Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Seoul National University College of Medicine, Seoul, Republic of Korea.
Br J Radiol. 2023 Jul;96(1147):20220943. doi: 10.1259/bjr.20220943. Epub 2023 Jun 10.
To investigate the outcomes of percutaneous cholecystostomy (PC) as a definitive treatment for acute acalculous cholecystitis (AAC) and to identify the risk factors for cholecystitis recurrence after catheter removal.
Between January 2008 and December 2017, 124 patients who had undergone PC as definitive treatment for moderate or severe AAC. The initial clinical success, complications, and recurrent cholecystitis after PC removal were retrospectively assessed. Twenty-one relevant variables were analyzed to identify risk factors for recurrent cholecystitis.
Clinical effectiveness was achieved in 107 patients (86.3%) at 3 days and in all patients (100%) at 5 days after PC placement. Six Grade 2 adverse events occurred, including catheter dislodgement ( = 3) and clogging ( = 3), which required catheter exchange. The PC catheter was removed in 123 patients (99.2%), with a median indwelling duration of 18 days (range 5-116 days). During the follow-up period (median, 1624 days; range, 40-4945 days), five patients experienced recurrent cholecystitis (4.1%). The cumulative recurrence rates were 3.3%, 4.1%, and 4.1% at 6 months, 1 year, and 5 years, respectively. Multivariate analysis revealed that an age-adjusted Charlson comorbidity index (aCCI)≥7 positively correlated with recurrence (OR, 1.97; 95% confidence interval, 1.07-3.64; = 0.029).
Definitive PC is a safe and effective treatment option for patients with AAC. The PC catheters can be safely removed in most patients. An aCCI≥7 was a risk factor for cholecystitis recurrence after catheter removal.
探讨经皮胆囊造口术（PC）作为急性非结石性胆囊炎（AAC）确定性治疗的结果，并确定导管拔除后胆囊炎复发的危险因素。
2008 年 1 月至 2017 年 12 月，124 例接受 PC 作为中度或重度 AAC 确定性治疗的患者。回顾性评估初始临床疗效、并发症以及 PC 拔除后的复发性胆囊炎。分析了 21 个相关变量，以确定胆囊炎复发的危险因素。
PC 放置后 3 天，107 例患者（86.3%）达到临床有效，所有患者（100%）在 5 天内达到临床有效。发生 6 例 2 级不良事件，包括导管移位（=3）和堵塞（=3），需要更换导管。123 例患者（99.2%）拔除了 PC 导管，中位留置时间为 18 天（范围 5-116 天）。在随访期间（中位数，1624 天；范围 40-4945 天），5 例患者发生复发性胆囊炎（4.1%）。6 个月、1 年和 5 年的累积复发率分别为 3.3%、4.1%和 4.1%。多变量分析显示，年龄调整 Charlson 合并症指数（aCCI）≥7 与复发呈正相关（OR，1.97；95%置信区间，1.07-3.64；=0.029）。
确定性 PC 是治疗 AAC 患者的一种安全有效的治疗选择。大多数患者（99.2%）可以安全地拔除 PC 导管，且复发率较低（4.1%）。aCCI≥7 是导管拔除后胆囊炎复发的危险因素。
