经皮胆囊穿刺引流术治疗高危急性胆囊炎25例

Percutaneous cholecystostomy in the treatment of acute cholecystitis in 25 poor-risk patients

目的 探讨经皮胆囊穿刺引流术（percutaneous cholecystostomy,PCT）治疗高危急性胆囊炎（acute cholecystitis,AC）的临床价值. 方法 回顾性分析2007年4月至2012年12月间接受PCT治疗的高危AC患者的临床资料,并与同期接受急诊胆囊切除术（cholecystectomy,CCY）的患者在治疗成功率、并发症发生率、住院时间、住院死亡率和再住院率方面进行对比研究.结果 本组51例患者中,25例行PCT引流术,26例接受CCY手术,平均年龄分别为75岁和74岁.PCT组ICU的入住时间平均长达13d,CCY组则为5d,PCT组明显长于CCY组（t=5.175,P=0.001）.PCT组平均住院时间明显长于CCY组,分别为21.3d和9.8 d（t=3.213,P=0.002）;但患者治疗成功率、并发症发生率、住院总死亡率的差异无统计学意义.PCT组25例患者中,19例术后拔管无复发,6例患者因结石性AC复发而需再次住院,3例获保守治疗,另3例重新行PCT穿刺引流,其中2例长期带管,1例4周后行延期CCY手术,PCT治疗成功率为76％.结论 与急诊CCY比较,PCT引流虽然住院时间长,再住院率高,但在患者治疗成功率、并发症发生率、住院总死亡率方面能达到与CCY手术治疗相同的效果.

Objective To evaluate the effects of percutaneous cholecystostomy （PCT） for the treatment of acute cholecystitis （AC） in poor-risk patients.Methods A retrospective clinical analysis was undertaken in poor-risk AC patients receiving PCT or emergency cholecystectomy （CCY） from April 2007 to December 2012.The success rate,complications,hospital stay and mortality,and readmission rate were compared between PCT and CCY groups.Results Of the 51 poor-risk acute cholecystitis patients,25 underwent PCT drainages and 26 received emergency CCY at an average age of 75 and 74 years respectively.The average intensive care unit length of stay was 13 days in PCT group and 5 days in CCY group （t =5.175,P =0.001）.The mean hospital length of stay in PCT patients （21.3 days） was longer than that in CCY patients （9.8 days） （t =3.213,P =0.002）.However,there was no significant difference in the overall hospital mortality,complications and successful rate between the two groups.No recurrence was observed in 19 out of 25 PCT cases after removing PCT catheter.The remaining six patients were readmitted for recurrent AC.Three of them were conservatively treated,while another 3 patients had PCT drainage anew and one of the three underwent delayed CCY 4 weeks after PCT replacement.The overall successful rate of PCT treatment was 76%.Conclusions Compared with emergency CCY,PCT has similar treatment effects in the successful rate of surgical management,morbidity,and overall hospital mortality although it is associated with longer hospital stays and higher readmission rate,which indicated that PCT is a convenient,safe and effective treatment option for poor-risk AC patients.