Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan.
Division of Epidemiology, Graduate School of Public Health, St. Luke's International University, 3-6-2 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
Jpn J Radiol. 2023 Sep;41(9):1015-1021. doi: 10.1007/s11604-023-01422-1. Epub 2023 Apr 8.
To compare the complication rate and clinical outcomes for percutaneous cholecystostomy (PC) in patients with or without coagulopathy.
We retrospectively reviewed electronic medical chart of patients who underwent ultrasound-guided PC with a 8.5-F drainage tube for acute cholecystitis between November 2003 and March 2017. We divided the patients into two groups: patients with coagulopathy (international normalized ratio > 1.5 or platelet count < 50 × 10/L or with a history of anticoagulant medication in preceding 5 days) and patients without coagulopathy. Duration of drainage, duration of hospital stay, 30-day mortality and complication rates were compared between these two groups. Student's t test, Chi-square test or Fisher's exact test was used for bivariate analyses. Age, age-adjusted Charlson Comorbidity Index (ACCI) and sepsis-adjusted complication rates were also compared.
In total, 141 patients had PC (mean age was 73.3 years [SD 13.3]; range 33-96 years; 94 men and 47 women). Fifty-two patients (36.9%) had coagulopathy and 89 patients (63.1%) were without any history of coagulopathy. Hemorrhagic complication rate was 3.5% (5 out of 141 patients, including 4 with coagulopathy and 1 without). One patient with coagulopathy died due to the hemorrhage. Duration of drainage was longer in patients with coagulopathy than patients without coagulopathy (20.0 days vs. 14.8 days; P = 0.033). No significant difference was observed with regard to duration of hospital stay (32.3 days vs. 25.6 days; P = 0.103) and 30-day mortality (7.7% vs. 1.1%; P = 0.062). The overall complication rate did not significantly differ (9.6% and 11.2%; P = 0.763), nor did age, ACCI or sepsis-adjusted complications.
Clinical outcomes and complications rates after PC did not statistically differ between patients with and without coagulopathy, but there was a tendency of higher risk of hemorrhage in coagulopathy patients. Therefore, the indication of this procedure should be carefully determined.
比较有凝血障碍和无凝血障碍患者行经皮胆囊造瘘术（PC）的并发症发生率和临床转归。
我们回顾性分析了 2003 年 11 月至 2017 年 3 月期间因急性胆囊炎行超声引导下 8.5F 引流管 PC 的患者的电子病历。将患者分为两组：凝血障碍组（国际标准化比值>1.5 或血小板计数<50×10/L 或在过去 5 天内使用抗凝药物）和无凝血障碍组。比较两组患者的引流时间、住院时间、30 天死亡率和并发症发生率。使用 Student's t 检验、卡方检验或 Fisher 确切概率法进行双变量分析。还比较了年龄、年龄调整 Charlson 合并症指数（ACCI）和脓毒症调整的并发症发生率。
共 141 例行 PC（平均年龄 73.3 岁[SD 13.3]；范围 33-96 岁；94 名男性和 47 名女性）。52 例（36.9%）患者有凝血障碍，89 例（63.1%）无凝血障碍史。出血性并发症发生率为 3.5%（141 例患者中有 5 例，包括 4 例凝血障碍患者和 1 例无凝血障碍患者）。1 例凝血障碍患者因出血死亡。凝血障碍组的引流时间长于无凝血障碍组（20.0 天 vs. 14.8 天；P=0.033）。住院时间（32.3 天 vs. 25.6 天；P=0.103）和 30 天死亡率（7.7% vs. 1.1%；P=0.062）无显著差异。总并发症发生率无显著差异（9.6%和 11.2%；P=0.763），年龄、ACCI 或脓毒症调整的并发症也无显著差异。
有凝血障碍和无凝血障碍患者行 PC 后的临床转归和并发症发生率无统计学差异，但凝血障碍患者出血风险较高。因此，应谨慎确定该手术的适应证。
