BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients wit...BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.展开更多
A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.Th...A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.There were three centesis scars for the PTGBD,and only one pathway from the most dorsal centesis scar reached the gallbladder.Microscopically,the PTGBD pathway crossed and injured the intrahepatic arterial wall,and hepatic parenchymal bleeding extended along the PTGBD pathway to the inferior surface of the liver.Blood flowed to the peritoneal cavity through a small gap between the liver and gallbladder.Consequently,the PTGBD caused lethal bleeding.When the percutaneous transhepatic cholangio drainage/PTGBD pathway runs close to vessels near the liver surface,it might be necessary to deal with the possibility of rapid and lethal peritoneal bleeding.展开更多
A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage...A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient’s previous antibiotics reinstated. After two weeks of drainage and antibiotics, the fistula healed spontaneously without the need for further intervention.展开更多
The gold-standard management of acute cholecystitis is cholecystectomy.Surgical intervention may be contraindicated due to permanent causes.To date,the classical approach is percutaneous cholecystostomy in patients un...The gold-standard management of acute cholecystitis is cholecystectomy.Surgical intervention may be contraindicated due to permanent causes.To date,the classical approach is percutaneous cholecystostomy in patients unresponsive to medical therapy.However, with this treatment some patients may experience discomfort,complications and a decrease in their quality of life.In these cases,endoscopic ultrasound (EUS)-guided gallbladder drainage may represent an effective minimally invasive alternative.Our objective is to describe in detail this new and not well-known technique:EUS-guided cholecystenterostomy.We will describe how the patient should be prepared,what accessories are needed and how the technique is performed.We will also discuss the possible indications for this technique and will provide a brief review based on published reports and our own experience.展开更多
Management of acute cholecystitis includes initial sta-bilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the ...Management of acute cholecystitis includes initial sta-bilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the severity of cholecystitis or comorbidities will require a temporary measure as a bridge to surgery or permanent nonoperative management to decrease the mortality and morbidity. Most of these patients who require conservative management were managed with percutaneous transhepatic cholecystostomy or trans-papillary drainage of gallbladder drainage with cystic duct stenting through endoscopic retrograde cholangiopancreaticography （ERCP）. Although, these conservative measures are effective, they can cause signifcant discomfort to the patients especially if used as a long-term measure. In view of this, there is a need for further minimally invasive procedures, which is safe, effective and comfortable to patients. Endoscopic ultrasound （EUS） guided gallbladder drainage is a novel method of gallbladder drainage frst described in 2007[1]. Over the last decade, EUS guided gallbladder drainage has evolved as an effective alternative to percutaneouscholecystostomy and trans-papillary gallbladder drai-nage. Our goal is to review available literature regarding the scope of EUS guided gallbladder drainage as a viable alternative to percutaneous cholecystostomy or cystic duct stenting through ERCP among patients who are not suitable for cholecystectomy.展开更多
BACKGROUND To date,the optimal timing for percutaneous transhepatic gallbladder drainage(PTGBD),particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy(LC)(within 72 hou...BACKGROUND To date,the optimal timing for percutaneous transhepatic gallbladder drainage(PTGBD),particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy(LC)(within 72 hours of symptom onset)has not been determined.AIM To study the effects of LC timing on outcomes of grade II/III acute cholecystitis(AC)in patients with delayed PTGBD.METHODS Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied.According to the interval between gallbladder drainage and cholecystectomy,the patients were divided into early and delayed LC groups.Outcomes including surgery time,postoperative complications and hospital stay,and patient satisfaction were analyzed and compared between the two groups using t-andχ^(2) tests.RESULTS There were no significant differences between the two groups in intraoperative blood loss,postoperative abdominal drainage tube placement time,pain index,or total disease duration(all P>0.05).Compared with those of the early LC group,the delayed group showed significant decreases in the length of procedure(surgery time),conversion rate to open surgery,degree of adhesions,surgical complications,postoperative hospital stay,and total treatment costs,and increased patient satisfaction despite a longer interval before PTGBD(all P<0.05).CONCLUSION For patients with grade II/III AC with delayed PTGBD,LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.展开更多
Patients with acute calculous cholecystitis are usually undertaken surgery laparoscopic cholecystectomy.However, there are controversies about the decision of operation for patients with high risk factors. Percutaneou...Patients with acute calculous cholecystitis are usually undertaken surgery laparoscopic cholecystectomy.However, there are controversies about the decision of operation for patients with high risk factors. Percutaneous transhepatic gallbladder drainage （PTGD） is palliative therapy to alleviate symptoms and physical signs. Since improved clinical outcome has been observed for PTGD,展开更多
