Johlin F C, Neil G A
Clifton Center for Digestive Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242.
Gastrointest Endosc. 1993 Sep-Oct;39(5):645-51. doi: 10.1016/s0016-5107(93)70216-3.
The mortality associated with acute acalculous cholecystitis approaches 50%. Removal or decompression of the gallbladder in these patients may prevent gallbladder rupture and may be lifesaving. This is usually accomplished by cholecystectomy, cholecystotomy, or percutaneous gallbladder drainage. We describe a novel transpapillary endoscopic approach to gallbladder drainage in patients at high surgical risk. A total of seven high surgical risk patients were treated with transpapillary endoscopic cholecystotomy. Cannulation of the cystic duct was accomplished by using standard hourglass-tipped catheters in two patients. A new "selector" catheter was developed for selective cannulation of the cystic duct and used in the other five patients. Five of the seven patients showed evidence of clinical, radiographic, and laboratory improvement after treatment. We conclude that transpapillary endoscopic cholecystotomy may be an effective treatment alternative for high surgical risk patients with acalculous cholecystitis.
急性非结石性胆囊炎的死亡率接近50%。对这些患者进行胆囊切除或减压可预防胆囊破裂，可能挽救生命。这通常通过胆囊切除术、胆囊造口术或经皮胆囊引流来完成。我们描述了一种针对手术风险高的患者进行胆囊引流的新型经乳头内镜方法。共有7例手术风险高的患者接受了经乳头内镜胆囊造口术治疗。2例患者使用标准沙漏形导管完成了胆囊管插管。为选择性胆囊管插管研制了一种新的“选择器”导管，并用于其他5例患者。7例患者中有5例在治疗后有临床、影像学和实验室检查改善的证据。我们得出结论，经乳头内镜胆囊造口术可能是手术风险高的非结石性胆囊炎患者的一种有效治疗选择。
