Wong S R, Lee K T, Kuo K K, Chen J S, Ker C G, Sheen P C
Department of Surgery, Kaohsiung Medical College Hospital, Taiwan, Republic of China.
Kaohsiung J Med Sci. 1998 Jan;14(1):19-24.
Acute cholecystitis is a common disease which may carry the risk of complications, including empyema, perforation, abscess, peritonitis and sepsis. Percutaneous transhepatic drainage of the gallbladder (PTGBD) with antibiotics can provide prompt decompression of gallbladder in acute cholecystitis and interrupt the natural history of the disease effectively. From July 1986 to June 1996, 154 patients with acute cholecystitis were reviewed retrospectively in Kaohsiung Medical College Hospital. The chief symptoms and signs were pain (98.1%), fever (57.1%) and jaundice (37.7%). WBC count more than 10,000 was noted in 116 (75.3%) patients. Associated diseases included empyema: 42 (27.3%), septic shock: 14 (9.1%), diabetes mellitus: 13 (8.4%), pancreatitis: 10 (6.5%), perforation: 7 (4.5%), liver cirrhosis: 6 (3.9%) and respiratory failure: 1 (0.6%). All of them underwent ultrasound-guided PTGBD immediately after the diagnosis was established. The symptoms and signs disappeared soon after this procedure. Bacterial culture was found positive in 104 (67.5%) of 154 patients in which Escherichia coli (51.9%) was the most common organism, followed by Klebsiella pneumonia (20.2%). After acute stage, 138 patients obtained the cholangiography via PTGBD tube. Gallbladder stones were only noted in 56 (40.6%) patients, gallbladder stone concomitant with common bile duct stone in 26 (18.8%), cystic duct obstruction in 25 (18.1%), acalculous cholecystitis in 21 (15.2%), gallbladder perforation in 1 (0.7%), choledochocyst in 1 (0.7%), and cholecystocolonic fistula in 1 (0.7%). There were 135 patients to undergo surgery after the clinical condition was stable. The operative findings included gallbladder stones only in 88 (65.2%), gallbladder stone concomitant with common bile duct stone in 34 (25.2%), acalculous cholecystitis in 13 (9.6%), choledochocyst in 1 (0.7%), and cholecysto-colonic fistula in 1 (0.7%). The postoperative complications included wound infection 8 (5.9%), UGI bleeding 3 (2.2%), acute renal failure 1 (0.7%) and acute respiratory failure 1 (0.7%). The postoperative mortality rate was 0.7% (1/135), which was much lower than those of previous reports, which not undergoing PTGBD initially. It led us to conclude that PTGBD, as an initial preoperative modality to treat acute cholecystitis, is effective in decreasing postoperative morbidity and mortality.
急性胆囊炎是一种常见疾病，可能伴有包括积脓、穿孔、脓肿、腹膜炎和脓毒症等并发症的风险。经皮经肝胆囊引流术（PTGBD）联合抗生素可使急性胆囊炎患者的胆囊迅速减压，并有效阻断疾病的自然发展进程。1986年7月至1996年6月，高雄医学院附属医院对154例急性胆囊炎患者进行了回顾性研究。主要症状和体征为疼痛（98.1%）、发热（57.1%）和黄疸（37.7%）。116例（75.3%）患者白细胞计数超过10000。相关疾病包括积脓：42例（27.3%），感染性休克：14例（9.1%），糖尿病：13例（8.4%），胰腺炎：10例（6.5%），穿孔：7例（4.5%），肝硬化：6例（3.9%），呼吸衰竭：1例（0.6%）。所有患者确诊后立即接受超声引导下PTGBD。术后症状和体征很快消失。154例患者中104例（67.5%）细菌培养呈阳性，其中大肠埃希菌（51.9%）是最常见的病原体，其次是肺炎克雷伯菌（20.2%）。急性期过后，138例患者通过PTGBD管进行了胆管造影。仅56例（40.6%）患者发现胆囊结石，26例（18.8%）患者胆囊结石合并胆总管结石，25例（18.1%）患者胆囊管梗阻，21例（15.2%）患者无结石性胆囊炎，1例（0.7%）患者胆囊穿孔，1例（0.7%）患者胆总管囊肿，1例（0.7%）患者胆囊结肠瘘。135例患者在临床状况稳定后接受了手术。手术所见包括仅88例（65.2%）患者有胆囊结石，34例（25.2%）患者胆囊结石合并胆总管结石，13例（9.6%）患者无结石性胆囊炎，1例（0.7%）患者胆总管囊肿，1例（0.7%）患者胆囊结肠瘘。术后并发症包括伤口感染8例（5.9%），上消化道出血3例（2.2%），急性肾衰竭1例（0.7%），急性呼吸衰竭1例（0.7%）。术后死亡率为0.7%（1/135），远低于先前未先行PTGBD的报道。由此我们得出结论，PTGBD作为治疗急性胆囊炎的一种术前初始治疗方法，可有效降低术后发病率和死亡率。