BACKGROUND Gallbladder perforation and gastrointestinal fistula are rare but serious complications of severe acute pancreatitis(SAP).However,neither spontaneous gallbladder perforation nor cholecysto-colonic fistula h...BACKGROUND Gallbladder perforation and gastrointestinal fistula are rare but serious complications of severe acute pancreatitis(SAP).However,neither spontaneous gallbladder perforation nor cholecysto-colonic fistula has been reported in acalculous acute pancreatitis patients.CASE SUMMARY A 31-year-old male presenting with epigastric pain was diagnosed with hypertriglyceridemia-related SAP.He suffered from multiorgan failure and was able to leave the intensive care unit on day 20.Three percutaneous drainage tubes were placed for profound exudation in the peripancreatic region and left paracolic sulcus.He developed spontaneous gallbladder perforation with symptoms of fever and right upper quadrant pain 1 mo after SAP onset and was stabilized by percutaneous drainage.Peripancreatic infection appeared 1 mo later and was treated with antibiotics but without satisfactory results.Then multiple colon fistulas,including a cholecysto-colonic fistula and a descending colon fistula,emerged 3 mo after the onset of SAP.Nephroscopy-assisted peripancreatic debridement and ileostomy were carried out immediately.The fistulas achieved spontaneous closure 7 mo later,and the patient recovered after cholecystectomy and ileostomy reduction.We presume that the causes of gallbladder perforation are poor bile drainage due to external pressure,pancreatic enzyme erosion,and ischemia.The possible causes of colon fistulas are pancreatic enzymes or infected necrosis erosion,ischemia,and iatrogenic injury.According to our experience,localized gallbladder perforation can be stabilized by percutaneous drainage.Pancreatic debridement and proximal colostomy followed by cholecystectomy are feasible and valid treatment options for cholecysto-colonic fistulas.CONCLUSION Gallbladder perforation and cholecysto-colonic fistula should be considered in acalculous SAP patients.展开更多
目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆...目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆行胰胆管造影(ERCP)取石+ENGD治疗(ENGD组),另外25例行ERCP取石+经皮肝穿刺胆管引流(PTGD)(PTGD组),比较两组操作成功率、手术时间、并发症发生率、不良事件发生率、住院时间、治疗费用、患者满意度,以及二期腹腔镜胆囊切除(LC)手术时间、并发症发生率、腹腔引流管留置率及住院时间。结果 两组患者操作成功率均为100%。ENGD组和PTGD组在手术时间[(46.4±4.8)min vs (55.0±6.0)min]、治疗费用[(3.2±0.3)万元vs (3.5±0.3)万元]、患者满意度[5(5,5)分vs 4(4,5)分]方面的比较,差异具有统计学意义(P<0.05);ENGD组二期LC手术时间[(45.4±7.0)min vs (58.4±9.2)min]、并发症发生率[1(4.8%) vs 7(28.0%)]、腹腔引流管留置率[10(47.6%) vs 23(92.0%)]及住院时间[(3.6±0.7)d vs (4.7±0.6)d]均低于PTGD组,差异具有统计学意义(P<0.05)。结论 ENGD治疗胆总管结石合并急性化脓性胆囊炎安全、有效,患者满意度高,并能降低LC风险。展开更多
文摘BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.
文摘A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.There were three centesis scars for the PTGBD,and only one pathway from the most dorsal centesis scar reached the gallbladder.Microscopically,the PTGBD pathway crossed and injured the intrahepatic arterial wall,and hepatic parenchymal bleeding extended along the PTGBD pathway to the inferior surface of the liver.Blood flowed to the peritoneal cavity through a small gap between the liver and gallbladder.Consequently,the PTGBD caused lethal bleeding.When the percutaneous transhepatic cholangio drainage/PTGBD pathway runs close to vessels near the liver surface,it might be necessary to deal with the possibility of rapid and lethal peritoneal bleeding.
文摘A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient’s previous antibiotics reinstated. After two weeks of drainage and antibiotics, the fistula healed spontaneously without the need for further intervention.
文摘The gold-standard management of acute cholecystitis is cholecystectomy.Surgical intervention may be contraindicated due to permanent causes.To date,the classical approach is percutaneous cholecystostomy in patients unresponsive to medical therapy.However, with this treatment some patients may experience discomfort,complications and a decrease in their quality of life.In these cases,endoscopic ultrasound (EUS)-guided gallbladder drainage may represent an effective minimally invasive alternative.Our objective is to describe in detail this new and not well-known technique:EUS-guided cholecystenterostomy.We will describe how the patient should be prepared,what accessories are needed and how the technique is performed.We will also discuss the possible indications for this technique and will provide a brief review based on published reports and our own experience.
文摘Management of acute cholecystitis includes initial sta-bilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the severity of cholecystitis or comorbidities will require a temporary measure as a bridge to surgery or permanent nonoperative management to decrease the mortality and morbidity. Most of these patients who require conservative management were managed with percutaneous transhepatic cholecystostomy or trans-papillary drainage of gallbladder drainage with cystic duct stenting through endoscopic retrograde cholangiopancreaticography （ERCP）. Although, these conservative measures are effective, they can cause signifcant discomfort to the patients especially if used as a long-term measure. In view of this, there is a need for further minimally invasive procedures, which is safe, effective and comfortable to patients. Endoscopic ultrasound （EUS） guided gallbladder drainage is a novel method of gallbladder drainage frst described in 2007[1]. Over the last decade, EUS guided gallbladder drainage has evolved as an effective alternative to percutaneouscholecystostomy and trans-papillary gallbladder drai-nage. Our goal is to review available literature regarding the scope of EUS guided gallbladder drainage as a viable alternative to percutaneous cholecystostomy or cystic duct stenting through ERCP among patients who are not suitable for cholecystectomy.
