Feretis C, Apostolidis N, Mallas E, Manouras A, Papadimitriou J
Second Surgical Clinic of Athens University Medical School, Greece.
Endoscopy. 1993 Aug;25(6):392-5. doi: 10.1055/s-2007-1010347.
Emergency biliary surgery for acute obstructive cholecystitis in the elderly is associated with an increased hospital mortality. We therefore attempted to drain the obstructed gallbladder via the transpapillary route in 18 patients (mean age: 67 years) who had cystic duct obstruction on ERC and who were at an increased surgical risk. A cholecystonasal catheter was successfully introduced after a small EPT in sixteen of them (89%). This resulted in effective bile drainage, obviating the need for emergency surgery in all patients. No procedure-associated morbidity or mortality was found. Following clinical remission, elective treatment consisted of ESWL/direct stone dissolution (n = 10) or elective surgery (n = 3). Three patients received no further therapy. Our results show that endoscopic gallbladder drainage may be a valuable alternative to emergency surgery in high risk patients with acute obstructive cholecystitis.
老年急性梗阻性胆囊炎的急诊胆道手术与医院死亡率增加相关。因此，我们尝试通过经乳头途径对18例患者（平均年龄：67岁）进行梗阻性胆囊引流，这些患者在逆行胰胆管造影（ERC）中存在胆囊管梗阻且手术风险增加。其中16例（89%）在进行小切口内镜乳头括约肌切开术（EPT）后成功置入鼻胆导管。这实现了有效的胆汁引流，所有患者均无需进行急诊手术。未发现与操作相关的并发症或死亡。临床缓解后，择期治疗包括体外冲击波碎石术（ESWL）/直接溶石（n = 10）或择期手术（n = 3）。3例患者未接受进一步治疗。我们的结果表明，对于急性梗阻性胆囊炎的高危患者，内镜下胆囊引流可能是急诊手术的一种有价值的替代方法。
