van Overhagen H, Meyers H, Tilanus H W, Jeekel J, Laméris J S
Department of Radiology, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Cardiovasc Intervent Radiol. 1996 Mar-Apr;19(2):72-6. doi: 10.1007/BF02563896.
To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk.
Thirty-three patients with acute cholecystitis (calculous, n = 22; acalculous, n = 11) underwent percutaneous cholecystostomy by means of a transhepatic (n = 21) or transperitoneal (n = 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy.
All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n = 13), normalization of the white blood cell count (n = 3), or both (n = 6). There were 6 (18%) minor-moderate complications (transhepatic access, n = 3; transperitoneal access, n = 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n = 9) and percutaneous and endoscopic stone removal (n = 3). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n = 2) and gallbladder ablation (n = 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related.
Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary.
评估经皮胆囊造瘘术在急性胆囊炎且手术风险增加患者中的应用。
33例急性胆囊炎患者（结石性，n = 22；非结石性，n = 11）通过经肝途径（n = 21）或经腹途径（n = 12）接受经皮胆囊造瘘术。对临床和实验室参数进行回顾性研究，以确定胆囊造瘘术的益处。
所有手术在技术上均获成功。22例（67%）患者在48小时内临床症状改善；体温显著下降（n = 13）、白细胞计数恢复正常（n = 3）或两者均有改善（n = 6）。有6例（18%）发生轻度至中度并发症（经肝途径，n = 3；经腹途径，n = 3）。结石性胆囊炎患者的进一步治疗为胆囊切除术（n = 9）以及经皮和内镜取石术（n = 3）。非结石性胆囊炎患者的进一步治疗为胆囊切除术（n = 2）和胆囊消融术（n = 2）。有4例（12%）患者在住院期间或引流后30天内死亡；无一例死亡与手术相关。
经皮胆囊造瘘术对于急性胆囊炎患者是一种安全有效的手术。对于大多数非结石性胆囊炎患者，经皮胆囊造瘘术可被视为一种确定性治疗。在结石性疾病中，这种治疗通常只是暂时的，最终仍需进行确定性的手术、内镜或放射治疗。
