Giannopoulos Spyridon, Makhecha Keith, Madduri Sathvik, Garcia Felix, Baumgartner Timothy C, Stefanidis Dimitrios
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA.
Surg Endosc. 2023 Nov;37(11):8764-8770. doi: 10.1007/s00464-023-10332-2. Epub 2023 Aug 11.
Acute cholecystitis (AC) is one of the most prevalent diseases in clinical practice. Poor surgical candidates may benefit from early percutaneous cholecystostomy (PC) drainage followed by interval cholecystectomy (IC), which is the definitive treatment. The optimal timing between the PC drainage and the IC has not been identified. This study aimed to investigate how the duration between PC and IC affects perioperative outcomes and identify the optimal IC timing to minimize complications.
This retrospective cohort study included all adult patients diagnosed with AC who underwent PC followed by IC at a single institution center between 2014 and 2022. Patients with a history of hepatobiliary surgery, stones in the common bile duct, cirrhosis, active malignancy, or prolonged immunosuppression were excluded. The analysis did not include cases with major concurrent procedures during cholecystectomy, previously aborted cholecystectomies, or failure of the PC drain to control the inflammation. Linear and logistic regression models were used to analyze the impact of the interval between PC and IC on intra- and perioperative outcomes.
One hundred thirty-two patients (62.1% male) with a mean age of 64.4 ± 15 (mean ± SD) years were diagnosed with AC (25% mild, 47.7% moderate, 27.3% severe). All patients underwent PC followed by IC after a median of 64 [48-91] days. Longer ICU stay was associated with longer time intervals between PC and IC (Coef 105.98, p < 0.001). No significant variations were detected in the intraoperative and perioperative outcomes between patients undergoing IC within versus after 8 weeks from PC placement. However, a higher percentage of patients with delayed IC (after 8 weeks) were discharged home (96.4% vs. 83.7%; p = 0.019).
Patients may benefit from undergoing IC after the 8-week cutoff after PC. However, very long periods between PC and IC procedures may increase the risk of longer ICU stay.
急性胆囊炎（AC）是临床实践中最常见的疾病之一。手术风险较高的患者可能会从早期经皮胆囊造瘘术（PC）引流，随后进行择期胆囊切除术（IC）中获益，IC是确定性治疗方法。PC引流与IC之间的最佳时机尚未确定。本研究旨在探讨PC与IC之间的间隔时间如何影响围手术期结局，并确定使并发症最小化的最佳IC时机。
这项回顾性队列研究纳入了2014年至2022年期间在单一机构中心接受PC后再行IC的所有成年AC患者。排除有肝胆手术史、胆总管结石、肝硬化、活动性恶性肿瘤或长期免疫抑制的患者。分析不包括胆囊切除术中同时进行重大手术、先前中止的胆囊切除术或PC引流未能控制炎症的病例。使用线性和逻辑回归模型分析PC与IC之间的间隔时间对术中和围手术期结局的影响。
132例患者（62.1%为男性）被诊断为AC，平均年龄为64.4±15（平均±标准差）岁（25%为轻度，47.7%为中度，27.3%为重度）。所有患者均接受了PC，中位时间为64[48 - 91]天后进行了IC。ICU住院时间延长与PC和IC之间的时间间隔较长有关（系数105.98，p<0.001）。在PC放置后8周内与8周后接受IC的患者之间，术中和围手术期结局未发现显著差异。然而，IC延迟（8周后）的患者出院回家的比例更高（96.4%对83.7%；p = 0.019）。
患者在PC后8周后进行IC可能会受益。然而，PC和IC手术之间间隔时间过长可能会增加ICU住院时间延长的风险。
