Kim Sung Bum, Gu Min Geun, Kim Kook Hyun, Kim Tae Nyeun
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Medicine (Baltimore). 2020 Feb;99(7):e19057. doi: 10.1097/MD.0000000000019057.
Although cholecystectomy is generally recommended for acute acalculous cholecystitis (AAC) treatment, non-surgical management can be considered in patients at a high risk for surgery. This study compared outcomes of surgical and non-surgical management and analyzed the long-term outcomes of AAC patients managed non-surgically.We retrospectively analyzed 89 patients diagnosed with AAC between January 1, 2007 and April 30, 2014. These patients were divided into 2 groups: non-surgical (n = 41) and surgical (n = 48). Non-surgical management methods were percutaneous cholecystostomy (PC, n = 14) and antibiotics only (n = 27). The non-surgical group was followed up for >3 years after treatment.The mean age was slightly higher in the non-surgical group than in the surgical group without significant difference. The prevalence of cerebrovascular accident in the non-surgical group was significantly higher than that in the surgical group (26.8% vs 8.3%, P = .020). Mean hospital stay was not statistically different between two groups. The surgical group had a significantly higher incidence of posttreatment complications than the non-surgical group (18.8% vs 2.4%, P = .015). During the mean follow-up of 5.7 years, AAC recurred in 4 (9.8%) patients in the non-surgical group. Three patients underwent cholecystectomy, 1 was treated with antibiotics, and no recurrence-related death occurred. The recurrence rate of AAC was not different between PC and antibiotics only groups (14.3% vs 7.4%, P = .596).Recurrence was observed in 9.8% of AAC patients treated non-surgically and the outcome in the non-surgical group was not inferior to that in the surgical group.
虽然一般建议对急性非结石性胆囊炎（AAC）进行胆囊切除术，但对于手术风险高的患者可考虑非手术治疗。本研究比较了手术和非手术治疗的结果，并分析了非手术治疗的AAC患者的长期预后。我们回顾性分析了2007年1月1日至2014年4月30日期间诊断为AAC的89例患者。这些患者分为两组：非手术组（n = 41）和手术组（n = 48）。非手术治疗方法为经皮胆囊造瘘术（PC，n = 14）和单纯使用抗生素（n = 27）。非手术组在治疗后随访超过3年。非手术组的平均年龄略高于手术组，但无显著差异。非手术组的脑血管意外患病率显著高于手术组（26.8%对8.3%，P = 0.020）。两组的平均住院时间无统计学差异。手术组治疗后并发症的发生率显著高于非手术组（18.8%对2.4%，P = 0.015）。在平均5.7年的随访期间，非手术组有4例（9.8%）患者复发AAC。3例患者接受了胆囊切除术，1例接受了抗生素治疗，未发生与复发相关的死亡。PC组和单纯抗生素组的AAC复发率无差异（14.3%对7.4%，P = 0.596）。非手术治疗的AAC患者中有9.8%出现复发，非手术组的预后不低于手术组。
