Acute Care Surgery Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa.
Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Cape Town, South Africa.
World J Surg. 2020 Dec;44(12):4077-4085. doi: 10.1007/s00268-020-05752-3. Epub 2020 Aug 28.
Acute (calculous) cholecystitis (AC) is an extremely common surgical presentation, managed by cholecystectomy. Percutaneous cholecystostomy (PC) is an alternative; however, its safety and efficacy, along with subsequent cholecystectomy, are underreported in South Africa, where patients often present late and access to emergency operating theatre is constrained. The aim of the study was to demonstrate the outcomes of PC in patients with AC not responding to antimicrobials.
A retrospective cohort review of patient records, who underwent PC in Groote Schuur Hospital, Cape Town, between May 2013 and July 2016, was performed. Patients with PC for malignancy or acalculous cholecystitis were excluded. Technical success, clinical response, procedure-related morbidity and mortality were recorded. Interval LC parameters were investigated.
Technical success and clinical improvement was seen in 29 of 37 patients (78.38%) who had PC. Malposition (8.11%) was the most common complication. Two patients required emergency surgery (5.4%), while one tube was dislodged. Median tube placement duration was 25 days (range 1-211). Post-procedure, 16 patients (43.24%) went on to have LC, of which 50% (eight patients) required conversion to open surgery and 25% (four) had subtotal cholecystectomy. Median surgical time was 130 min. There were no procedure-related mortalities but eight patients (21.62%) died in the 90-day period following tube insertion.
In patients with AC, PC is safe, with high technical success and low complication rate. Subsequent cholecystectomy should be performed, but is usually challenging. The requirement for PC may predict a more complex disease process.
急性（结石性）胆囊炎（AC）是一种极其常见的外科疾病，通常通过胆囊切除术进行治疗。经皮胆囊造口术（PC）是一种替代方案；然而，在南非，PC 的安全性和疗效以及随后的胆囊切除术的安全性和疗效报告较少，因为南非的患者通常就诊较晚，并且紧急手术室的使用受到限制。本研究旨在展示对对抗生素治疗无反应的 AC 患者行 PC 的结果。
对 2013 年 5 月至 2016 年 7 月在开普敦格罗特舒尔医院接受 PC 的患者的病历进行了回顾性队列研究。排除了因恶性肿瘤或非结石性胆囊炎而行 PC 的患者。记录了技术成功率、临床反应、与操作相关的发病率和死亡率，并调查了间隔性 LC 参数。
29 例（78.38%）接受 PC 的患者取得了技术成功和临床改善。最常见的并发症是位置不当（8.11%）。2 例患者需要紧急手术（5.4%），1 例引流管脱落。引流管放置的中位数时间为 25 天（范围 1-211 天）。术后，16 例患者（43.24%）进行了 LC，其中 50%（8 例）需要转为开腹手术，25%（4 例）需要行次全胆囊切除术。中位手术时间为 130 分钟。无操作相关死亡率，但 8 例（21.62%）患者在插入引流管后的 90 天内死亡。
在 AC 患者中，PC 是安全的，具有较高的技术成功率和较低的并发症发生率。应进行后续的胆囊切除术，但通常具有挑战性。对 PC 的需求可能预示着更复杂的疾病过程。
