Department of Surgery, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan.
Department of Surgery, National Hospital Organization Tochigi Medical Center, Tochigi Medical Center, 1-10-37, Nakatomatsuri, Utsunomiya, Tochigi, 320-0057, Japan.
World J Surg. 2019 Nov;43(11):2789-2796. doi: 10.1007/s00268-019-05117-5.
We usually performed percutaneous transhepatic gallbladder drainage (PTGBD) for moderate and severe acute cholecystitis (AC) prior to cholecystectomy. But, the validity of preoperative drainage for AC is still controversial. The aim of this study is to evaluate the efficacy and safety of PTGBD for moderate and severe AC, based on the Tokyo Guidelines 2018.
Total of 146 AC patients from 2012 to 2017 were enrolled. Patients were classified in the grade of severity according to TG18, compared with PTGBD and non-PTGBD group. We retrospectively reviewed clinical backgrounds and laboratory data at admission. We evaluated surgical performances as the primary outcomes and recovery periods based on guidelines.
A total of 61 cases were moderate, and 18 cases were severe AC, and PTGBD were performed in 34 cases. For moderate AC, age, DM rate and ASA in PTGBD group were significantly higher than those in non-PTGBD group. Also, serum albumin and hemoglobin at admission were significantly lower in the PTGBD group. However, surgical outcomes were almost the same. For severe AC patients, laparoscopic cholecystectomy was performed safely in all of pre-operating drainage cases, while almost all of non-PTGBD cases underwent open laparotomy and needed transfusion for massive bleeding.
Preoperative PTGBD is a useful and safe procedure for AC patients with comorbidities, especially in severe AC cases. Treatment flowchart in TG18 can be feasible to make accurate prediction for surgically high-risk patients in AC.
我们通常在胆囊切除术之前对中度和重度急性胆囊炎（AC）进行经皮经肝胆囊引流（PTGBD）。但是，术前引流对 AC 的有效性仍然存在争议。本研究旨在根据 2018 年东京指南评估 PTGBD 对中度和重度 AC 的疗效和安全性。
共纳入 2012 年至 2017 年的 146 例 AC 患者。根据 TG18 将患者分为严重程度等级，并与 PTGBD 和非 PTGBD 组进行比较。我们回顾性分析了入院时的临床背景和实验室数据。我们将手术表现作为主要结局，并根据指南评估恢复时间。
共有 61 例为中度 AC，18 例为重度 AC，34 例患者进行了 PTGBD。对于中度 AC，PTGBD 组的年龄、糖尿病发生率和 ASA 明显高于非 PTGBD 组。此外，PTGBD 组入院时的血清白蛋白和血红蛋白明显较低。然而，手术结果几乎相同。对于重度 AC 患者，所有术前引流病例均安全进行腹腔镜胆囊切除术，而几乎所有非 PTGBD 病例均行剖腹手术，并因大量出血需要输血。
对于合并症的 AC 患者，术前 PTGBD 是一种有用且安全的方法，特别是在重度 AC 病例中。TG18 中的治疗流程图可以为 AC 中手术高风险患者进行准确预测。
