Søreide Jon Arne, Fjetland Anja, Desserud Kari F, Greve Ole Jakob, Fjetland Lars
Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger.
Department of Clinical Medicine, University of Bergen, Bergen.
Medicine (Baltimore). 2020 May;99(19):e20101. doi: 10.1097/MD.0000000000020101.
While urgent percutaneous cholecystostomy (PC) was introduced as an alternative to acute surgical treatment for acute cholecystitis (AC), the current place of PC in the treatment algorithm for AC is challenged. We evaluate demographics and outcomes of PC in routine clinical practice in a population-based cohort.Retrospective evaluation of consecutive patients treated with PC for AC between 2000 and 2015. The severity of cholecystitis was graded according to the 2013 Tokyo Guidelines.One hundred forty-nine patients were included (82; 55% males) (median age of 72.5 years; range, 21-92). The Tokyo Guidelines criteria of 2013 (TG13) severity grade distribution was 4%, 61.7%, and 34.2% for grades I, II, and III, respectively. No difference was observed between males and females with regard to age, American Society of Anesthesiologists (ASA) score, comorbidities, or previous history of cholecystitis. PC was successfully performed in all but 1 patient, and complications were few and minor. Less than half (48.3%) of all patients subsequently received definitive surgical treatment, mostly (83.3%) laparoscopy. No or minor complications were encountered in 58 (80.6%) patients. Operated patients were significantly younger (P = <.001) and had lower ASA scores (P = .005), less comorbidities (P < .001), and had more seldomly a severe grade 3 cholecystitis (P < .001) than non-operated patients.PC is useful in selected patients with AC. However, since only a half of the patients eventually received definitive surgical treatment, a better routine decision-making based on proper criteria may enable an improved allocation of the individual patient for tailored treatment according to the disease severity, the patient's comorbidity burden, and also to the treatment options available at the institution to prevent overutilization of a non-definitive treatment approach. Comprehension of this responsibility should be acknowledged by hospitals with an emergency surgical service, although the clinical decision-making remains a challenge of the responsible surgeon on call.
虽然紧急经皮胆囊造瘘术（PC）被引入作为急性胆囊炎（AC）急性手术治疗的替代方法，但PC在AC治疗算法中的当前地位受到挑战。我们在一个基于人群的队列中评估常规临床实践中PC的人口统计学和结果。对2000年至2015年间接受PC治疗AC的连续患者进行回顾性评估。根据2013年东京指南对胆囊炎的严重程度进行分级。纳入149例患者（82例；55%为男性）（中位年龄72.5岁；范围21 - 92岁）。2013年东京指南（TG13）严重程度分级分布为I级4%、II级61.7%、III级34.2%。在年龄、美国麻醉医师协会（ASA）评分、合并症或胆囊炎既往史方面，男性和女性之间未观察到差异。除1例患者外，所有患者均成功进行了PC，并发症少且轻微。所有患者中不到一半（48.3%）随后接受了确定性手术治疗，大多数（83.3%）为腹腔镜手术。58例（80.6%）患者未出现或出现轻微并发症。与未手术患者相比，手术患者明显更年轻（P <.001）、ASA评分更低（P =.005）、合并症更少（P <.001），且很少有严重的3级胆囊炎（P <.001）。PC对选定的AC患者有用。然而，由于只有一半的患者最终接受了确定性手术治疗，基于适当标准的更好的常规决策可能有助于根据疾病严重程度、患者的合并症负担以及机构可用的治疗选择，对个体患者进行更合理的分配，以进行量身定制的治疗，防止过度使用非确定性治疗方法。尽管临床决策仍然是值班责任外科医生面临的挑战，但提供急诊手术服务的医院应认识到这一责任。
