Wong S K, Yu S C, Lam Y H, Chung S S
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T. Hong Kong.
Surg Endosc. 1999 Jan;13(1):48-52. doi: 10.1007/s004649900896.
Percutaneous cholecystostomy is a valuable alternative temporary measure for acute cholecystitis in elderly patients with severe underlying cardiopulmonary disease, but the subsequent management of gallbladder calculi is still controversial.
Eleven patients treated with percutaneous endoscopic cholecystolithotripsy after percutaneous cholecystostomy were evaluated retrospectively.
All patients showed clinical improvement after percutaneous cholecystostomy. Tract dilation succeeded in 9 patients. Complete stone clearance was achieved in seven patients over one to four sessions (average, two sessions). Stone extraction could not be completed in two patients because gallbladder access was lost in one patient, and the other refused further procedure. There were three complications, with two biliary fistulas and one major bile leakage leading to emergency cholecystectomy. The duration of the entire procedure ranged from 30 to 126 days (mean, 58 days). During the follow-up (mean 17.2 months), one patient had recurrent cholangitis and the others remained asymptomatic.
Percutaneous cholecystolithotripsy after percutaneous cholecystostomy is a safe alternative in the management of high-risk elderly patients with acute cholecystitis.
经皮胆囊造瘘术是患有严重基础心肺疾病的老年急性胆囊炎患者一种有价值的替代性临时措施，但胆囊结石的后续处理仍存在争议。
回顾性评估11例经皮胆囊造瘘术后接受经皮内镜胆囊碎石术治疗的患者。
所有患者经皮胆囊造瘘术后临床症状均有改善。9例患者扩张通道成功。7例患者经1至4次手术（平均2次）结石完全清除。2例患者无法完成结石取出，其中1例患者无法进入胆囊，另1例拒绝进一步手术。出现3例并发症，2例胆瘘，1例严重胆汁漏导致急诊胆囊切除术。整个手术过程持续30至126天（平均58天）。随访期间（平均17.2个月），1例患者复发性胆管炎，其他患者无症状。
经皮胆囊造瘘术后经皮内镜胆囊碎石术是治疗高危老年急性胆囊炎患者的一种安全替代方法。
