Charrier Thibaut, Kepenekian Vahan, Muller Arnaud, Valette Pierre-Jean, Glehen Olivier, Cotte Eddy, Passot Guillaume
Departments of General and Oncologic Surgery.
Lyon 1 University, Lyon, France.
Surg Laparosc Endosc Percutan Tech. 2018 Aug;28(4):256-260. doi: 10.1097/SLE.0000000000000559.
Percutaneous cholecystostomy (PC) is an alternative to cholecystectomy for acute calculous cholecystitis (ACC) in patients with high mortality risk, but the catheters' and patients' management remains unclear. This study aimed to determine outcomes after PC and to define surgical strategy.
All patients who underwent PC between 2009 and 2014 for ACC in a single institution were reviewed for outcomes and postdrainage management.
Forty-one patients underwent PC with a median age of 77 years. Twenty patients (45%) presented American Society of Anesthesiologists (ASA) score 3-4, and all had cholecystitis grade II or III. The 6-month mortality was 17% (7/41 patients). Twelve patients (29%) presented PC-related complications. Catheters were removed, clamped, left open, and dislodged for 17, 9, 5, and 5 patients, respectively. Three patients died after PC, and data were missing for 2 patients. Twenty-five (61%) patients underwent cholecystectomy after PC, and were significantly younger (median age, 70 vs. 83; P<0.010), and presented with higher ASA score (ASA: 3-4, 36% vs. 68%; P=0.041) and more grade III cholecystitis (16% vs. 44%; P=0.050). Among 16 patients who did not undergo cholecystectomy, none presented recurrent gallstone disease (median survival, 7 mo; range, 0 to 55).
The risk of complications associated with the catheter is high. To prevent morbidity related to PC, we suggest removing the catheter when ACC is controlled.
经皮胆囊造瘘术（PC）是高死亡风险患者急性结石性胆囊炎（ACC）胆囊切除术的替代方案，但导管及患者管理仍不明确。本研究旨在确定PC术后结局并明确手术策略。
回顾2009年至2014年在单一机构因ACC接受PC的所有患者的结局及引流后管理情况。
41例患者接受了PC，中位年龄77岁。20例患者（45%）美国麻醉医师协会（ASA）评分为3 - 4分，且均为II级或III级胆囊炎。6个月死亡率为17%（7/41例患者）。12例患者（29%）出现PC相关并发症。导管拔除、夹闭、开放及脱出的患者分别为17、9、5和5例。3例患者PC术后死亡，2例患者数据缺失。25例（61%）患者PC术后接受了胆囊切除术，且明显更年轻（中位年龄，70岁对83岁；P<0.010），ASA评分更高（ASA：3 - 4分，36%对68%；P = 0.041），III级胆囊炎更多（16%对44%；P = 0.050）。16例未接受胆囊切除术的患者中，无一例出现复发性胆结石疾病（中位生存期，7个月；范围，0至55个月）。
导管相关并发症风险高。为预防与PC相关的发病情况，我们建议在ACC得到控制时拔除导管。
