The Therapeutic Efficacy of Percutaneous Transhepatic Gallbladder Drainage in Acute Cholecystitis

經皮穿肝膽囊引流術在急性膽囊炎的治療效果

謝博任(Po-Jen Hsieh) ； 張家昌(Jia-Jang Chang) ； 林志郎(Chih-Lang Lin) ； 陳立偉(Li-Wei Chen) ； 李宗實(Tsung-Shih Lee) ； 錢政弘(Cheng-Hung Chien) ； 簡榮南(Rong-Nan Chien)

《臺灣消化醫學雜誌》 29卷1期 (2012/03) Pp. 8-16

https://doi.org/10.6557/GJT.201203_29(1).0002

摘要

前言：急性膽囊炎是膽囊的急性發炎，96%急性膽囊炎病患是因膽囊管被結石阻塞引起。它會造成老年體虛病人較高的死亡率及罹病率。經皮穿肝膽囊引流術合併抗生素治療可以讓病人在較好臨床狀況下接收手術。本研究的目的是評估經皮穿肝膽囊引流術在有急性膽囊炎的老年體虛病人的治療效果。病人及方法：共有496位急性膽囊炎病人被收錄於本研究。排除只有接受傳統治療的病人，總共有65位接受經由超音波或電腦斷層導引的經皮穿肝膽囊引流術的病人被納入，並分析臨床表現，生化資料及最後結果。結果：在所有的65位病人中，有27位病人在經皮穿肝膽囊引流術後接受膽囊切除術，而其中的67%是在28天內接受手術。有14位病人（22%）死亡，這些病人有較高的血清黃疸、肝指數及較多的敗血症。臨床及實驗室檢查的表現在接受及不接受手術兩組之間是相似的，但是沒有接受手術的病人有較高的比率會發生敗血症及死亡。結論：經皮穿肝膽囊引流術合併抗生素可以讓敗血性膽囊炎變成非敗血性的狀態，尤其在老年體虛的病人更形重要，而在經皮穿肝膽囊引流術之後進行選擇性手術對於老年體虛的病患或許是必須的。因為有進行選擇性手術者其死亡率較低及敗血症較少。至於年輕及較少合併症的病人則可以直接進行手術切除膽囊，不需再進行經皮穿肝膽囊引流術，因為手術本身的死亡率很低。

關鍵字

經皮穿肝膽囊引流術 ； 急性膽囊炎 ； 膽囊切除術

並列摘要

Introduction: Acute cholecystitis is an acute inflammation of the gallbladder. In 96% of patients, the cystic duct is obstructed with gallstones. This results in a high risk of mortality and morbidity in debilitated and elderly patients. Percutaneous transhepatic gallbladder drainage (PTGBD) combined with intensive antibiotic treatment may allow the patients to receive elective surgery in a better clinical condition. The aim of the present study was to investigate the therapeutic efficacy of PTGBD in debilitated and elderly patients with acute cholecystitis.Patients and Methods: A total of 496 patients with acute cholecystitis were enrolled in this study. Patients who received conservative treatment and who had common bile duct (CBD) stones (evidenced by endoscopic retrograde cholangiopancreatography [ERCP] or magnetic resonance cholangiopancreatography [MRCP]) and Mirizzi's syndrome were excluded. PTGBD was performed under ultrasound or computed tomography (CT) guidance in 65 patients. The clinical features, biochemical data, and outcomes were analyzed.Results: Among the 65 patients, 27 patients underwent cholecystectomy after PTGBD and 18 patients (67%) underwent surgery within 28 days. Fourteen (22%) patients died during follow up; they had significantly higher levels of total bilirubin, aspartate amminotransferase (AST), and alkaline phosphatase (ALP), and a higher incidence of sepsis. The clinical and laboratory features were similar between patients with and without surgery after PTGBD. However, patients without surgery had higher rates of sepsis and mortality, which was associated with more comorbidities.Conclusion: Elective surgery after PTGBD may be necessary for debilitated patients with acute cholecystitis. PTGBD together with antibiotics can convert a septic into a non-septic cholecystitis, particularly in elderly and debilitated patients. Surgery alone has a lower mortality rate and may be a better treatment choice for patients with acute cholecystitis who are younger and have fewer comorbidities.

並列關鍵字

percutaneous transhepatic gallbladder drainage ； acute cholecystitis ； cholecystectomy