超声引导下经肝入路和套管针技术在急性胆囊炎患者床边经皮胆囊造瘘术中的疗效和安全性。

IF 1.7 4区 医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Ahmet Cem Demirşah, Berat Acu, Çiğdem Öztunalı
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引用次数: 0

摘要

目的:尽管大量患者需要经皮胆囊造口术(PC)治疗急性胆囊炎(AC),但在最佳成像引导方式、技术(Seldinger vs.套管针)或入路(经肝(TH) vs.经腹膜)方面尚无明确的结果。本研究评估超声(US)引导下仅使用TH入路和套管针技术的床边PC在ac患者中的效果。方法:2018年至2023年9月在某三级大学医院进行单中心回顾性研究。该研究纳入了81例AC患者,采用us引导的床边PC,仅使用TH入路和套管针技术。患者通过临床、实验室和放射学检查进行诊断,并由经验丰富的介入放射科医生执行这些程序。然后评估结果和并发症发生率。结果:技术成功率100%,临床成功率93%。无手术相关并发症发生。4.9%(4/81)发生导管脱位。使用的导管尺寸分别为6f(12.3%)、7f(40.7%)、8f(37%)和10f(9.9%)。中位置管时间为42天。胆囊炎消退后,大多数存活的患者都成功摘除了导管。随访结束时,10例患者(12.3%)行择期胆囊切除术,12例患者(14.8%)死于导管置入后的合并症。结论:us引导下采用TH入路和套管针技术的床边PC是治疗高危AC的安全有效的方法。该研究没有发现明显的并发症,强调了彻底的术前评估和技术优化的重要性。需要对更大的同质患者群体进行进一步的研究,以比较不同PC技术和方法的结果。临床意义:尽管在AC的治疗中越来越多地采用PC,但最终的最佳通路和手术技术仍未解决。目前的文献受限于研究之间的相当大的异质性,包括技术方法、操作员经验、患者凝血概况和结果定义的可变性。本研究仅采用床边us引导PC,采用TH入路和套管针技术,未观察到手术相关并发症,包括出血、胆漏、感染或脓肿形成。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficacy and safety of ultrasound-guided bedside percutaneous cholecystostomy using the transhepatic approach and trocar technique in patients with acute cholecystitis.

Purpose: Despite the large number of patients requiring percutaneous cholecystostomy (PC) for acute cholecystitis (AC), no definitive results exist on the optimal imaging guidance modality, technique (Seldinger vs. trocar), or approach [transhepatic (TH) vs. transperitoneal]. This study evaluates the outcomes of ultrasound (US)-guided bedside PC using solely the TH approach and trocar technique in patients with AC.

Methods: A single-center retrospective study was conducted at a tertiary university hospital between 2018 and September 2023. The study included 81 patients with AC treated with US-guided bedside PC using the TH approach and trocar technique alone. Patients were diagnosed through clinical, laboratory, and radiological examinations, and an experienced interventional radiologist performed the procedures. Outcomes and complication rates were then evaluated.

Results: Technical and clinical success rates were 100% and 93%, respectively. No procedure-related complications occurred. Catheter dislodgement occurred in 4.9% (4/81). The catheter sizes used were 6 F (12.3%), 7 F (40.7%), 8 F (37%), and 10 F (9.9%). The median catheter dwell time was 42 days. Catheters were successfully removed in the majority of surviving patients following resolution of cholecystitis. At the end of the follow-up, 10 patients (12.3%) underwent elective cholecystectomy, and 12 patients (14.8%) died due to comorbidities with the catheter in place.

Conclusion: US-guided bedside PC using the TH approach and trocar technique is safe and effective for managing AC in high-risk patients. The study found no significant complications, highlighting the importance of thorough preprocedural evaluation and technique optimization. Further studies with larger, homogeneous patient groups are needed to compare outcomes across different PC techniques and approaches.

Clinical significance: Despite the growing adoption of PC in the management of AC, the definitive optimal access route and procedural technique remain unresolved. The current body of literature is limited by considerable heterogeneity across studies, including variability in technical approach, operator experience, patient coagulation profiles, and outcome definitions. This study exclusively employed bedside US-guided PC using the TH approach and trocar technique, and observed no procedure-related complications, including hemorrhage, bile leakage, infection, or abscess formation.

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来源期刊
Diagnostic and interventional radiology
Diagnostic and interventional radiology Medicine-Radiology, Nuclear Medicine and Imaging
自引率
4.80%
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0
期刊介绍: Diagnostic and Interventional Radiology (Diagn Interv Radiol) is the open access, online-only official publication of Turkish Society of Radiology. It is published bimonthly and the journal’s publication language is English. The journal is a medium for original articles, reviews, pictorial essays, technical notes related to all fields of diagnostic and interventional radiology.
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