Lee Seung Ok, Yim Sung Kyun
Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.
Korean J Gastroenterol. 2018 May 25;71(5):264-268. doi: 10.4166/kjg.2018.71.5.264.
Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient. If appropriate treatment is delayed, complications can develop as a consequence with a grave prognosis. The current standard of care in acute cholecystitis is an early laparoscopic cholecystectomy with the appropriate administration of fluid, electrolyte, and antibiotics. On the other hand, the severity of the disease and patient's operational risk must be considered. In those with high operational risks, gall bladder drainage can be performed as an alternative. Currently percutaneous and endoscopic drainage are available and show clinical success in most cases. After recovering from acute cholecystitis, the patients who have undergone drainage should be considered for cholecystectomy as a definitive treatment. However, in elderly patients or patients with significant comorbidity, operational risks may still be high, making cholecystectomy inappropriate. In these patients, gallstone removal using the percutaneous tract or endoscopy may be considered.
急性胆囊炎是胆结石常见的严重并发症。据报道,急性胆囊炎的死亡率约为3%,但该比率会随着患者年龄增长或合并症而升高。若延误适当治疗,可能会引发并发症,预后严重。目前急性胆囊炎的标准治疗方法是早期进行腹腔镜胆囊切除术,并适当补充液体、电解质及使用抗生素。另一方面,必须考虑疾病的严重程度和患者的手术风险。对于手术风险高的患者,可选择进行胆囊引流。目前有经皮引流和内镜引流两种方式,且在大多数情况下临床效果良好。急性胆囊炎康复后,接受过引流的患者应考虑进行胆囊切除术作为最终治疗手段。然而,对于老年患者或合并症严重的患者,手术风险可能仍然很高,不适合进行胆囊切除术。在这些患者中,可以考虑通过经皮途径或内镜进行胆结石取出术。