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Abstract：
Introduction Percutaneous cholecystostomy (PC) is a treatment option for patients with acute cholecystitis (AC) who are too unwell, or too morbid for laparoscopic cholecystectomy (LC). Some patients have PC as a definitive treatment, whereas others have PC as a bridging treatment prior to LC. The aim of this study is to investigate patient characteristics and mortality among those who received PC as definitive treatment versus bridging treatment. Methods Our study retrospectively reviewed all patients treated with PC for AC from February 2019 to November 2022 at the Torbay and South Devon NHS Foundation Trust, Torquay, England. Fifty patients underwent PC for AC, with 48 patients having follow-up data available for analysis. Of these, 26 patients (54%) only received PC (definitive PC), and 22 patients (46%) later underwent LC (bridging LC). Results In this study, 68.8% of the patients were male, with a mean age of 76 ± 9 years. The overall mean Charlson Comorbidity Index (CCI) score was 4.96 ± 1.12, and the mean American Society of Anesthesiologists (ASA) score was 2.83 ± 0.36. The median PC drain duration was 42 days. Six patients (12.5%) had a recurrence of AC with a mean of 57 days onset after PC insertion. Twelve patients (25%) experienced PC complications: 11 (23%) were minor, involving pain or a dislodged tube, and one (2%) was major, resulting in a subhepatic abscess. The median duration from PC insertion to LC surgery was 50.5 days. The bridging LC cohort had a 30-day and one-year mortality of 0%, while the definitive PC cohort had a 30-day mortality of 30.8% (eight patients) and a one-year mortality of 46.1% (12 patients). The bridging LC cohort compared to the definitive PC cohort had a significantly lower CCI (4.39 vs 5.57, p<0.05), and a significantly lower ASA (2.61 vs 3.04, p<0.05). The one-year survival cohort compared to the 30-day mortality cohort had significantly lower ASA (2.71 vs 3.25 p<0.05), and a non-significantly lower CCI (4.66 vs 5.86 p=0.094). The presence of negative predictive factors of respiratory dysfunction and hyperbilirubinemia had higher 30-day and 90-day mortality rates of 31.3% and 37.5%, compared to their absence of 9.4% and 21.4% respectively. Conclusion Our results demonstrate that PC is a safe procedure with a high success rate and low complications. We showed that PC is an effective treatment option for bridging a select cohort of patients to receive a delayed LC. Furthermore, the data suggests ASA and CCI scoring can be used as clinical adjuncts to assess whether bridging patients from PC to LC is appropriate. Finally, ASA, respiratory dysfunction, and hyperbilirubinemia can be used as significant negative predictors of post-PC mortality.
摘要：
介绍经皮胆囊造口术（PC）是急性胆囊炎（AC）患者的一种治疗选择，或太病态腹腔镜胆囊切除术（LC）。一些患者有PC作为一种确定的治疗方法，而其他人则在LC之前将PC作为桥接治疗。这项研究的目的是调查接受PC作为确定性治疗与桥接治疗的患者的患者特征和死亡率。方法我们的研究回顾性回顾了2019年2月至2022年11月在Torbay和SouthDevonNHSFoundationTrust接受PC治疗的所有患者，托基,英格兰。50名患者接受了AC的PC治疗，48例患者有随访数据可供分析。其中,26名患者（54％）仅接受PC（最终PC），22例患者(46%)后来接受了LC(桥接LC).结果在这项研究中，68.8%的患者为男性,平均年龄为76±9岁。总体平均Charlson合并症指数（CCI）评分为4.96±1.12，平均美国麻醉医师协会（ASA）评分为2.83±0.36。PC排出时间的中位数为42天。6例患者（12.5％）的AC复发，在PC插入后平均发作57天。12例患者（25％）经历了PC并发症：11例（23％）是轻微的，涉及疼痛或脱落的管子，一个（2%）是主要的，导致肝下脓肿.从PC插入到LC手术的中位持续时间为50.5天。桥接LC队列的30天和1年死亡率为0%，而最终的PC队列30日死亡率为30.8%(8例),1年死亡率为46.1%(12例).与确定的PC队列相比，桥接LC队列的CCI显着降低（4.39vs5.57，p<0.05），ASA明显降低（2.61vs3.04，p<0.05）。1年生存队列与30天死亡率队列相比，ASA显著降低（2.71vs3.25p<0.05），和非显著较低的CCI（4.66vs5.86p=0.094）。呼吸功能障碍和高胆红素血症的阴性预测因素的存在具有较高的30天和90天死亡率，分别为31.3％和37.5％，相比之下，他们分别为9.4%和21.4%。结论我们的结果表明，PC是一种安全的手术，成功率高，并发症少。我们表明，PC是一种有效的治疗选择，可以桥接选定的患者队列以接受延迟LC。此外，数据提示ASA和CCI评分可作为临床辅助手段,用于评估从PC过渡到LC的患者是否合适.最后,ASA,呼吸功能障碍,和高胆红素血症可用作PC后死亡率的显著阴性预测因子。
