Turan Mujdat, Cimen Sebnem, Bahcecioglu Ibrahim Burak, Dogru Kubra Nur, Akgul Gokhan Giray, Morkavuk Sevket Baris, Gulcelik Mehmet Ali
Department of General Surgery, Health Sciences University, Faculty of Medicine, Ankara Gülhane Research and Training Hospital, Ankara, Turkey.
Department of Surgical Oncology, Gülhane Research and Training Hospital, Ankara, Turkey.
Medicine (Baltimore). 2025 Sep 19;104(38):e44561. doi: 10.1097/MD.0000000000044561.
Acute cholecystitis is a common and benign gallbladder disease frequently encountered in surgical practice. Diagnosis and treatment are managed in 3 groups following the updated 2018 Tokyo Guideline. Percutaneous cholecystostomy is recommended as an adjunct to conservative treatment for patients at grades 2 and 3. We aimed to evaluate hyponatremia's role in predicting percutaneous cholecystostomy and identify a cutoff value.
The patients admitted to the hospital diagnosed with acute cholecystitis between January 2020 and December 2024 were investigated. One hundred seven patients were included in the study who were evaluated as grade 2 based on the Tokyo Guideline. The patients were divided into 2 groups: with percutaneous cholecystostomy and without percutaneous cholecystostomy. The groups were compared based on descriptive characteristics, physical examinations and imaging findings, blood parameters, and duration of hospitalization. The efficacy of sodium levels in predicting the necessity for percutaneous cholecystostomy and the severity of the disease was investigated.
Twenty-three (21.5%) and 84 (78.5%) patients were treated with conventional and percutaneous cholecystostomy, respectively. No statistically significant difference was observed between the groups with and without percutaneous cholecystostomy for age, gender, gallbladder wall thickness, and presence of gallbladder hydrops (P = .555, P =.499, P =.635, and P = .773). Blood parameters such as white blood cell (P = .496), C-reactive protein (P = .937), alanine aminotransferase (P = .180), gamma-glutamyl transferase (P =.056), and alkaline phosphatase (P = .079) were not statistically significantly different between the groups. A statistically significant difference was observed in aspartate aminotransferase between the groups (P = .021). A statistically significant difference was observed between the distributions of mean hospitalization sodium and median sodium levels on the day of percutaneous cholecystostomy in the 2 groups (P = .002 and P < .001). The cutoff value of serum sodium for percutaneous cholecystostomy insertion was 133.5 mEq/L in the receiver operating characteristic curve analysis.
Individualization of the management of grade 2 patients and determination of objective values are critical to ensuring that each patient receives the correct treatment. Our study is the first in its field, highlighting the critical role of hyponatremia in necessitating percutaneous cholecystostomy. It also establishes a cutoff number, underscoring its importance for the literature.
急性胆囊炎是外科实践中常见的良性胆囊疾病。根据2018年更新的东京指南，诊断和治疗分为3组。对于2级和3级患者，推荐经皮胆囊造瘘术作为保守治疗的辅助手段。我们旨在评估低钠血症在预测经皮胆囊造瘘术中的作用，并确定一个临界值。
对2020年1月至2024年12月期间入院诊断为急性胆囊炎的患者进行调查。纳入107例根据东京指南评估为2级的患者进行研究。将患者分为两组：接受经皮胆囊造瘘术组和未接受经皮胆囊造瘘术组。根据描述性特征、体格检查和影像学检查结果、血液参数以及住院时间对两组进行比较。研究钠水平在预测经皮胆囊造瘘术必要性和疾病严重程度方面的有效性。
分别有23例（21.5%）和84例（78.5%）患者接受了传统治疗和经皮胆囊造瘘术。在年龄、性别、胆囊壁厚度和胆囊积液情况方面，接受和未接受经皮胆囊造瘘术的两组之间未观察到统计学显著差异（P = 0.555、P = 0.499、P = 0.635和P = 0.773）。两组之间白细胞（P = 0.496）、C反应蛋白（P = 0.937）、丙氨酸氨基转移酶（P = 0.180）、γ-谷氨酰转移酶（P = 0.056）和碱性磷酸酶（P = 0.079）等血液参数无统计学显著差异。两组之间天冬氨酸氨基转移酶存在统计学显著差异（P = 0.021）。两组在经皮胆囊造瘘术当天的平均住院钠分布和中位钠水平之间存在统计学显著差异（P = 0.002和P < 0.001）。在受试者工作特征曲线分析中，经皮胆囊造瘘术血清钠的临界值为133.5 mEq/L。
2级患者管理的个体化和客观值的确定对于确保每位患者接受正确治疗至关重要。我们的研究在该领域尚属首次，突出了低钠血症在经皮胆囊造瘘术必要性方面的关键作用。它还确定了一个临界值，强调了其对文献的重要性。
