Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: A prospective randomized controlled trial
Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: A prospective randomized controlled trial
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DOI：
10.2214/ajr.183.1.1830193
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发表时间：
2004-07-01
影响因子：
5
通讯作者：
Horaguchi, J
中科院分区：
文献类型：
--
作者：
Ito, K;Fujita, N;Horaguchi, J
目标。本研究旨在确定并比较经皮胆囊造瘘术和胆囊穿刺术治疗严重急性胆囊炎的疗效和并发症发生率。研究对象和方法。58例重症急性胆囊炎患者经抗生素治疗后未见好转。患者随机分为经皮胆囊造瘘组（n = 30）和胆囊穿刺组（n = 28）。在超声引导下，经皮胆囊造瘘采用常规方式，使用6.5或7法导管。超声引导下用21号针穿刺胆囊。观察两组手术的技术成功率、临床反应及并发症。经皮胆囊造口术和胆囊穿刺术在技术上分别成功30例（100%）和23例（82%）（无统计学意义）。在胆囊抽吸组的5例患者（18%）中，由于胆汁被密集的胆道污泥或脓液所替代，抽吸失败。经皮胆囊造瘘组27例（90%）、胆囊抽吸组14例（61%）临床反应良好（p < 0.05）。并发症方面，经皮胆囊造瘘组1例出现导管脱出，1例胆囊穿刺后出现轻度出血。两组均未发生重大并发症或手术相关死亡。对于严重急性胆囊炎，经皮胆囊造瘘术临床疗效优于胆囊抽吸术，并发症发生率与胆囊抽吸术相同。
OBJECTIVE. This study was performed to determine and compare the effectiveness and incidence of complications of percutaneous cholecystostomy and gallbladder aspiration in cases of severe acute cholecystitis.SUBJECTS AND METHODS. Fifty-eight patients with severe acute cholecystitis who did not improve after antibiotic treatment were included in this study. The patients were randomized into either the percutaneous cholecystostomy group (n = 30) or the gallbladder aspiration group (n = 28). Under sonographic guidance, percutaneous cholecystostomy was performed in the usual manner using a 6.5- or 7-French catheter. Gallbladder aspiration was carried out with a 21-gauge needle under sonographic guidance. The technical success, clinical response, and complications in each group were evaluated.RESULTS. Percutaneous cholecystostomy and gallbladder aspiration were technically successful in 30 patients (100%) and 23 patients (82%), respectively (not statistically significant). In five patients (18%) of the gallbladder aspiration group, aspiration was unsuccessful because of replacement of bile with dense biliary sludge or pus. Good clinical response was obtained in 27 patients (90%) of the percutaneous cholecystostomy group and in 14 patients (61%) of the gallbladder aspiration group (p < 0.05). As for complications, dislodgment of the catheter occurred in one patient of the percutaneous cholecystostomy group and minor bleeding in one patient after gallbladder aspiration. No major complications or procedure-related deaths occurred in either group.CONCLUSION. For severe acute cholecystitis, percutaneous cholecystostomy was superior to gallbladder aspiration in terms of clinical effectiveness and had the same complication rate as gallbladder aspiration.