Sgantzou Ioanna Konstantina, Samara Athina A, Adamou Antonis, Floros Theodoros, Diamantis Alexandros, Fytsilis Fotios, Papaefthymiou Apostolis, Karagiorgas Georgios, Ioannidis Ioannis, Kapsoritakis Andreas, Zacharoulis Dimitrios, Vlychou Marianna, Rountas Christos
Department of Radiology (Ioanna Konstantina Sgantzou, Antonis Adamou, Georgios Karagiorgas, Ioannis Ioannidis, Marianna Vlychou, Christos Rountas).
Department of Surgery (Athina A. Samara, Theodoros Floros, Alexandros Diamantis, Dimitrios Zacharoulis).
Ann Gastroenterol. 2022 Nov-Dec;35(6):668-672. doi: 10.20524/aog.2022.0755. Epub 2022 Oct 17.
Acute cholecystitis (AC) is an emergency commonly managed by a surgical department. The interventional part of the standard treatment algorithm includes laparoscopic or open cholecystectomy. Percutaneous cholecystostomy (PC) under imaging guidance is recommended as the first-line approach in the subset of high-risk patients for perioperative complications, as a bridging therapy to elective surgery or as a definitive solution. The aim of the present study was to evaluate the mortality and morbidity of PC performed under computed tomographic (CT) guidance in patients at high surgical risk.
Medical and imaging records from all consecutive patients who underwent a CTPC between 2015 and 2020 were reviewed. Adult patients with a definite indication for CTPC were recruited and mortality 7 and 30 days post-procedure was recorded. Variables potentially affecting those outcomes were retrieved and included in our analysis.
Eighty-six consecutive patients at high risk for surgical management were identified and included in the present study. Most patients (58.1%) were diagnosed with AC, while 14 (16.3%) had concurrent AC and cholangitis, 13 (15.2%) gallbladder empyema, and 9 (10.4%) hydrops. The 7- and 30-day mortality rates were 16.3% (14/86) and 22.1% (19/86), respectively, and were significantly associated with patients' hospitalization in the intensive care unit (P<0.05). Other parameters investigated, such as age, sex, diagnosis, catheter diameter, and duration of hospital stay were not significantly associated with our primary outcome.
PC is a safe alternative to surgery in patients with high perioperative risk, thus providing acceptable mortality rates.
急性胆囊炎（AC）是一种通常由外科处理的急症。标准治疗方案中的介入部分包括腹腔镜或开腹胆囊切除术。对于围手术期并发症高危患者的亚组，推荐在影像引导下进行经皮胆囊造瘘术（PC），作为择期手术的过渡治疗或作为最终解决方案。本研究的目的是评估在计算机断层扫描（CT）引导下对手术风险高的患者进行PC的死亡率和发病率。
回顾了2015年至2020年间所有连续接受CT引导下经皮胆囊造瘘术（CTPC）患者的医疗和影像记录。招募有明确CTPC指征的成年患者，并记录术后7天和30天的死亡率。检索可能影响这些结果的变量并纳入我们的分析。
本研究确定并纳入了86例连续的手术管理高危患者。大多数患者（58.1%）被诊断为AC，而14例（16.3%）同时患有AC和胆管炎，13例（15.2%）有胆囊积脓，9例（10.4%）有胆囊积水。7天和30天死亡率分别为16.3%（14/86）和22.1%（19/86），并且与患者入住重症监护病房显著相关（P<0.05）。研究的其他参数，如年龄、性别、诊断、导管直径和住院时间，与我们的主要结果没有显著相关性。
对于围手术期风险高的患者，PC是一种安全的手术替代方法，因此死亡率可接受。
