Dvorak Petr, Hoffmann Petr, Renc Ondrej, Dusek Tomas, Rejchrt Stanislav, Slezak Ondrej, Vyroubal Pavel
Department of Radiology, University Hospital, Hradec Kralove, Czech Republic.
Department of Surgery, University Hospital, Hradec Kralove, Czech Republic.
Wideochir Inne Tech Maloinwazyjne. 2019 Dec;14(4):516-525. doi: 10.5114/wiitm.2019.84704. Epub 2019 May 5.
The preferred treatment for acute cholecystitis is cholecystectomy, but for patients with precluded general anesthesia due to critical illness or multiple medical comorbidities it is not suitable. Cholecystostomy could be a minimally invasive therapeutic alternative.
To retrospectively evaluate the indications, technical features, efficacy, complications, patients' development and relationships among monitored parameters of percutaneous computed tomography (CT)-guided cholecystostomies in cases of acute cholecystitis and find the role of this procedure in appropriate treatment selection.
Over the course of 10 years, 75 percutaneous cholecystostomy procedures in 69 patients were performed in cases with diagnosed acute cholecystitis, precluded general anesthesia and contraindicated cholecystectomy by an experienced surgeon and anesthesiologist. These interventions were done using only local anesthesia. The patients were men in 39 cases and women in 33 cases, aged 33 to 91 years.
Technical success was achieved in all cases. The indications were sepsis in 34 (45.3%) cases, bridging acute gallbladder inflammatory status in 15 (20%) interventions, serious medical comorbidities in 8 (10.7%) cases, disseminated malignancy and cardiac failure in 6 cases each (both 8%) and neurological affections in 5 (6.5%) cases. Cholecystostomy was frequently the final solution in acalculous cholecystitis (79.3%). The 30-day mortality rate was determined at 10.7% and the overall complication rate was 21.3%, but all of these complications were managed conservatively or using minimally invasive treatment.
Percutaneous CT-guided cholecystostomy is reserved for patients with a serious medical status for various reasons that preclude surgical treatment and general anesthesia. Simultaneously, technical success and efficacy are high and the complication rate is acceptable.
急性胆囊炎的首选治疗方法是胆囊切除术，但对于因危重病或多种内科合并症而无法进行全身麻醉的患者而言并不适用。胆囊造口术可能是一种微创治疗选择。
回顾性评估经皮计算机断层扫描（CT）引导下胆囊造口术在急性胆囊炎病例中的适应证、技术特点、疗效、并发症、患者病情发展以及监测参数之间的关系，并确定该手术在合适治疗选择中的作用。
在10年期间，由经验丰富的外科医生和麻醉师对69例诊断为急性胆囊炎、无法进行全身麻醉且禁忌行胆囊切除术的患者实施了75例经皮胆囊造口术。这些干预措施仅采用局部麻醉。患者中男性39例，女性33例，年龄33至91岁。
所有病例均取得技术成功。适应证包括败血症34例（45.3%）、缓解急性胆囊炎症状态15例（20%）、严重内科合并症8例（10.7%）、播散性恶性肿瘤和心力衰竭各6例（均为8%）以及神经病变5例（6.5%）。胆囊造口术常是无结石性胆囊炎的最终解决方案（79.3%）。30天死亡率为10.7%，总体并发症发生率为21.3%，但所有这些并发症均通过保守治疗或微创治疗得到处理。
经皮CT引导下胆囊造口术适用于因各种原因导致病情严重而无法进行手术治疗和全身麻醉的患者。同时，技术成功率和疗效较高，并发症发生率可接受。