文摘BACKGROUND To date,the optimal timing for percutaneous transhepatic gallbladder drainage(PTGBD),particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy(LC)(within 72 hours of symptom onset)has not been determined.AIM To study the effects of LC timing on outcomes of grade II/III acute cholecystitis(AC)in patients with delayed PTGBD.METHODS Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied.According to the interval between gallbladder drainage and cholecystectomy,the patients were divided into early and delayed LC groups.Outcomes including surgery time,postoperative complications and hospital stay,and patient satisfaction were analyzed and compared between the two groups using t-andχ^(2) tests.RESULTS There were no significant differences between the two groups in intraoperative blood loss,postoperative abdominal drainage tube placement time,pain index,or total disease duration(all P>0.05).Compared with those of the early LC group,the delayed group showed significant decreases in the length of procedure(surgery time),conversion rate to open surgery,degree of adhesions,surgical complications,postoperative hospital stay,and total treatment costs,and increased patient satisfaction despite a longer interval before PTGBD(all P<0.05).CONCLUSION For patients with grade II/III AC with delayed PTGBD,LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.
基金This study was supported by grants from Science and Technology Development Plan of Shandong Province （No. 2011GSF 11836）, Natural Science Foundation of Shandong Province （No. ZR2012HM029） and Shandong Taishan Scholarship （Liu J）.
文摘Patients with acute calculous cholecystitis are usually undertaken surgery laparoscopic cholecystectomy.However, there are controversies about the decision of operation for patients with high risk factors. Percutaneous transhepatic gallbladder drainage （PTGD） is palliative therapy to alleviate symptoms and physical signs. Since improved clinical outcome has been observed for PTGD,
基金Supported by Beijing Science and Technology Program,No.Z181100001618013Peking Union Medical College Education Reform Program,No.2019zlgc0116.
文摘BACKGROUND Gallbladder perforation and gastrointestinal fistula are rare but serious complications of severe acute pancreatitis(SAP).However,neither spontaneous gallbladder perforation nor cholecysto-colonic fistula has been reported in acalculous acute pancreatitis patients.CASE SUMMARY A 31-year-old male presenting with epigastric pain was diagnosed with hypertriglyceridemia-related SAP.He suffered from multiorgan failure and was able to leave the intensive care unit on day 20.Three percutaneous drainage tubes were placed for profound exudation in the peripancreatic region and left paracolic sulcus.He developed spontaneous gallbladder perforation with symptoms of fever and right upper quadrant pain 1 mo after SAP onset and was stabilized by percutaneous drainage.Peripancreatic infection appeared 1 mo later and was treated with antibiotics but without satisfactory results.Then multiple colon fistulas,including a cholecysto-colonic fistula and a descending colon fistula,emerged 3 mo after the onset of SAP.Nephroscopy-assisted peripancreatic debridement and ileostomy were carried out immediately.The fistulas achieved spontaneous closure 7 mo later,and the patient recovered after cholecystectomy and ileostomy reduction.We presume that the causes of gallbladder perforation are poor bile drainage due to external pressure,pancreatic enzyme erosion,and ischemia.The possible causes of colon fistulas are pancreatic enzymes or infected necrosis erosion,ischemia,and iatrogenic injury.According to our experience,localized gallbladder perforation can be stabilized by percutaneous drainage.Pancreatic debridement and proximal colostomy followed by cholecystectomy are feasible and valid treatment options for cholecysto-colonic fistulas.CONCLUSION Gallbladder perforation and cholecysto-colonic fistula should be considered in acalculous SAP patients.
文摘目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆行胰胆管造影(ERCP)取石+ENGD治疗(ENGD组),另外25例行ERCP取石+经皮肝穿刺胆管引流(PTGD)(PTGD组),比较两组操作成功率、手术时间、并发症发生率、不良事件发生率、住院时间、治疗费用、患者满意度,以及二期腹腔镜胆囊切除(LC)手术时间、并发症发生率、腹腔引流管留置率及住院时间。结果 两组患者操作成功率均为100%。ENGD组和PTGD组在手术时间[(46.4±4.8)min vs (55.0±6.0)min]、治疗费用[(3.2±0.3)万元vs (3.5±0.3)万元]、患者满意度[5(5,5)分vs 4(4,5)分]方面的比较,差异具有统计学意义(P<0.05);ENGD组二期LC手术时间[(45.4±7.0)min vs (58.4±9.2)min]、并发症发生率[1(4.8%) vs 7(28.0%)]、腹腔引流管留置率[10(47.6%) vs 23(92.0%)]及住院时间[(3.6±0.7)d vs (4.7±0.6)d]均低于PTGD组,差异具有统计学意义(P<0.05)。结论 ENGD治疗胆总管结石合并急性化脓性胆囊炎安全、有效,患者满意度高,并能降低LC风险。
