Kamer Erdinc, Cengiz Fevzi, Cakir Volkan, Balli Omur, Acar Turan, Peskersoy Mustafa, Haciyanli Mehmet
Department of Surgery, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey.
Department of Interventional Radiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey.
Prz Gastroenterol. 2017;12(4):250-255. doi: 10.5114/pg.2017.72098. Epub 2017 Dec 14.
Percutaneous cholecystostomy (PC) has been used as a relatively safe and efficient temporising measure in the treatment of acute cholecystitis (AC) in high-risk patients with serious co-morbidity and in elderly patients.
To assess the effectiveness, possible advantages, and complication of delayed laparoscopic cholecystectomy (LC) following PC in patients with AC.
A total of 52 LC for AC were divided into two groups: the first group consisted of patients who had PC followed by LC (PCLC group, = 12), and the second group consisted of patients who had conservative treatment followed by LC (non-PCLC group, = 40). Eight of these patients were males and four were female. The groups were statistically compared regarding their demographic, comorbidity, hospital stay, conservation, and complication rates. PC was performed via the transhepatic route under ultrasound guidance using local anaesthesia.
Percutaneous cholecystostomy was technically successful in 12 patients with no attributable mortality or major complications. Upon the regression of cholecystitis and the decrease in APACHE-II scores, the PC catheter was unplugged and elective LC was scheduled for after 8 weeks. Ninety-two percent had complete resolution of symptoms within 48 h of intervention while 8% had partial resolution. All of the patients in PCLC and non-PCLC groups recovered well from cholecystectomy.
This study suggests that PCLC would not significantly improve the outcome of LC as assessed by conversion and morbidity rate and hospital stay compared with non-PCLC. Percutaneous cholecystostomy is a valid alternative for patients with acute cholecystitis. And our study shows that the laparoscopic cholecystectomy is a good option in high-risk patients who have been treated by percutaneous cholecystostomy for acute cholecystitis.
经皮胆囊造瘘术（PC）已被用作一种相对安全有效的临时措施，用于治疗患有严重合并症的高危患者及老年患者的急性胆囊炎（AC）。
评估AC患者在PC后延迟行腹腔镜胆囊切除术（LC）的有效性、可能的优势及并发症。
总共52例因AC行LC的患者被分为两组：第一组由先行PC后行LC的患者组成（PCLC组，n = 12），第二组由先行保守治疗后行LC的患者组成（非PCLC组，n = 40）。这些患者中8例为男性，4例为女性。对两组患者的人口统计学、合并症、住院时间、保守治疗情况及并发症发生率进行统计学比较。PC在超声引导下经肝途径使用局部麻醉进行。
12例患者的经皮胆囊造瘘术在技术上取得成功，无相关死亡或重大并发症。随着胆囊炎消退及急性生理与慢性健康状况评分系统（APACHE-II）评分降低，拔除PC导管，并计划在8周后择期行LC。92%的患者在干预后48小时内症状完全缓解，8%的患者部分缓解。PCLC组和非PCLC组的所有患者胆囊切除术后恢复良好。
本研究表明，与非PCLC组相比，PCLC在中转率、发病率及住院时间方面评估的LC结局并无显著改善。经皮胆囊造瘘术是急性胆囊炎患者的有效替代方案。并且我们的研究表明腹腔镜胆囊切除术对于经皮胆囊造瘘术治疗急性胆囊炎的高危患者是一个不错的选择。
