Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary?
Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary?
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DOI：
10.1159/000477780
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发表时间：
2018-01-01
影响因子：
2.7
通讯作者：
Silva, Michael A.
中科院分区：
文献类型：
--
作者：
Abbas, Syed H.;Ghazanfar, Mudassar A.;Silva, Michael A.
背景：急性非结石性胆囊炎（AAC）占急性胆囊炎病例的 5-10%。间歇性胆囊切除术对于 AAC 患者的优势尚不清楚。因此，我们对我们机构诊断为 AAC 的患者进行了 5 年的回顾性分析。方法：通过医院编码，使用关键词“非结石性胆囊炎、胆囊造口术和胆囊穿孔”来识别患者。通过对患者的医院记录进行回顾性审查来获得随访数据。结果：共鉴定出 33 名 AAC 患者，并进行中位随访 18 个月。就诊时的中位年龄为 70 岁 (10-96)，美国麻醉医师协会 (ASA) 等级为 3 (15) 级。 23 名患者（70%）仅接受抗生素治疗，7 名患者（21%）接受经皮胆囊造口术，3 名患者（9%）接受腹腔镜胆囊切除术。 90 天死亡率为 30%，与合并症状况显着相关，因为所有死亡均发生在 ASA 3-5 级个体中 (p = 0.020)。两名患者 (6%) 出现复发性 AAC，并接受非手术治疗。结论：抗生素和胆囊造口术是 AAC 治疗的主要手段，合并症状况影响相关死亡率。我们的研究结果表明，从 AAC 恢复的患者避免间隔期胆囊切除术似乎是安全的，因为他们通常是高风险手术候选者。 (C) 2017 S. Karger AG，巴塞尔
Background: Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period. Methods: Patients were identified via hospital coding using the keywords "acalculous cholecystitis, cholecystostomy and gall bladder perforation."Follow-up data was obtained by performing a retrospective review of the patients' hospital records. Results: A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (15). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively. Conclusion: Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality.Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates. (C) 2017 S. Karger AG, Basel