目的探讨急性胆囊炎患者行经皮胆囊造瘘术后序贯腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的最佳手术时机,以期为临床提供参考。方法依据纳入和排除标准选择新疆医科大学第五附属医院2021年3月至2023年7月期间先行经皮胆囊造...目的探讨急性胆囊炎患者行经皮胆囊造瘘术后序贯腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的最佳手术时机,以期为临床提供参考。方法依据纳入和排除标准选择新疆医科大学第五附属医院2021年3月至2023年7月期间先行经皮胆囊造瘘术后延期行LC的患者,根据患者经皮胆囊造瘘术后到LC的时间间隔分成3组,分别为短间隔组(3~4周)、中间隔组(5~8周)及长间隔组(>8周),比较3组患者的手术时间、术中出血量、术后住院时间、总住院时间、引流管放置时间、引流管放置例数、入住重症加强护理病房(intensive care unit,ICU)、中转开腹、并发症发生及住院总费用方面的差异。结果本研究共纳入99例患者,其中短间隔组25例、中间隔组41例、长间隔组33例,3组患者在人口学特征、血常规、C反应蛋白、白细胞介素-6、纤维蛋白原、国际标准化比值、丙氨酸转氨酶、天冬氨酸转氨酶等及其他如基础疾病方面比较差异均无统计学意义(P>0.05)。3组患者在行经皮胆囊造瘘术后LC前的胆囊壁厚度以及行LC的手术时间、术中出血量、术后住院时间、总住院时间、引流管放置时间、引流管放置例数、入住ICU、中转开腹、并发症发生及住院总费用方面比较差异均有统计学意义(P<0.05),中间隔组在上述各个观察指标方面均优于短间隔组(P<0.05)和长间隔组(P<0.05),而短间隔组和长间隔组间仅在住院总费用方面差异有统计学意义(短间隔组高于长间隔组,P=0.019)。结论从本研究分析的结果看,经皮胆囊造瘘术后序贯LC的最佳时间间隔为5~8周,只是该结论需要进一步扩大样本或用多中心的数据验证。展开更多
The gold-standard management of acute cholecystitis is cholecystectomy.Surgical intervention may be contraindicated due to permanent causes.To date,the classical approach is percutaneous cholecystostomy in patients un...The gold-standard management of acute cholecystitis is cholecystectomy.Surgical intervention may be contraindicated due to permanent causes.To date,the classical approach is percutaneous cholecystostomy in patients unresponsive to medical therapy.However, with this treatment some patients may experience discomfort,complications and a decrease in their quality of life.In these cases,endoscopic ultrasound (EUS)-guided gallbladder drainage may represent an effective minimally invasive alternative.Our objective is to describe in detail this new and not well-known technique:EUS-guided cholecystenterostomy.We will describe how the patient should be prepared,what accessories are needed and how the technique is performed.We will also discuss the possible indications for this technique and will provide a brief review based on published reports and our own experience.展开更多
Aims and Objectives: To assess efficacy and safety of percutaneous cholecystostomy (PC) in high risk patients with acute cholecystitis. Materials and Methods: The study was carried out in high risk patients with acute...Aims and Objectives: To assess efficacy and safety of percutaneous cholecystostomy (PC) in high risk patients with acute cholecystitis. Materials and Methods: The study was carried out in high risk patients with acute calculous or acalculous cholecystitis. Patients qualifying for the study were subjected to PC under ultrasound (USG) guidance. A cholecystogram was done postoperatively, to help establish satisfactory catheter position. Results: 24 (70.59%) patients had empyema-gallbladder, 8 (23.53%) had acute calcular cholecystitis and 2 (5.9%) patients were diagnosed as acalcular cholecystitis. None of the patients was fit for general anesthesia at the time of admission. Median hospital-stay after performing procedure was 4 days. Clinical success rate was reported 100% in our study. Bile cultures yielded growth of E Coli in 10 (29.41%), klebsela in 8 (23.53%), pseudomonas aeruginosa in 6 (17.65%) and Proteus mirabilis in 4 (11.8%) of patients. 6 (17.65%) patients did not grow any organism in their bile. Growth noted was sensitive to imipenem 29.41% (10), ciprofloxacin 17.65% (6), levofloxacin 17.65% % (6) and cefuroxime 11.76% (4). No major complication was recorded in our study. No procedure related death was observed. Tube displacement occurred in one patient and minor bleeding was reported in 2 patients. Catheter was removed after a mean of 25.25 days. All patients underwent definitive surgical intervention during the follow up period of 3 months. Conclusion: USG guided PC is a safe and effective procedure for treating high-risk patients who present with acute cholecystitis. Once the acute symptoms diminish or resolve, it should be followed by elective surgery.展开更多
Objective The aim of the present study was to assess experience with percutaneous cholecystostomy (PC) in high risk aged patients with presumed acute cholecystitis. Methods\ PC was performed by transhepatic route und...Objective The aim of the present study was to assess experience with percutaneous cholecystostomy (PC) in high risk aged patients with presumed acute cholecystitis. Methods\ PC was performed by transhepatic route under local anaesthesia guided by ultrasonography cholecystostomy catheters. The catheters used include the Cope loop(produced by Japan hakko). Results\ PC was performed successfully in all 18 patients, without immediate procedural or technical complications. Symptoms and clinical signs of cholecystitis resolved within 24 48 h after the procedures in all but one patient. Conclusion\ PC is a cost effective ,mini invasive, and reliable alternative to surgical placement of cholecystostomy tubes in critically ill patient. This study also can be used in hepatic abscess, obstructive jaundice and necrostic pancreatitis caused by stone or tumor.\;展开更多
