Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Gastroenterology, Department of Internal Medicine, Good Gang-an Hospital, Busan, Korea.
J Gastroenterol Hepatol. 2019 Apr;34(4):784-790. doi: 10.1111/jgh.14611. Epub 2019 Feb 11.
Percutaneous cholecystostomy (PC) has been frequently used as an alternative treatment for acute cholecystitis in seriously ill patients unfit for surgery. The aim of this study was to investigate the recurrence rate and risk factors of recurrence.
Medical records of 102 patients who were followed up for more than 1 year after PC tube removal among 716 patients who underwent PC for acute cholecystitis treatment were retrospectively analyzed.
The recurrence rate of acute cholecystitis after PC tube removal was 20.6% (21/102), and the mean time to recur was 660 days. Underlying cancer (odds ratio [OR]: 3.369; 95% confidence interval [CI]: 1.006-11.282; P = 0.0489), PC duration shorter than 44 days (OR: 5.596; 95% CI: 1.35-23.201; P = 0.0176), and the presence of common bile duct stone in initial imaging studies (OR: 24.393; 95% CI: 2.696-220.746; P = 0.0045) were positively correlated with recurrence. Tubogram before PC tube removal did not significantly lower the recurrence. However, PC tube clamping for several days significantly lowered the recurrence (OR: 0.108; 95% CI: 0.015-0.794; P = 0.0288). Fifty-nine (57.8%) had acalculous cholecystitis. Calculous cholecystitis was negatively correlated with recurrence (OR: 0.267; 95% CI: 0.074-0.967; P = 0.0444). Receiver operating characteristic curve of the prediction model for recurrence verified its accuracy (area under the curve: 0.8475).
We should try to keep PC more than 6 weeks and clamp for 1-2 weeks before removal. For those with the presence of common bile duct stones, calculous cholecystitis, and underlying malignancy, we should keep PC for longer duration and carefully observe symptoms and signs of recurrence.
经皮胆囊造口术（PC）已被广泛应用于不能耐受手术的重症急性胆囊炎患者的替代治疗。本研究旨在探讨 PC 管拔除后复发的发生率和复发的危险因素。
回顾性分析了 716 例因急性胆囊炎行 PC 治疗的患者中，102 例 PC 管拔除后随访时间超过 1 年的患者的病历。
PC 管拔除后急性胆囊炎的复发率为 20.6%（21/102），复发的平均时间为 660 天。基础癌症（比值比[OR]：3.369；95%置信区间[CI]：1.006-11.282；P=0.0489）、PC 持续时间短于 44 天（OR：5.596；95%CI：1.35-23.201；P=0.0176）和初始影像学研究中存在胆总管结石（OR：24.393；95%CI：2.696-220.746；P=0.0045）与复发呈正相关。PC 管拔除前的 Tubogram 并不能显著降低复发率。然而，PC 管夹闭数天可显著降低复发率（OR：0.108；95%CI：0.015-0.794；P=0.0288）。59 例（57.8%）为非结石性胆囊炎。结石性胆囊炎与复发呈负相关（OR：0.267；95%CI：0.074-0.967；P=0.0444）。复发预测模型的受试者工作特征曲线验证了其准确性（曲线下面积：0.8475）。
我们应尽量将 PC 时间延长至 6 周以上，并在拔除前夹闭 1-2 周。对于存在胆总管结石、结石性胆囊炎和基础恶性肿瘤的患者，我们应将 PC 时间延长，并仔细观察复发的症状和体征。
