Sugiyama M, Tokuhara M, Atomi Y
First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
World J Surg. 1998 May;22(5):459-63. doi: 10.1007/s002689900416.
In elderly patients emergent cholecystectomy for acute cholecystitis is a high risk procedure. We prospectively assessed the value of percutaneous cholecystostomy for acute cholecystitis in 38 consecutive elderly (> or = 80 years) patients. All 38 underwent percutaneous transhepatic cholecystostomy under ultrasonographic and fluoroscopic guidance for acute cholecystitis (25 calculous, 13 acalculous). Eight (21%) patients had acute severe medical problems, such as shock and respiratory distress. Thirty-one (82%) patients had chronic severe underlying diseases, including cardiovascular and neurologic diseases. Cholecystostomy was successful in all 38 patients. Prompt clinical improvement was obtained in 36 (95%) patients. Morbidity and mortality rates were 3% and 3%, respectively. After cholecystostomy, 10 patients with cholelithiasis underwent elective cholecystectomy without serious complications. Two patients underwent percutaneous cholecystolithotomy, which produced complete resolution of symptoms. Four of 12 patients with and none of 12 without cholelithiasis had recurrent cholecystitis after catheter removal during a mean follow-up of 1.8 years. A second cholecystostomy was successful in these four patients. Elderly patients are often poor surgical candidates because of severe cholecystitis or concomitant medical problems. Percutaneous cholecystostomy is a safe, effective treatment for acute cholecystitis even in elderly patients. For calculous cholecystitis, cholecystostomy can be followed by elective surgery, if possible, or by nonsurgical treatment or expectant conservative management in high-risk patients. Cholecystostomy may be a definitive treatment for acalculous cholecystitis.
对于老年患者，因急性胆囊炎而行急诊胆囊切除术是一项高风险手术。我们前瞻性地评估了经皮胆囊造瘘术对38例连续的老年（≥80岁）急性胆囊炎患者的治疗价值。所有38例患者均在超声和荧光镜引导下接受了经皮经肝胆囊造瘘术治疗急性胆囊炎（25例为结石性，13例为非结石性）。8例（21%）患者有急性严重内科问题，如休克和呼吸窘迫。31例（82%）患者有慢性严重基础疾病，包括心血管和神经疾病。38例患者的胆囊造瘘术均成功。36例（95%）患者临床症状迅速改善。发病率和死亡率分别为3%和3%。胆囊造瘘术后，10例胆石症患者接受了择期胆囊切除术，无严重并发症。2例患者接受了经皮胆囊取石术，症状完全缓解。在平均1.8年的随访期间，12例有胆石症的患者中有4例在拔管后发生复发性胆囊炎，12例无胆石症的患者均未发生。这4例患者再次行胆囊造瘘术成功。由于严重胆囊炎或合并内科问题，老年患者往往不是手术的合适人选。经皮胆囊造瘘术即使对老年患者也是一种安全、有效的急性胆囊炎治疗方法。对于结石性胆囊炎，如果可能，胆囊造瘘术后可进行择期手术，或对高危患者进行非手术治疗或观察性保守治疗。胆囊造瘘术可能是治疗非结石性胆囊炎的一种确定性治疗方法。