文摘目的探讨急性胆囊炎患者行经皮胆囊造瘘术后序贯腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的最佳手术时机,以期为临床提供参考。方法依据纳入和排除标准选择新疆医科大学第五附属医院2021年3月至2023年7月期间先行经皮胆囊造瘘术后延期行LC的患者,根据患者经皮胆囊造瘘术后到LC的时间间隔分成3组,分别为短间隔组(3~4周)、中间隔组(5~8周)及长间隔组(>8周),比较3组患者的手术时间、术中出血量、术后住院时间、总住院时间、引流管放置时间、引流管放置例数、入住重症加强护理病房(intensive care unit,ICU)、中转开腹、并发症发生及住院总费用方面的差异。结果本研究共纳入99例患者,其中短间隔组25例、中间隔组41例、长间隔组33例,3组患者在人口学特征、血常规、C反应蛋白、白细胞介素-6、纤维蛋白原、国际标准化比值、丙氨酸转氨酶、天冬氨酸转氨酶等及其他如基础疾病方面比较差异均无统计学意义(P>0.05)。3组患者在行经皮胆囊造瘘术后LC前的胆囊壁厚度以及行LC的手术时间、术中出血量、术后住院时间、总住院时间、引流管放置时间、引流管放置例数、入住ICU、中转开腹、并发症发生及住院总费用方面比较差异均有统计学意义(P<0.05),中间隔组在上述各个观察指标方面均优于短间隔组(P<0.05)和长间隔组(P<0.05),而短间隔组和长间隔组间仅在住院总费用方面差异有统计学意义(短间隔组高于长间隔组,P=0.019)。结论从本研究分析的结果看,经皮胆囊造瘘术后序贯LC的最佳时间间隔为5~8周,只是该结论需要进一步扩大样本或用多中心的数据验证。
文摘The gold-standard management of acute cholecystitis is cholecystectomy.Surgical intervention may be contraindicated due to permanent causes.To date,the classical approach is percutaneous cholecystostomy in patients unresponsive to medical therapy.However, with this treatment some patients may experience discomfort,complications and a decrease in their quality of life.In these cases,endoscopic ultrasound (EUS)-guided gallbladder drainage may represent an effective minimally invasive alternative.Our objective is to describe in detail this new and not well-known technique:EUS-guided cholecystenterostomy.We will describe how the patient should be prepared,what accessories are needed and how the technique is performed.We will also discuss the possible indications for this technique and will provide a brief review based on published reports and our own experience.
文摘Aims and Objectives: To assess efficacy and safety of percutaneous cholecystostomy (PC) in high risk patients with acute cholecystitis. Materials and Methods: The study was carried out in high risk patients with acute calculous or acalculous cholecystitis. Patients qualifying for the study were subjected to PC under ultrasound (USG) guidance. A cholecystogram was done postoperatively, to help establish satisfactory catheter position. Results: 24 (70.59%) patients had empyema-gallbladder, 8 (23.53%) had acute calcular cholecystitis and 2 (5.9%) patients were diagnosed as acalcular cholecystitis. None of the patients was fit for general anesthesia at the time of admission. Median hospital-stay after performing procedure was 4 days. Clinical success rate was reported 100% in our study. Bile cultures yielded growth of E Coli in 10 (29.41%), klebsela in 8 (23.53%), pseudomonas aeruginosa in 6 (17.65%) and Proteus mirabilis in 4 (11.8%) of patients. 6 (17.65%) patients did not grow any organism in their bile. Growth noted was sensitive to imipenem 29.41% (10), ciprofloxacin 17.65% (6), levofloxacin 17.65% % (6) and cefuroxime 11.76% (4). No major complication was recorded in our study. No procedure related death was observed. Tube displacement occurred in one patient and minor bleeding was reported in 2 patients. Catheter was removed after a mean of 25.25 days. All patients underwent definitive surgical intervention during the follow up period of 3 months. Conclusion: USG guided PC is a safe and effective procedure for treating high-risk patients who present with acute cholecystitis. Once the acute symptoms diminish or resolve, it should be followed by elective surgery.
文摘Objective The aim of the present study was to assess experience with percutaneous cholecystostomy (PC) in high risk aged patients with presumed acute cholecystitis. Methods\ PC was performed by transhepatic route under local anaesthesia guided by ultrasonography cholecystostomy catheters. The catheters used include the Cope loop(produced by Japan hakko). Results\ PC was performed successfully in all 18 patients, without immediate procedural or technical complications. Symptoms and clinical signs of cholecystitis resolved within 24 48 h after the procedures in all but one patient. Conclusion\ PC is a cost effective ,mini invasive, and reliable alternative to surgical placement of cholecystostomy tubes in critically ill patient. This study also can be used in hepatic abscess, obstructive jaundice and necrostic pancreatitis caused by stone or tumor.\;
