高风险手术患者经皮胆囊引流术后的内镜胆囊引流术转换与保守治疗。

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Gut and Liver Pub Date : 2024-03-15 Epub Date: 2023-07-17 DOI:10.5009/gnl230019

Hyung Ku Chon, Seong-Hun Kim, Tae Hyeon Kim

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引用次数: 0

摘要

背景/目的：对于接受经皮胆囊造口术但不适合行间歇性胆囊切除术的急性胆囊炎患者，目前尚无共识指南。本研究旨在比较内镜下胆囊引流术（即从经皮胆囊造口术（包括内镜下经胆囊旁胆囊支架置入术和内镜下超声引导胆囊引流术）转为经皮胆囊造口术后保守治疗的临床效果：这项回顾性研究纳入了2017年1月至2020年12月期间因急性胆囊炎接受经皮胆囊造口术的患者。连续接受内镜胆囊引流术或经皮胆囊造口术胆囊管拔除术而未进行间歇性胆囊切除术的患者均包括在内。结果指标包括复发性急性胆囊炎和因胆石相关疾病导致的计划外再入院：研究期间共选取了 238 例患者（63 例接受了内镜胆囊引流术，175 例接受了保守治疗）。与经皮胆囊造口术拔管后接受保守治疗的患者相比，接受内镜胆囊引流术的患者复发急性胆囊炎的比例（3 [4.76%] vs 31 [17.71%]，P=0.012）和因胆石相关疾病而计划外再入院的比例（6 [9.52%] vs 40 [22.86%]，P=0.022）较低。在单变量和多变量分析中，结石性胆囊炎（几率比，13.75；95% 置信区间，1.83 至 102.83；P=0.011）和内镜胆囊引流术转换（几率比，0.23；95% 置信区间，0.06 至 0.78；P=0.019）是急性胆囊炎复发的重要预测因素：结论：与经皮胆囊造口术拔除胆囊管后的保守治疗相比，内镜胆囊引流转流术的疗效更佳。因此，对于接受经皮胆囊造口术的高手术风险患者来说，内镜下胆囊引流转化术可能是一种很有前景的治疗方案。

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Endoscopic Gallbladder Drainage Conversion versus Conservative Treatment Following Percutaneous Gallbladder Drainage in High-Risk Surgical Patients.

Background/aims: There are no consensus guidelines for patients with acute cholecystitis undergoing percutaneous cholecystostomy who are unfit for interval cholecystectomy. The current study aimed to compare the clinical outcomes of endoscopic gallbladder drainage, i.e. conversion from percutaneous cholecystostomy (including endoscopic transpapillary gallbladder stenting and endoscopic ultrasound-guided gallbladder drainage), and conservative treatment after percutaneous cholecystostomy tube removal.

Methods: This retrospective review included patients who underwent percutaneous cholecystostomy for acute cholecystitis between January 2017 and December 2020. Consecutive patients who underwent endoscopic gallbladder drainage or percutaneous cholecystostomy tube removal without interval cholecystectomy were included. Outcome measures included recurrent acute cholecystitis and unplanned readmission due to gallstone-related diseases.

Results: During the study period, 238 patients were selected (63 underwent endoscopic gallbladder drainage conversion and 175 underwent conservative treatment). Patients who underwent endoscopic gallbladder drainage conversion had lower rates of recurrent acute cholecystitis (3 [4.76%] vs 31 [17.71%], p=0.012) and unplanned readmission due to gallstone-related diseases (6 [9.52%] vs 40 [22.86%], p=0.022) than those who underwent conservative treatment following percutaneous cholecystostomy tube removal. In the univariate and multivariate analyses, calculus cholecystitis (odds ratio, 13.75; 95% confidence interval, 1.83 to 102.83; p=0.011) and conversion of endoscopic gallbladder drainage (odds ratio, 0.23; 95% confidence interval, 0.06 to 0.78; p=0.019) were significant predictive factors for recurrent acute cholecystitis.

Conclusions: Endoscopic gallbladder drainage conversion led to more favorable outcomes than conservative treatment after percutaneous cholecystostomy tube removal. Therefore, endoscopic gallbladder drainage conversion may be considered a promising treatment option for patients undergoing percutaneous cholecystostomy who are at a high surgical risk.

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来源期刊

Gut and Liver 医学-胃肠肝病学

CiteScore

7.50

自引率

8.80%

发文量

119

审稿时长

6-12 weeks

期刊介绍： Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut and Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. Gut and Liver is jointly owned and operated by 8 affiliated societies in the field of gastroenterology, namely: the Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, the Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Association for the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, the Korean Pancreatobiliary Association, and the Korean Society of Gastrointestinal Cancer.