Morcos Rami K, Dabas Muath M, Sherwani Dua F, Shaikh Javeryah R, Rehman Abdur, Shehryar Abdullah, Rahbani Roohollah, Asghar Aima B, Ramírez Paliza Yuri André, Khan Ramadan
General Surgery, Ain Shams University Hospitals, Cairo, EGY.
General Surgery, Ministry of Health Holdings, Dammam, SAU.
Cureus. 2024 Nov 12;16(11):e73504. doi: 10.7759/cureus.73504. eCollection 2024 Nov.
Acute cholecystitis, often caused by gallstones obstructing the cystic duct, is a potentially life-threatening condition that requires timely intervention. High-risk patients, particularly those with significant comorbidities, may not be suitable candidates for laparoscopic cholecystectomy, necessitating alternative drainage techniques such as percutaneous cholecystostomy (PC) and endoscopic gallbladder drainage (EGD). This systematic review aims to compare the efficacy, safety, and outcomes of PC and EGD in managing acute cholecystitis in high-risk surgical patients. A comprehensive literature search was conducted across multiple databases, including PubMed, Medline, Embase, Cochrane Library, and Scopus, from inception to October 2024. Studies were included if they assessed the outcomes of PC versus EGD in high-risk patients with acute cholecystitis. Data extraction focused on primary outcomes such as complication rates, reintervention needs, symptom resolution, hospital stay duration, and mortality. A qualitative synthesis was conducted due to heterogeneity in the study designs. Four randomized controlled trials and cohort studies were included, encompassing a total of 238 high-risk patients. Laparoscopic cholecystectomy showed significantly better outcomes compared to percutaneous drainage in reducing major complications, reintervention rates, and recurrent biliary disease. Endoscopic drainage techniques, including naso-gallbladder drainage and gallbladder stenting, demonstrated similar clinical success rates with fewer complications than percutaneous methods, particularly in patients with concurrent biliary conditions. The findings suggest that while percutaneous drainage provides rapid symptom relief, it is associated with higher reintervention rates. Endoscopic techniques offer fewer complications and are particularly beneficial for patients with suspected choledocholithiasis. However, the choice of drainage method should be based on individual patient profiles, taking into account overall health status and comorbidities. Both percutaneous and endoscopic drainage methods are effective in managing acute cholecystitis in high-risk patients, with distinct advantages depending on patient-specific factors. Further research is needed to explore long-term outcomes and hybrid approaches that may optimize care for these patients.
急性胆囊炎通常由胆囊结石阻塞胆囊管引起，是一种可能危及生命的疾病，需要及时干预。高危患者，尤其是那些有严重合并症的患者，可能不适合进行腹腔镜胆囊切除术，因此需要采用经皮胆囊造瘘术（PC）和内镜下胆囊引流术（EGD）等替代引流技术。本系统评价旨在比较PC和EGD在高危手术患者急性胆囊炎治疗中的疗效、安全性和结局。从创刊至2024年10月，在包括PubMed、Medline、Embase、Cochrane图书馆和Scopus在内的多个数据库中进行了全面的文献检索。纳入评估PC与EGD在高危急性胆囊炎患者中结局的研究。数据提取集中在并发症发生率、再次干预需求、症状缓解、住院时间和死亡率等主要结局上。由于研究设计的异质性，进行了定性综合分析。纳入了四项随机对照试验和队列研究，共238例高危患者。与经皮引流相比，腹腔镜胆囊切除术在减少主要并发症、再次干预率和复发性胆道疾病方面显示出明显更好的结局。内镜引流技术，包括鼻胆管引流和胆囊支架置入术，显示出相似的临床成功率，且并发症少于经皮方法，尤其是在合并胆道疾病的患者中。研究结果表明，虽然经皮引流能迅速缓解症状，但与较高的再次干预率相关。内镜技术并发症较少，对疑似胆总管结石的患者尤其有益。然而，引流方法的选择应基于患者的个体情况，同时考虑整体健康状况和合并症。经皮和内镜引流方法在高危患者急性胆囊炎的治疗中均有效，根据患者的具体因素具有不同的优势。需要进一步研究以探索长期结局和可能优化这些患者治疗的联合方法。
