Inoue Koetsu, Ueno Tatsuya, Nishina Orie, Douchi Daisuke, Shima Kentaro, Goto Shinji, Takahashi Michinaga, Shibata Chikashi, Naito Hiroo
Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan.
Division of Gastroenterological Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Hukumuro, Miyagino-ku, Sendai, Miyagi, Japan.
BMC Gastroenterol. 2017 May 31;17(1):71. doi: 10.1186/s12876-017-0631-8.
The Tokyo guideline for acute cholecystitis recommended percutaneous transhepatic gallbladder drainage followed by cholecystectomy for severe acute cholecystitis, but the optimal timing for the subsequent cholecystectomy remains controversial.
Sixty-seven patients who underwent either laparoscopic or open cholecystectomy after percutaneous transhepatic gallbladder drainage for severe acute cholecystitis were enrolled and divided into difficult cholecystectomy (group A) and non-difficult cholecystectomy (group B). Patients who had one of these conditions were placed in group A: 1) conversion from laparoscopic to open cholecystectomy; 2) subtotal cholecystectomy and/or mucoclasis; 3) necrotizing cholecystitis or pericholecystic abscess formation; 4) tight adhesions around the gallbladder neck; and 5) unsuccessfully treated using PTGBD. Preoperative characteristics and postoperative outcomes were analyzed.
The interval between percutaneous transhepatic gallbladder drainage and cholecystectomy in Group B was longer than that in Group A (631 h vs. 325 h; p = 0.031). Postoperative complications occurred more frequently when the interval was less than 216 h compared to when it was more than 216 h (35.7 vs. 7.6%; p = 0.006).
Cholecystectomy for severe acute cholecystitis was technically difficult when performed within 216 h after percutaneous transhepatic gallbladder drainage.
东京急性胆囊炎指南推荐对严重急性胆囊炎患者先行经皮经肝胆管胆囊引流术，随后进行胆囊切除术，但后续胆囊切除术的最佳时机仍存在争议。
纳入67例因严重急性胆囊炎行经皮经肝胆管胆囊引流术后接受腹腔镜或开腹胆囊切除术的患者，并分为困难胆囊切除术组（A组）和非困难胆囊切除术组（B组）。符合以下任一情况的患者被纳入A组：1）由腹腔镜胆囊切除术转为开腹胆囊切除术；2）胆囊次全切除术和/或黏膜剥除术；3）坏疽性胆囊炎或胆囊周围脓肿形成；4）胆囊颈部紧密粘连；5）经皮经肝胆管胆囊引流术治疗失败。分析术前特征和术后结果。
B组经皮经肝胆管胆囊引流术与胆囊切除术之间的间隔时间长于A组（631小时对325小时；p = 0.031）。间隔时间小于216小时时术后并发症的发生率高于间隔时间大于216小时时（35.7%对7.6%；p = 0.006）。
严重急性胆囊炎在经皮经肝胆管胆囊引流术后216小时内进行胆囊切除术时，技术上较为困难。
