Melin M M, Sarr M G, Bender C E, van Heerden J A
Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Br J Surg. 1995 Sep;82(9):1274-7. doi: 10.1002/bjs.1800820939.
Percutaneous cholecystostomy offers a potentially important therapeutic modality for critically ill patients with acute cholecystitis who represent a high risk for general anaesthesia. The aim of the study was to assess experience with percutaneous cholecystostomy in resolving the acute episode of cholecystitis without operative intervention. Twenty-two consecutive patients with a clinical diagnosis of acute cholecystitis underwent the procedure. All were at high risk for general anaesthesia, and all but one developed cholecystitis while hospitalized for another co-morbid condition; 14 were in an intensive care unit. Twenty-one of the 22 patients proved to have acute cholecystitis (11 acalculous, ten cholelithiasis). There were no acute technical complications. Toxaemia resolved in 17 of the 21 patients with acute cholecystitis. Acute cholecystitis failed to resolve in three patients; all died within 48 h from overwhelming generalized sepsis. One patient required emergency cholecystectomy for bile peritonitis when the cholecystostomy catheter became dislodged 24 h after placement. The 60-day mortality rate for the acalculous and calculous patient groups was 55 and 20 per cent, respectively. Only three interval cholecystectomies have been performed at a mean follow-up of 19 months. In conclusion, percutaneous cholecystostomy may be the procedure of choice for the management of acute cholecystitis in the very high-risk critically ill patient. If symptoms fail to resolve quickly, ongoing sepsis, cholangitis or gallbladder necrosis should be suspected.
经皮胆囊造瘘术为患有急性胆囊炎且全身麻醉风险高的重症患者提供了一种潜在的重要治疗方式。本研究的目的是评估经皮胆囊造瘘术在无需手术干预的情况下解决急性胆囊炎发作的经验。连续22例临床诊断为急性胆囊炎的患者接受了该手术。所有患者全身麻醉风险都很高，除1例患者外，其余患者均在因另一种合并症住院期间发生胆囊炎；14例患者在重症监护病房。22例患者中有21例被证实患有急性胆囊炎（11例无结石性，10例有结石性）。无急性技术并发症。21例急性胆囊炎患者中有17例的毒血症得到缓解。3例患者的急性胆囊炎未得到缓解；均在48小时内死于严重的全身性败血症。1例患者在胆囊造瘘管放置24小时后移位，因胆汁性腹膜炎需要紧急胆囊切除术。无结石性和有结石性患者组的60天死亡率分别为55%和20%。平均随访19个月时仅进行了3例间隔期胆囊切除术。总之，经皮胆囊造瘘术可能是极高风险重症患者急性胆囊炎治疗的首选方法。如果症状未能迅速缓解，应怀疑存在持续性败血症、胆管炎或胆囊坏死。
