Imanzadeh Amir, Kokabi Nima, Pourjabbar Sarvenaz, Latich Igor, Pollak Jeffrey, Kim Hyun, Gunabushanam Gowthaman
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut.
Department of Interventional Radiology, Emory University Hospital Midtown, Atlanta, Georgia.
J Clin Imaging Sci. 2020 Mar 27;10:9. doi: 10.25259/JCIS_145_2019. eCollection 2020.
The objective of the study was to evaluate the safety and efficacy of percutaneous cholecystostomy (PC) in treating critically ill patients with emphysematous cholecystitis who were deemed poor surgical candidates.
The Institutional Review Board exemption was obtained for this retrospective study. Patients with emphysematous cholecystitis who were deemed to be poor operative candidates by the treating surgeon and underwent PC placement between May 2008 and April 2017 at a single institution were identified through a medical records search. Demographics, laboratory values, imaging data, procedural technique, complications, hospitalization course, clinical outcome, and survival data were obtained.
Ten consecutive patients were included, with a mean age of 75.0 ± 12.2 years, including six men and four women. The most common comorbidity was diabetes (60%, 6/10) followed by hypertension (40%, 4/10). Intraluminal or intramural gas as well as gallbladder wall thickening were noted in all patients. Procedure technical success rate was 100%. There was a complete resolution of symptoms in 90% (9/10) of patients at a mean of 2.9 ± 1.4 days post-procedure. Thirty-day survival rate was 90% (9/10); one patient died on the 6 post- procedure day from sepsis. Two more deaths occurred within a year after PC from unrelated causes. About 50% (5/10) of patients underwent elective cholecystectomy at a median interval of 69 days post-procedure. In 40% (4/10) of patients, cholecystostomy was the definitive treatment, with tube removal at a median of 140 days post- procedure.
PC appears to be a safe and generally effective alternative management option in patients with emphysematous cholecystitis that is considered very high risk for surgery.
本研究的目的是评估经皮胆囊造瘘术（PC）在治疗被认为手术风险高的重症气肿性胆囊炎患者中的安全性和有效性。
本回顾性研究获得了机构审查委员会的豁免。通过病历检索，确定了2008年5月至2017年4月在单一机构接受治疗的外科医生认为手术风险高且接受了PC置管的气肿性胆囊炎患者。收集了人口统计学、实验室检查值、影像学数据、手术技术、并发症、住院过程、临床结局和生存数据。
连续纳入10例患者，平均年龄75.0±12.2岁，其中男性6例，女性4例。最常见的合并症是糖尿病（60%，6/10），其次是高血压（40%，4/10）。所有患者均观察到腔内或壁内气体以及胆囊壁增厚。手术技术成功率为100%。90%（9/10）的患者在术后平均2.9±1.4天症状完全缓解。30天生存率为90%（9/10）；1例患者在术后第6天死于败血症。PC术后一年内又有2例患者因无关原因死亡。约50%（5/10）的患者在术后中位间隔69天接受了择期胆囊切除术。40%（4/10）的患者中，胆囊造瘘术是最终治疗方法，术后中位140天拔除引流管。
对于被认为手术风险非常高的气肿性胆囊炎患者，PC似乎是一种安全且总体有效的替代治疗选择。
