Clinical course of percutaneous cholecystostomies:A crosssectional study  

作　　者：Sadettin Er Hüseyin Berkem Sabri Ozden Birkan Birben Erdinc Cetinkaya Mesut Tez Bülent Cavit Yüksel 

机构地区：[1]Department of Surgery,Ankara Numune Training and Research Hospital,Ankara 06100,Turkey

出　　处：《World Journal of Clinical Cases》2020年第6期1033-1041,共9页世界临床病例杂志

摘　　要：BACKGROUND Although cholecystectomy is the standard treatment modality,it has been shown that perioperative mortality is approaching 19 To in critical and elderly patients.Percutaneous cholecystostomy (PC) can be considered as a safer option with a significantly lower complication rate in these patients.AIM To assess the clinical course of acute cholecystitis (AC) in patients we treated with PC.METHODS The study included 82 patients with GradeⅠ,Ⅱ or Ⅲ AC according to the Tokyo Guidelines 2018 (TG18) and treated with PC.The patients’demographic and clinical features,laboratory parameters,and radiological findings were retrospectively obtained from their medical records.RESULTS Eighty-two patients,45 (54.9%) were male,and the median age was 76 (35-98)years.According to TG18,25 patients (30.5%) had Grade Ⅰ,34 (41.5%) Grade Ⅱ,and 23 (28%) Grade Ⅲ AC.The American Society of Anesthesiologists (ASA)physical status score was Ⅲ or more in 78 patients (95.%).The patients,who had been treated with PC,were divided into two groups:discharged patients and those who died in hospital.The groups statistically significantly differed only concerning the ASA score (P=0.0001) and WBCC (P=0.025).Two months after discharge,two patients (3%) were readmitted with AC,and the intervention was repeated.Nine of the discharged patients (13.6%) underwent interval open cholecystectomy or laparoscopic cholecystectomy (8/1) within six to eight weeks after PC.The median follow-up time of these patients was 128 (12-365) wk,and their median lifetime was 36 (1-332) wk.CONCLUSION For high clinical success in AC treatment,PC is recommended for high-risk patients with moderate-severe AC according to TG18,elderly patients,and especially those with ASA scores of≥Ⅲ.According to our results,PC,a safe,effective and minimally invasive treatment,should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.BACKGROUND Although cholecystectomy is the standard treatment modality,it has been shown that perioperative mortality is approaching 19%in critical and elderly patients.Percutaneous cholecystostomy(PC)can be considered as a safer option with a significantly lower complication rate in these patients.AIM To assess the clinical course of acute cholecystitis(AC)in patients we treated with PC.METHODS The study included 82 patients with GradeⅠ,ⅡorⅢAC according to the Tokyo Guidelines 2018(TG18)and treated with PC.The patients’demographic and clinical features,laboratory parameters,and radiological findings were retrospectively obtained from their medical records.RESULTS Eighty-two patients,45(54.9%)were male,and the median age was 76(35-98)years.According to TG18,25 patients(30.5%)had GradeⅠ,34(41.5%)GradeⅡ,and 23(28%)GradeⅢAC.The American Society of Anesthesiologists(ASA)physical status score wasⅢor more in 78 patients(95.1%).The patients,who had been treated with PC,were divided into two groups:discharged patients and those who died in hospital.The groups statistically significantly differed only concerning the ASA score(P=0.0001)and WBCC(P=0.025).Two months after discharge,two patients(3%)were readmitted with AC,and the intervention was repeated.Nine of the discharged patients(13.6%)underwent interval open cholecystectomy or laparoscopic cholecystectomy(8/1)within six to eight weeks after PC.The median follow-up time of these patients was 128(12-365)wk,and their median lifetime was 36(1-332)wk.CONCLUSION For high clinical success in AC treatment,PC is recommended for high-risk patients with moderate-severe AC according to TG18,elderly patients,and especially those with ASA scores of≥Ⅲ.According to our results,PC,a safe,effective and minimally invasive treatment,should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.

关 键 词：Catheter ablation CHOLECYSTOSTOMY CHOLECYSTITIS Acute CHOLECYSTECTOMY MORTALITY MORBIDITY 

分 类 号：R657.4[医药卫生—外科学]