Gandhi Rozil, Gala Kunal, Shariq Mohd, Gandhi Aditi, Gandhi Manish, Shah Amit
Department of Interventional Radiology, Sushrut Hospital, Ahmedabad, Gujarat, India.
Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India.
Indian J Radiol Imaging. 2023 Dec 28;34(2):262-268. doi: 10.1055/s-0043-1777744. eCollection 2024 Apr.
The aim of this study was to report technical and clinical success of bedside ultrasound-guided percutaneous cholecystostomy (PC) tube placement in intensive care unit (ICU). This is a retrospective study of 51 patients (36 males:15 females, mean age: 67 years) who underwent ultrasound-guided PC from May 2015 to January 2020. The indication for cholecystostomy tube placement, comorbidities, imaging finding, technical success, clinical success, timing of surgery post-cholecystostomy tube placement, indwelling catheter time, complications, and follow-up were recorded. Indications for cholecystostomy tube placement were acute calculous cholecystitis ( = 43; 84.3%), perforated cholecystitis ( = 5; 9.8%), and emphysematous cholecystitis ( = 3; 5.9%). Most of the patients had multiple comorbidities; these were diabetes mellitus, hypertension, cardiovascular disease, chronic renal disease, underlying malignancy, and multisystem disease with sepsis. All patients had undergone PC through transhepatic approach under ultrasound guidance in ICU. Technical success rate of the procedure was 100%. Clinical success rate was 92.1% (47/51) and among these 44/51 (86.2%) patients underwent definitive elective cholecystectomy, 3/51 (5.9%) patients had elective tube removal. Three of fifty-one (5.9%) patients did not improve; among these two underwent emergency surgery, while there was 1/51 (1.9%) mortality due to ongoing sepsis and multiorgan dysfunction. There were no procedure-related mortalities or procedure-related major complications. One patient had bile leak due to multiple attempts for cholecystostomy placement. Mean tube indwelling time was 13 days (range: 3-45 days). Ultrasound-guided PC can be safely performed in ICU in critically ill patients unfit for surgery with high technical and clinical success rates. Early laparoscopic cholecystectomy should be preferred after stabilization of clinical condition following cholecystostomy.
本研究的目的是报告在重症监护病房（ICU）床边超声引导下经皮胆囊造瘘术（PC）置管的技术成功率和临床成功率。 这是一项对2015年5月至2020年1月期间接受超声引导下PC的51例患者（36例男性，15例女性，平均年龄67岁）的回顾性研究。记录胆囊造瘘管置入的适应证、合并症、影像学表现、技术成功率、临床成功率、胆囊造瘘管置入术后手术时机、留置导管时间、并发症及随访情况。 胆囊造瘘管置入的适应证为急性结石性胆囊炎（n = 43；84.3%）、穿孔性胆囊炎（n = 5；9.8%）和气肿性胆囊炎（n = 3；5.9%）。大多数患者有多种合并症，包括糖尿病、高血压、心血管疾病、慢性肾病、潜在恶性肿瘤以及伴有脓毒症的多系统疾病。所有患者均在ICU超声引导下经肝途径进行了PC。该手术的技术成功率为100%。临床成功率为92.1%（47/51），其中44/51（86.2%）的患者接受了确定性择期胆囊切除术，3/51（5.9%）的患者进行了择期拔管。51例患者中有3例（5.9%）病情未改善，其中2例接受了急诊手术，1/51（1.9%）的患者因持续脓毒症和多器官功能障碍死亡。没有与手术相关的死亡或与手术相关的严重并发症。1例患者因多次尝试胆囊造瘘置管出现胆漏。平均导管留置时间为13天（范围：3 - 45天）。 超声引导下的PC可以在ICU中对不适合手术的危重症患者安全进行，技术成功率和临床成功率都很高。在胆囊造瘘术后临床情况稳定后，应优先选择早期腹腔镜胆囊切除术。
