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The timing and clinical experience of percutaneous cholecystostomy in the treatment of moderate to severe acute cholecystitis
- CAI Yi-feng, ZHANG Mei-hua
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2021, 21(05):
521-525.
DOI: 10.3969/j.issn.1009-976X.2021.05.006
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Objective To discuss the timing and clinical experience report of percutaneous cholecystostomy （PC） for the treatment of acute cholecystitis. Methods A retrospective analysis of clinical data was performed in patients diagnosed with acute cholecystitis （AC） from January 2015 to January 2021. According to the Tokyo Guidelines 2013 （TG13）, patients with AC severity grade Ⅱ （moderate） and grade Ⅲ（severe） were screened for clinical evaluation, including clinical characteristics, treatment, hospital stay, outcome, morbidity and 30-day death. Results A total of 134 patients were included in the study, with a median age of 63.5 years. Among them, 41 received PC （PC group）, Charlson Complication Index （CCI）： 0 points in 18 cases （43.9%）, 1 point in 11 cases （26.8%）, ≥ 2 points in 12 cases （29.3%）; 77 received conservative treatment （conservative group）, CCI： 0 points in 31 cases （40.2%）, 1 point in 18 cases （23.4%）, ≥ 2 points in 28 cases （36.4%）; 26 had cholecystectomy, CCI： 0 points 17 （65.4）, 1 point 5 （19.2）, ≥ 2 points 4 （15.4）; The patients were followed up for 60 days in which 12 were lost to follow-up. Among the three different management groups, compared with the conservative group, the PC group showed faster WBC reduction, less antibiotic administration time, and shorter hospital stay; but compared with the cholecystectomy group, there was no advantage in hospital stay and antibiotic administration time. PC group： WBC decreased significantly on the first day after bile drainage （compared with admission, P<0.001）; the average time of antibiotic use was 11.4±2.6 days; 25 cases （25/38） were performed delayed LC, and the main complication was drainage tube dislocation 3 For example, one patient died of septic shock and heart failure on the second day after PC operation. Conservative treatment group： antibiotic treatment and nutritional support were mainly taken. WBC decreased significantly 3 days after admission, which was significantly different from that at admission （P<0.001）; antibiotics were used for 12.9±3.1 days; 43 cases （43/65） underwent LC; 4 patients died, 4 days, 7 days, 15 days and 24 days after admission, respectively. The causes of death included severe infection, MODS, pulmonary embolism and cerebral hemorrhage; 4 cases （6.2%, 4/65） recurrence within 60 days after surgery. Conclusion For patients with moderate to severe AC, the management should be selected according to the actual situation of the patient. PC is an effective treatment for patients with moderate to severe AC who is not suitable for surgery, and early use is recommended.
