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安全有效的短时间经皮胆囊穿刺引流术:一项回顾性观察研究。

Safe and effective short-time percutaneous cholecystostomy: A retrospective observational study.

机构信息

Department of Gastroenterology and Hepatology, University Hospital Split, Split, Croatia.

Department of Diagnostic and Interventional Radiology, University Hospital Split, Split, Croatia.

出版信息

Medicine (Baltimore). 2022 Nov 4;101(44):e31412. doi: 10.1097/MD.0000000000031412.

Abstract

The introduction of percutaneous cholecystostomy (PCT) has shifted the paradigm in treatment of acute calculous and acalculous cholecystitis. PCT has high success and low complication rates, but there are still unresolved issues regarding the duration of the procedure. The aim of our study is to determine the characteristics and outcome of patients treated with short-term PCT drainage. Patients who were admitted to the Department of gastroenterology and the Department of Abdominal Surgery at the University Hospital Center Split under the diagnosis of acute cholecystitis and who were treated with the PCT, in a period between January 2015 and January 2020, were retrospectively included in the study. During that timeframe we identified 92 patients and have analyzed their characteristics and clinical outcomes. The statistical analysis included the Kaplan-Meier method for calculating survival curves for grades 2 and 3, the log-rank test for testing the difference between survival rates of grade 2 and 3 patients, and logistic regression to determine variables that affected the outcome of our patients. According to the Tokyo guidelines, most of the patients (74, 80.43%) met the criteria for grade 2 cholecystitis, and the minority had grade 1 (9, 9.78%) and grade 3 (9, 9.78%) cholecystitis. The average drainage duration was 10.1 ± 4.8 (3-28) days. We identified mild complications in 6 cases. Nine patients (10%) had lethal outcome. The mortality in the largest group of patients with grade 2 cholecystitis was 5.48% and as high as 71.43% in patients with grade 3 cholecystitis. The complication rate was 6.5%. One quarter of gallbladder aspirates showed a ciprofloxacin resistance. Short-time PCT lasting approximately 10 days can be used safely and effectively for the treatment of patients with acute cholecystitis.

摘要

经皮胆囊穿刺引流术(PCT)的引入改变了急性结石性和非结石性胆囊炎的治疗模式。PCT 成功率高,并发症发生率低,但在手术持续时间方面仍存在未解决的问题。我们的研究目的是确定接受短期 PCT 引流治疗的患者的特征和结局。2015 年 1 月至 2020 年 1 月期间,我们回顾性纳入了在斯普利特大学医院中心消化内科和腹部外科接受诊断为急性胆囊炎的 PCT 治疗的患者。在此期间,我们共确定了 92 例患者,并分析了他们的特征和临床结局。统计分析包括 Kaplan-Meier 法计算 2 级和 3 级的生存曲线,对数秩检验比较 2 级和 3 级患者的生存率差异,以及逻辑回归确定影响患者结局的变量。根据东京指南,大多数患者(74 例,80.43%)符合 2 级胆囊炎标准,少数患者为 1 级(9 例,9.78%)和 3 级(9 例,9.78%)胆囊炎。平均引流时间为 10.1±4.8(3-28)天。我们发现 6 例患者有轻度并发症。9 例(10%)患者死亡。最大组 2 级胆囊炎患者的死亡率为 5.48%,3 级胆囊炎患者的死亡率高达 71.43%。并发症发生率为 6.5%。四分之一的胆囊抽吸物显示对环丙沙星有耐药性。持续约 10 天的短期 PCT 可安全有效地用于治疗急性胆囊炎患者。

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