Conservative Treatment of Acute Cholecystitis with Percutaneous Cholecystostomy and Antibiotics: Retrospective Review of Outcomes

KC Chan, PSF Lee, CC Chan

Hong Kong J Radiol 2011;14:68-72

Objective: To review the outcome of patients treated by percutaneous cholecystostomy and antibiotics alone for acute cholecystitis without resorting to elective cholecystectomy.

Methods: Data on patients who underwent percutaneous cholecystostomy in our department between March 2008 and June 2009 were retrieved from the radiology information system and logbook of the interventional radiology suite. Using the electronic patient record, their clinical records were also reviewed retrospectively in early July 2010.

Results: A total of 31 patients underwent percutaneous cholecystostomy for acute cholecystitis during the study period, of whom 16 patients were treated non-surgically (by percutaneous cholecystostomy and antibiotics only). Among these, 11 (69%) were free from recurrent acute cholecystitis; five (31%) had recurrent acute cholecystitis; 11 (69%) had experienced catheter dislodgement; seven (44%) had undergone revision or reinsertion of their cholecystostomy for recurrent acute cholecystitis or catheter dislodgement. For carrying the cholecystostomy catheter, the median duration was 92 days. At the time of review, only two (13%) of the patients still had their cholecystostomy catheters in situ, whilst four had died. None of the deaths were related to acute cholecystitis or choledocholithiasis.

Conclusion: The majority of our patients with acute cholecystitis responded to the treatment of percutaneous cholecystostomy and antibiotics. Elective cholecystectomy was considered to be the preferable and definitive option if the patient’s condition allowed such surgery and was desired by the patient. Nevertheless, the outcome of patients not having elective cholecystectomy after percutaneous cholecystostomy was quite favourable and entailed no mortality related to cholecystitis or choledocholithiasis.

中文摘要

經皮膽囊穿刺造瘻術及抗生素療法保守治療急性膽囊炎：治療結果回顧

陳嘉智、李醒芬、陳澤宗

目的：回顧急性膽囊炎患者在未有進行開腹膽囊切除術的情況下，單用經皮膽囊穿刺造瘻術及抗生 素治療的結果。

方法：從放射學資訊系統及介入放射治療室的紀錄中，找出2008年3月至2009年6月期間於本部門進 行經皮膽囊穿刺造瘻術的病人。並於2010年7月再透過電子病歷紀錄，回顧這些病人的臨床結果。

結果：研究期間共31名急性膽囊炎患者接受經皮膽囊穿刺造瘻術，其中16人只接受經皮膽囊穿刺造 瘻術及抗生素療法，沒有進行開腹手術。16人中，11人（69%）的急性膽囊炎未有復發，其餘5人 （31%）出現復發；11人（69%）出現導管移位；7人（44%）因急性膽囊炎復發或導管移位而須再 次接受經皮膽囊穿刺造瘻術或重新置入導管。膽囊導管在患者體內逗留的時間的中位數為92天。回 顧患者的臨床結果時，只有兩人（13%）仍然保留膽囊導管；另4人死亡，死亡原因均與急性膽囊炎 或膽結石無關。

結論：經皮膽囊穿刺造瘻術及抗生素治療對大部份急性膽囊炎患者有療效。如果患者病情允許而又 得到病人的同意，開腹膽囊切除術應該是一個可取的方法。雖然如此，急性膽囊炎患者如果沒有接 受開腹膽囊切除術的話，經皮膽囊穿刺造瘻術亦是一種對病人有利的治療方法。此療法並沒有與膽 囊炎或膽結石有關的死亡病例。