Er Sadettin, Berkem Hüseyin, Özden Sabri, Birben Birkan, Çetinkaya Erdinç, Tez Mesut, Yüksel Bülent Cavit
Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey.
World J Clin Cases. 2020 Mar 26;8(6):1033-1041. doi: 10.12998/wjcc.v8.i6.1033.
Although cholecystectomy is the standard treatment modality, it has been shown that perioperative mortality is approaching 19% in critical and elderly patients. Percutaneous cholecystostomy (PC) can be considered as a safer option with a significantly lower complication rate in these patients.
To assess the clinical course of acute cholecystitis (AC) in patients we treated with PC.
The study included 82 patients with Grade I, II or III AC according to the Tokyo Guidelines 2018 (TG18) and treated with PC. The patients' demographic and clinical features, laboratory parameters, and radiological findings were retrospectively obtained from their medical records.
Eighty-two patients, 45 (54.9%) were male, and the median age was 76 (35-98) years. According to TG18, 25 patients (30.5%) had Grade I, 34 (41.5%) Grade II, and 23 (28%) Grade III AC. The American Society of Anesthesiologists (ASA) physical status score was III or more in 78 patients (95.1%). The patients, who had been treated with PC, were divided into two groups: discharged patients and those who died in hospital. The groups statistically significantly differed only concerning the ASA score ( = 0.0001) and WBCC ( = 0.025). Two months after discharge, two patients (3%) were readmitted with AC, and the intervention was repeated. Nine of the discharged patients (13.6%) underwent interval open cholecystectomy or laparoscopic cholecystectomy (8/1) within six to eight weeks after PC. The median follow-up time of these patients was 128 (12-365) wk, and their median lifetime was 36 (1-332) wk.
For high clinical success in AC treatment, PC is recommended for high-risk patients with moderate-severe AC according to TG18, elderly patients, and especially those with ASA scores of ≥ III. According to our results, PC, a safe, effective and minimally invasive treatment, should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.
尽管胆囊切除术是标准的治疗方式，但研究表明，在病情危急的患者和老年患者中，围手术期死亡率接近19%。经皮胆囊造瘘术（PC）可被视为一种更安全的选择，在这些患者中并发症发生率显著更低。
评估我们采用经皮胆囊造瘘术治疗的急性胆囊炎（AC）患者的临床病程。
本研究纳入了82例根据《2018东京指南》（TG18）诊断为I级、II级或III级急性胆囊炎且接受经皮胆囊造瘘术治疗的患者。从他们的病历中回顾性获取患者的人口统计学和临床特征、实验室参数以及影像学检查结果。
82例患者中，45例（54.9%）为男性，中位年龄为76岁（35 - 98岁）。根据TG18，25例患者（30.5%）为I级，34例（41.5%）为II级，23例（28%）为III级急性胆囊炎。美国麻醉医师协会（ASA）身体状况评分为III级或更高的患者有78例（95.1%）。接受经皮胆囊造瘘术治疗的患者被分为两组：出院患者和在医院死亡的患者。两组在统计学上仅在ASA评分（P = 0.0001）和白细胞计数（P = 0.025）方面存在显著差异。出院两个月后，2例患者（3%）因急性胆囊炎再次入院，并再次接受了干预治疗。9例出院患者（13.6%）在经皮胆囊造瘘术后6至8周内接受了择期开腹胆囊切除术或腹腔镜胆囊切除术（8/1）。这些患者的中位随访时间为128周（12 - 365周），中位生存期为36周（1 - 了32周）。
为了在急性胆囊炎治疗中取得较高的临床成功率，对于根据TG18诊断为中重度急性胆囊炎的高危患者、老年患者，尤其是ASA评分≥III级的患者，推荐采用经皮胆囊造瘘术。根据我们的研究结果，对于有胆囊切除术后死亡高风险的急性胆囊炎患者，经皮胆囊造瘘术这种安全、有效且微创的治疗方法应作为首选。
