Outcome After Percutaneous Cholecystostomy for Acute Cholecystitis: a Single-Center Experience

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• 作者：Yun-Cheng Hsieh (1) (2)
  Chun-Ku Chen (3)
  Chien-Wei Su (1) (2)
  Che-Chang Chan (1) (2) (7)
  Teh-Ia Huo (1) (4)
  Chia-Jen Liu (5)
  Wen-Liang Fang (6) (7)
  Kuei-Chuan Lee (1) (2) (7)
  Han-Chieh Lin (1) (2)
  
• 关键词：Acute cholecystitis ; Cholecystectomy ; Percutaneous cholecystostomy
• 刊名：Journal of Gastrointestinal Surgery
• 出版年：2012
• 出版时间：October 2012
• 年：2012
• 卷：16
• 期：10
• 页码：1860-1868
• 全文大小：248KB
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• 作者单位：Yun-Cheng Hsieh (1) (2)
  Chun-Ku Chen (3)
  Chien-Wei Su (1) (2)
  Che-Chang Chan (1) (2) (7)
  Teh-Ia Huo (1) (4)
  Chia-Jen Liu (5)
  Wen-Liang Fang (6) (7)
  Kuei-Chuan Lee (1) (2) (7)
  Han-Chieh Lin (1) (2)
  
  1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
  2. Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
  3. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
  7. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
  4. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
  5. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  6. Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
  

文摘

Background Percutaneous cholecystostomy is an alternative treatment for acute cholecystitis patients with high surgical risk. Methods One hundred and sixty-six patients consecutively treated by percutaneous cholecystostomy for acute cholecystitis in a single medical center were retrospectively reviewed. Results The cohort included 121 males and 45 females with mean age of 75.9?years. The overall inhospital mortality rate was 15.1?% (n--5). Elevated serum creatinine level at diagnosis [odds ratio (OR) 1.497; p--.020], septic shock (OR 11.755; p--.001), and development of cholecystitis during admission (OR 7.256; p--.007) were predictive of inhospital mortality. Of 126 patients who recovered from calculous cholecystitis, 11 experienced recurrent cholecystitis within 2?months. Serum C-reactive protein (CRP) level >15?mg?dl? at diagnosis [hazard ratio (HR) 10.141; p--.027] and drainage duration of cholecystostomy longer than 2?weeks (HR 3.638; p--.039) were independent risk factors of early recurrence. The 53 patients who underwent cholecystectomy had an 18.9?% perioperative complication rate and no operation-related mortality. Conclusions In-patients or those with septic shock or renal insufficiency have worse outcome. Prolonged drainage duration and high CRP level predict early recurrence. Removal of the drainage tube is recommended after resolution of the acute illness.