Braun B, Blank W
Medizinische Klinik, Kreiskrankenhaus Reutlingen.
Med Klin (Munich). 1996 Jun 15;91(6):359-65.
An ultrasound-guided, percutaneous puncture (n = 30) and cholecystostomy (n = 10) was performed on 40 high-risk patients aged between 38 and 99 (mean age 78 years old) suffering from acute lithogenic cholecystitis or acalculous stress cholecystitis on account of general inoperability. Two catheter dislocations and in 3 cases a slight bile leakage were observed as complications.
The puncture and drainage led to a dramatic alleviation of pain for all patients, the involution of a paralytic subileus and improvement of the general condition. Eighteen patients underwent a laparoscopic or open interval cholecystectomy in a stabilised condition. There was no recurrence of inflammation in 22 patients over a follow-up period of up to 5 years, so that one can assume a cicatrised healing of the acute choleycstitis.
Ultrasound-guided, percutaneous puncture and cholecystostomy are effective, low-risk, and only slightly invasive procedures which can be employed for risk patients with acute cholecystitis as a life-saving, and in some cases definitive treatment. On account of pathogenic considerations, they should be included in the diagnostic and therapeutic concept at an early stage, particularly for acute, acalculous stress cholecystitis.
对40例年龄在38至99岁（平均年龄78岁）之间、因全身情况不宜手术而患有急性结石性胆囊炎或非结石性应激性胆囊炎的高危患者进行了超声引导下经皮穿刺（n = 30）和胆囊造瘘术（n = 10）。观察到2例导管移位和3例轻微胆漏作为并发症。
穿刺引流使所有患者的疼痛显著减轻，麻痹性小肠梗阻消退，全身状况改善。18例患者在病情稳定后接受了腹腔镜或开放择期胆囊切除术。在长达5年的随访期内，22例患者无炎症复发，因此可以认为急性胆囊炎已瘢痕愈合。
超声引导下经皮穿刺和胆囊造瘘术是有效、低风险且微创的手术，可用于急性胆囊炎高危患者，作为挽救生命的治疗方法，在某些情况下也是确定性治疗。出于病因学考虑，它们应尽早纳入诊断和治疗方案，特别是对于急性非结石性应激性胆囊炎。
