内镜超声引导下使用 lumen-apposing 金属支架经壁内胆囊引流与内镜经乳头引流与经皮胆囊造口术在伴有急性胆囊炎的高危手术患者中进行胆囊引流的三向比较研究：国际多中心研究中的临床结局和成功率。
Three-way comparative study of endoscopic ultrasound-guided transmural gallbladder drainage using lumen-apposing metal stents versus endoscopic transpapillary drainage versus percutaneous cholecystostomy for gallbladder drainage in high-risk surgical patients with acute cholecystitis: clinical outcomes and success in an International, Multicenter Study.
机构信息
Thomas Jefferson University, Philadelphia, PA, USA.
Aarhus University, Aarhus, Denmark.
出版信息
Surg Endosc. 2019 Apr;33(4):1260-1270. doi: 10.1007/s00464-018-6406-7. Epub 2018 Sep 12.
BACKGROUND
Percutaneous cholecystostomy tube (PTGBD), endoscopic retrograde cholangiopancreatography with transpapillary gallbladder drainage (TP), and endoscopic ultrasound-guided transmural gallbladder drainage (EGBD) using lumen-apposing metal stents (LAMS) have been offered for gallbladder decompression for acute cholecystitis in high-risk surgical patients. Yet, there are limited data comparing these therapies. Our aim was to compare the safety and efficacy of EGBD to TP and PTGBD for gallbladder drainage.
METHODS
We retrospectively collected high-risk surgical patients from six centers with acute cholecystitis who underwent gallbladder drainage by EGBD, TP, or PTGBD. Data included technical success (gallbladder drainage), clinical success (acute cholecystitis resolution), adverse events (AE), and follow-up.
RESULTS
From 2010 to 2016, 372 patients underwent gallbladder drainage, with 146 by PTGBD, 124 by TP, and 102 drained by EGBD. Technical (98% vs. 88% vs. 94%; p = 0.004) and Clinical (97% vs. 90% vs. 80%; p < 0.001) success rates were significantly higher with PTGBD and EGBD compared to TP. PTGBD group had statistically significantly higher number of complications as compared to EGBD and TP groups (2 0% vs. 2% vs. 5%; p = 0.01). Mean hospital stay in the EGBD group was significantly less than TP and PTGBD (16 vs. 18 vs. 19 days; p = 0.01), while additional surgical intervention was significantly higher in the PTGBD group compared to the EGBD and TP groups (49% vs. 4% vs. 11%; p < 0.0001).
CONCLUSIONS
EGBD with LAMS is an effective and safer alternative to TP and PTGBD for treatment of patients with acute cholecystitis who cannot undergo surgery. EGBD with LAMS has significantly lower overall AEs, hospital stay, and unplanned admissions compared to PTGBD.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01522573.
背景
经皮胆囊造口术（PTGBD）、内镜逆行胰胆管造影术联合经乳头胆囊引流术（TP）和内镜超声引导经壁胆囊引流术（EGBD）联合使用腔内置入金属支架（LAMS）已被用于高危手术患者的急性胆囊炎胆囊减压。然而，比较这些治疗方法的资料有限。我们的目的是比较 EGBD 与 TP 和 PTGBD 用于胆囊引流的安全性和有效性。
方法
我们从 6 家中心回顾性收集了患有急性胆囊炎的高危手术患者，这些患者接受了 EGBD、TP 或 PTGBD 治疗。数据包括技术成功率（胆囊引流）、临床成功率（急性胆囊炎缓解）、不良事件（AE）和随访。
结果
2010 年至 2016 年，372 名患者接受了胆囊引流，其中 146 例行 PTGBD，124 例行 TP，102 例行 EGBD。PTGBD 和 EGBD 的技术（98% vs. 88% vs. 94%；p=0.004）和临床（97% vs. 90% vs. 80%；p<0.001）成功率均显著高于 TP。与 EGBD 和 TP 组相比，PTGBD 组的并发症发生率显著更高（20% vs. 2% vs. 5%；p=0.01）。EGBD 组的平均住院时间明显短于 TP 和 PTGBD 组（16 天 vs. 18 天 vs. 19 天；p=0.01），而 PTGBD 组的额外手术干预率明显高于 EGBD 和 TP 组（49% vs. 4% vs. 11%；p<0.0001）。
结论
对于不能手术的急性胆囊炎患者，LAMS 联合 EGBD 是一种有效且更安全的替代 TP 和 PTGBD 的治疗方法。与 PTGBD 相比，LAMS 联合 EGBD 的总体不良事件、住院时间和计划外入院率明显更低。
试验注册
ClinicalTrials.gov 标识符：NCT01522573。
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