Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA.
Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA.
Diagn Interv Imaging. 2018 Jan;99(1):15-21. doi: 10.1016/j.diii.2017.04.006. Epub 2017 May 12.
To investigate the rates of interval cholecystectomy and recurrent cholecystitis after initial percutaneous cholecystostomy (PC) and identify predictors of patient outcome after PC.
A total of 144 patients with acute cholecystitis who were treated with PC were included. There were 96 men and 48 women, with a mean age of 71±13 (SD) years (range: 25-100 years). Patient characteristics, diagnostic imaging studies and results of laboratory tests at initial presentation, clinical outcomes after the initial PC treatment were reviewed.
Among the 144 patients, 56 patients were referred for acute acalculous and 88 patients for calculus cholecystitis. Five procedure-related major complications (3.6%) were observed including bile peritonitis (n=3), hematoma (n=1) and abscess formation (n=1). Recurrent acute cholecystitis after initial clinical resolution and PC tube removal was observed in 8 patients (6.0%). The rate of interval cholecystectomy was 33.6% (47/140) with an average interval period of 100±482 (SD) days (range: 3-1017 days). PC was a definitive treatment in 85 patients (60.7%) whereas 39 patients (27.9%) had elective interval cholecystectomy without having recurrent cholecystitis. The clinical outcomes after PC did not significantly differ between patients with calculous cholecystitis and those with acalculous cholecystitis. Multiple prior abdominal operations were associated with higher rates of recurrent cholecystitis.
For both acute acalculous and calculous cholecystitis, PC is an effective and definitive treatment modality for more than two thirds of our study patients over 3.5-year study period with low rates of recurrent disease and interval cholecystectomy.
探讨初始经皮胆囊造口术（PC）后行间隔性胆囊切除术和复发性胆囊炎的发生率，并确定 PC 后患者结局的预测因素。
共纳入 144 例接受 PC 治疗的急性胆囊炎患者，其中男 96 例，女 48 例，平均年龄 71±13（SD）岁（年龄范围：25-100 岁）。回顾患者特征、初始表现时的诊断影像学研究和实验室检查结果、初始 PC 治疗后的临床结局。
在 144 例患者中，56 例为急性非结石性胆囊炎，88 例为结石性胆囊炎。观察到 5 例与操作相关的主要并发症（3.6%），包括胆汁性腹膜炎（n=3）、血肿（n=1）和脓肿形成（n=1）。初始临床缓解和 PC 管移除后，8 例（6.0%）患者发生复发性急性胆囊炎。间隔性胆囊切除术的发生率为 33.6%（47/140），平均间隔时间为 100±482（SD）天（范围：3-1017 天）。PC 是 85 例患者（60.7%）的确定性治疗方法，而 39 例（27.9%）患者在没有复发性胆囊炎的情况下择期行间隔性胆囊切除术。PC 后的临床结局在结石性胆囊炎和非结石性胆囊炎患者之间无显著差异。既往多次腹部手术与复发性胆囊炎的发生率较高相关。
对于急性非结石性和结石性胆囊炎，PC 是一种有效的确定性治疗方法，超过三分之二的患者在 3.5 年的研究期间接受了 PC，疾病复发和间隔性胆囊切除术的发生率较低。
