1 Peninsula HPB Unit, Level 7, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK.
2 Department of Radiology, Derriford Hospital, Plymouth, UK.
Scand J Surg. 2019 Jun;108(2):124-129. doi: 10.1177/1457496918798209. Epub 2018 Sep 18.
Acute cholecystitis has the potential to cause sepsis and death, particularly in patients with poor physiological reserve. The gold standard treatment of acute cholecystitis (cholecystectomy) is often not safe in high-risk patients and recourse is made to percutaneous cholecystostomy as either definite treatment or temporizing measure. The aim of this study is to evaluate early and late outcomes following percutaneous cholecystostomy in patients with acute cholecystitis treated at our institution.
All patients who underwent percutaneous cholecystostomy for acute cholecystitis (excluding patients with malignancy) between January 2005 and September 2014 were included in the study.
A total of 53 patients (22 female, median age, 74 years; range, 27-95 years) underwent percutaneous cholecystostomy during the study period. In total, 12 patients (22.6%) had acalculous cholecystitis. The main indications for percutaneous cholecystostomy were significant co-morbidities (n = 28, 52.8%) and patients too unstable for surgery (n = 21, 39.6%). The median time to percutaneous cholecystostomy from diagnosis of acute cholecystitis was 3.6 days (range, 0-45 days). The median length of hospital stay was 27 (range, 4-87) days. The overall 90-day mortality was 9.3% with two further deaths at 12-month follow up. The mortality was significantly higher in patients with American Society of Anesthesiology grade 4-5 (18% vs 0% in American Society of Anesthesiology grade 2-3, p = 0.026) and in patients with acalculous cholecystitis (25% vs 4.5%, p = 0.035). The overall readmission rate was 18%. A total of 24 (45.2%) patients had surgery: laparoscopic cholecystectomy, n = 11; laparoscopic converted to open, n = 5; open total cholecystectomy, n = 5; open cholecystectomy, n = 1; laparotomy and washout, n = 1; laparotomy partial cholecystectomy and closure of perforated small intestine and gastrostomy, n = 1.
Percutaneous cholecystostomy is a useful temporary or permanent procedure in patients with acute cholecystitis of both calculous and acalculous origin, who are unfit for surgery.
急性胆囊炎有引发脓毒症和死亡的风险，尤其是对生理储备能力差的患者而言。急性胆囊炎的金标准治疗方法（胆囊切除术）在高危患者中往往并不安全，因此会采用经皮胆囊造口术作为确定性或临时治疗方法。本研究旨在评估我院收治的急性胆囊炎患者行经皮胆囊造口术的早期和晚期结局。
本研究纳入了 2005 年 1 月至 2014 年 9 月期间因急性胆囊炎而行经皮胆囊造口术（不包括恶性肿瘤患者）的所有患者。
研究期间共 53 例患者（22 例女性，中位年龄 74 岁；范围 27-95 岁）接受了经皮胆囊造口术。共有 12 例（22.6%）患者患有非结石性胆囊炎。行经皮胆囊造口术的主要指征为合并严重合并症（n=28，52.8%）和患者手术风险过高（n=21，39.6%）。从急性胆囊炎诊断到行经皮胆囊造口术的中位时间为 3.6 天（范围 0-45 天）。中位住院时间为 27 天（范围 4-87 天）。90 天总死亡率为 9.3%，在 12 个月的随访中有 2 例患者死亡。美国麻醉医师协会（ASA）分级 4-5 级患者的死亡率显著高于 ASA 分级 2-3 级患者（18% vs. 0%，p=0.026），非结石性胆囊炎患者的死亡率也显著高于结石性胆囊炎患者（25% vs. 4.5%，p=0.035）。总的再入院率为 18%。共有 24 例（45.2%）患者接受了手术治疗：腹腔镜胆囊切除术 11 例；腹腔镜转为开腹手术 5 例；开腹总胆囊切除术 5 例；开腹胆囊切除术 1 例；剖腹探查和冲洗术 1 例；剖腹探查部分胆囊切除术、穿孔小肠缝合和胃造口术 1 例。
对于因生理储备能力差而不能手术的结石性和非结石性胆囊炎患者，经皮胆囊造口术是一种有用的临时或永久性治疗方法。
