Hjaltadottir Katrin, Haraldsdottir Kristin Huld, Hannesson Petur Hordur, Moller Pall Helgi
Department of General Surgery.
Department of General Surgery, The Faculty of Medicine, University of Iceland.
Laeknabladid. 2019 Apr;105(4):171-176. doi: 10.17992/lbl.2019.04.226.
Acute cholecystitis is one of the most common reasons for acute admission in abdominal surgery. The recom-mended therapy is cholecystectomy but occasionally that is not possible and a conservative treatment with intravenous antibiotics is used. Should the patient not respond to conservative treatment a percutaneous catheter can be placed in the gallbladder (cholecystostomy). The aim of the study was to look at the frequency of which cholecystostomies were used and the complication rates at Landspitali, The National University Hospital of Iceland.
A retrospective study where patient charts of those with ICD - diagnosis numbers K80 - 85 at Landspitali University Hospital looked at and patients who received cholecystostomies were identified in the period from 2010 - 2016. Clinical information was registered in Excel. Descriptive statistics were used.
A total of 4423 patients were diagnosed with biliary disease during the study period. 1255 (28%) of them had acute cholecystitis with mean age of 58 years (range: 18 - 99). A cholecystostomy was put in 88 patients (14%), mean age 71 years (range: 28 - 92). A transhepatic route was used for 62 (70%) and the drain was in place for an average of 12 days (range: 0 - 87). A secondary cholangiography was performed in 71 cases. Seventeen patients were discharged home with the cholecystostomy in place. Half of the patients underwent a laparoscopic cholecystectomy 101 days from drain insertion (range: 30 - 258). A total of 28 complications were noted in 27 patients (31%) and the most common complication was dislodgement of the catheter (n=20). Five patients (6%) died within thirty days of the intervention, three from septic shock and two from reasons unrelated to the treatment.
Cholecystostomy is not a common choice of treatment for acute cholecystitis at Landspitali, The National University Hospital of Iceland. Few serious complications arise from the treatment and no patients died in relation to the intervention.
急性胆囊炎是腹部外科急性入院最常见的原因之一。推荐的治疗方法是胆囊切除术，但偶尔无法进行，此时会采用静脉注射抗生素的保守治疗。如果患者对保守治疗无反应，可在胆囊内放置经皮导管（胆囊造瘘术）。本研究的目的是观察冰岛国家大学医院兰斯皮塔利医院胆囊造瘘术的使用频率及并发症发生率。
一项回顾性研究，查阅了兰斯皮塔利大学医院国际疾病分类（ICD）诊断编码为K80 - 85的患者病历，并确定了2010年至2016年期间接受胆囊造瘘术的患者。临床信息记录在Excel中，采用描述性统计方法。
研究期间共有4423例患者被诊断为胆道疾病。其中1255例（28%）患有急性胆囊炎，平均年龄58岁（范围：18 - 99岁）。88例患者（14%）接受了胆囊造瘘术，平均年龄71岁（范围：28 - 92岁）。62例（70%）采用经肝途径，引流管平均留置12天（范围：0 - 87天）。71例患者进行了二次胆管造影。17例患者带胆囊造瘘管出院。一半患者在引流管插入后101天（范围：30 - 258天）接受了腹腔镜胆囊切除术。27例患者（31%）共出现28例并发症，最常见的并发症是导管移位（n = 20）。5例患者（6%）在干预后30天内死亡，3例死于感染性休克，2例死于与治疗无关的原因。
在冰岛国家大学医院兰斯皮塔利医院，胆囊造瘘术并非急性胆囊炎常见的治疗选择。该治疗引起的严重并发症较少，且无患者因干预死亡。
