). Independent predictors of 1-year mortality following PC were DNR status [19.7 (2.1-186)], disseminated cancer [7.5 (2.1-26)], and congestive heart failure [3.9 (1.4-11)]. PC patients with none of these risk factors had 17.9% 90-day mortality and no deaths after 90 days; late deaths continued to occur among patients with DNR, CHF, or disseminated cancer. At baseline, PC patients had greater acute and chronic disease burden than CCY patients. After matching, PC and CCY patients had similar age (69 vs. 70 years), TG13 grade (2.4 vs. 2.4), and predicted 30-day mortality (5.5 vs. 6.8%). Matched PC patients had higher 30-day mortality (14.3 vs. 2.4%, p = 0.109) and 180-day mortality (28.6 vs. 7.1%, p = 0.048).
Treatment response to PC predicted 30-day mortality; DNR status, and chronic diseases predicted 1-year mortality. Although the matching procedure did not eliminate selection bias, PC was associated with persistent systemic inflammation and higher long-term mortality than CCY.
经皮胆囊造口术（PC）后长期结果的数据有限，且缺乏与胆囊切除术（CCY）的比较。我们假设慢性疾病负担会预测 PC 后 1 年的死亡率，并且在控制术前风险因素后，PC 和 CCY 的结果将相似。
我们对接受 PC（n=114）或 CCY（n=234）治疗的急性胆囊炎患者进行了 10 年回顾性队列分析。通过 PC/CCY 时和 72 小时后的全身炎症反应综合征（SIRS）标准评估治疗反应。Logistic 回归确定了 PC 后 30 天和 1 年死亡率的预测因素。根据年龄、东京指南（TG13）胆囊炎严重程度等级和 VASQIP 计算器预测死亡率（n=42/组）对 PC 和 CCY 患者进行匹配。
PC 后 72 小时时存在 SIRS 与 30 天死亡率相关[OR 8.9（95%CI 2.6-30）]。PC 患者中有 21.4%存在 SIRS，明显高于未匹配的 CCY 患者（4.7%，p=0.048）。PC 后 1 年死亡率的独立预测因素为 DNR 状态[19.7（2.1-186）]、播散性癌症[7.5（2.1-26）]和充血性心力衰竭[3.9（1.4-11）]。没有这些危险因素的 PC 患者 90 天死亡率为 17.9%，90 天后无死亡；DNR、CHF 或播散性癌症患者仍继续发生晚期死亡。在基线时，PC 患者的急性和慢性疾病负担均大于 CCY 患者。匹配后，PC 和 CCY 患者的年龄（69 岁与 70 岁）、TG13 分级（2.4 与 2.4）和预测 30 天死亡率（5.5%与 6.8%）相似。匹配的 PC 患者的 30 天死亡率（14.3%比 2.4%，p=0.109）和 180 天死亡率（28.6%比 7.1%，p=0.048）更高。
PC 的治疗反应预测了 30 天的死亡率；DNR 状态和慢性疾病预测了 1 年的死亡率。尽管匹配程序并未消除选择偏倚，但与 CCY 相比，PC 与持续的全身炎症和更高的长期死亡率相关。
