Hanna Kamil, Zangbar Bardiya, Kirsch Jordan, Bronstein Matthew, Okumura Kenji, Gogna Shekhar, Shnaydman Ilya, Prabhakaran Kartik, Con Jorge
Department of Surgery, Westchester Medical Center, New York, USA.
Department of Surgery, Medstar Health, Washington, USA.
Am J Surg. 2023 Nov;226(5):668-674. doi: 10.1016/j.amjsurg.2023.07.019. Epub 2023 Jul 11.
Nonoperative management (NOM) of acute calculous cholecystitis (ACC) in patients with cirrhosis was proposed. We examined the outcomes of cirrhotic patients with ACC treated with cholecystectomy compared to NOM.
We analyzed the 2017-Nationwide Readmissions Database including cirrhotic patients with ACC. Patients were stratified: cholecystectomy, percutaneous cholecystostomy (PCT), and antibiotics only.
complications, failure of NOM.
mortality, length of stay (LOS), and charges.
3454 patients were identified. 1832 underwent cholecystectomy, 360 PCT, and 1262 were treated with antibiotics. PCT patients had higher mortality 16.9% vs. the antibiotics group 10.9% vs. cholecystectomy group 4.2%. PCT patients had longer LOS, but lower charges compared to the operative group. Failure of NOM was 28.2%. On regression, PCT was associated with mortality.
ACC remains a morbid disease in cirrhosis patients. One in three failed NOM, had longer LOS, and higher mortality. Further studies are warranted to identify predictors of NOM failure.
Level III, prognostic.
有人提出对肝硬化患者的急性结石性胆囊炎（ACC）进行非手术治疗（NOM）。我们比较了接受胆囊切除术与非手术治疗的肝硬化ACC患者的治疗结果。
我们分析了2017年全国再入院数据库中肝硬化ACC患者的情况。患者被分为：胆囊切除术组、经皮胆囊造瘘术（PCT）组和仅使用抗生素组。
并发症、非手术治疗失败。
死亡率、住院时间（LOS）和费用。
共识别出3454例患者。1832例行胆囊切除术，360例行PCT，1262例仅接受抗生素治疗。PCT组患者死亡率更高（16.9%），抗生素组为10.9%，胆囊切除术组为4.2%。与手术组相比，PCT组患者住院时间更长，但费用更低。非手术治疗失败率为28.2%。回归分析显示，PCT与死亡率相关。
ACC在肝硬化患者中仍然是一种严重疾病。三分之一的非手术治疗失败，住院时间更长，死亡率更高。有必要进一步研究以确定非手术治疗失败的预测因素。
三级，预后性。
