담낭 조루술의 유효성과 복강경 담낭절제술 1000예에 대한 고찰

주리호,조병선,윤여대,강윤중,박주승 凡石學術奬學財團 1998 凡石學術論文集 Vol.2 No.-

급성담낭염으로 경피적 담낭배액술을 시행한 환자에서 담낭절제술 시행의 적절한 시기

정우현 ( Woohyun Jung ),박동은 ( Dong Eun Park ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.4

Background/Aims: Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Percutaneous cholecystostomy is an alternative treatment to resolve acute inflammation in patients with severe comorbidities. The purpose of this study is to determine the optimal timing of laparoscopic cholecystectomy after percutaneous cholecystostomy for the patients with acute cholecystitis. Methods: This retrospective study was conducted in patients who underwent cholecystectomy after percutaneous cholecystostomy from January 2010 through November 2014. Seventy-four patients were included in this study. The patients were divided into two groups by the operation timing. Group I patients underwent cholecystectomy within 10 days after percutaneous cholecystostomy (n=30) and group II patients underwent cholecystectomy at more than 10 days after percutaneous cholecystostomy (n=44). Results: There was no significant difference between groups in conversion rate to open surgery, operation time, perioperative complications rate, and days of hospital stay after operation. However, complications related to cholecystostomy such as catheter dislodgement occurred significantly more often in group II than group I (group I:group II=0%:18.2%, p=0.013). Conclusions: Timing of laparoscopic cholecystectomy after percutaneous cholecystostomy did not influence postoperative outcomes. However, late surgery caused more complications related to cholecystostomy than early surgery. Therefore, early laparoscopic cholecystectomy should be considered over late surgery after percutaneous cholecystostomy insertion. (Korean J Gastroenterol 2015,66:209-214)

경피적 담낭루 설치술의 안전성과 유용성 : 해부학적 접근경로 및 시술방법을 중심으로 Evaluation of Complication with Regard to the Access Route and Technique

신경숙,조준식,신병석 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Our purpose was to evaluate the safety and feasibility of percutaneous cholecystostomy with regard to access route(transperitoneal vs transhepatic) and technique in patients of acute cholecystitis. In 139 consecutive patients(80 male, 59 female mean age; 67years) with acute cholecystits, medical records about percutaneous cholecystostomy (approach route, technique, used device and complication) were reviewed, retrospectively. In all patients, the procedure were performed under ultrasound guidance for GB puncture and fluoroscopy control for catheter manipulation. In 136 of 139 patients, percutaneous cholecystostomy was technically successful (98%). In three cases, successful second trial after initial failure was performed. The procedure was performed by meansof a transhepatic(n=63) or a transperitoneal(n=76) access route. During procedure, seldinger technique was performed(transhepatic approach, n=63, transperitoneal approach, n=62) in 125 patients, while in the remaining 14 patients the procedure were performed using troca technique with transperitoneal approach. Chiba needle(20G, MDtech, Denmark, n=22), JELCO needle(16G, Johnson & Johnson, USA, n= 67), Secalon catehter(16G, Ohmeda, UK, n=36) were used for initial puncture of GB. Only minor complications such as abdominal pain(n=16), hemorrhage(n=2), referred pain(n=4) occurred in 21cases(15%). Abdominal pain is more frequent in transhepatic approach(18%) than in transperitoneal approach(7%), but not statistically significant(p=0.061). Overall complication rate is lower in transperitoneal approach(8B) than in transhepatic approach(24%)(p=0.016). According to puncture needle, there is no significant difference in complication rate between Chiba needle(18%) and 16G needle(Jelco needle and Secalon catheter, 16%). In Conclusion, percutaneous cholecystostomy has proved to be safe and effective treatment for patients with acute cholecystitis.

고 위험군 급성 담낭염 환자에서 경피적 담낭배액술의 치료 효과

김남재(Nam Jae Kim),이경태(Kyung Tae Lee),이승민(Seung Min Lee),김석현(Seok Hyun Kim),이병석(Byung Seok Lee),서광식(Kwang Sik Seo),김진희(Jin Hee Kim),김성걸(Seong Gul Kim),이헌영(Heon Young Lee) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.4

N/A Background/Aims: Percutaneous cholecystostomy for decompression and drainage of the gallbladder is indicated when the patient is elderly or suffers from an inflatnmatory process of the gallbladder and is unable to tolerate an operation. To evaluate the role of percutaneous cholecystostomy in the management of acute cholecystitis in the high risk patients, we reviewed our experiences. Methods: Fourteen high risk critically ill patients with acute cholecystitis underwent percutaneous cholecystostomy from January, 1994 to July, 1995 using 8.'7 Fr pigtail catheter under real-time ultrasound and fluoroscopic guidance. Results: The clinical conditions of 14 patients improved after percutaneous cholecystostomy without technical complications. Eight patients subsequently underwent successful elective cholecystectomy after improvement in their medical condition, but one patient who underwent surgery died 10 days after surgery due to gastric varix bleeding which was not related to the gallbladder catheter. The remaining six patients had resolution of acute cholecystitis but did not undergo elective operation because of their poor medical conditions (three in calculous disease) and restoration of gallbladder function(three in acalculous disease). Conclusions: Percutaneous cholecystostomy may be used as an initial life saving procedure for critically I]1 patients with acute cholecystitis, and serves as a definitive procedure for patients considered to be at high operative risk and who have no residual stones. (Korean J Gastroenterol 1997; 29:515-521)

고 위험군 급성 담낭염 환자에서 경피적 담낭배액술의 치료 효과

김남재,이경태,이승민,김석현,이병석,서광식,김진희,김성걸,이헌영 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.29 No.4

간장 ( 肝臟 ) , 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 급성 담낭염의 치료에 있어서 경피적 담낭루 설치술의 이용

민영일(Young Il Min),이성구(Sung Koo Lee),안세현(Sei Hyun Ahn),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),전용철(Yong Cheol Jeon),성규보(Kyu Bo Seong),조경식(Kyung Sik Cho),이문규(Mun Gyu Lee) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3

N/A Percutaneous cholecystostomy is a techniue to obviate cholestectomy or surgical cholecystostomy in high risk patients. We evaluated 12 relatively high risk patients who underwent percutaneous cholecystostomy in recent 1 year. Overall success rate of percutaneous cholecystostomy was 92%(12/ 13). Relief of pain and defervescence could be observed promptly in almost all patients. In 4 cases of acalculous cholecytstitis, the catheters were removed successfully after resolution of acute inflammation. 3 cases of calculous cholecystitis were treated with elective cholecystectomy after resolution of septic condition. Percutaneous stone removal was performed via the enlarged tract with stone basket or other mechanical devices in 3 cases of calculous cholecystitis. Two cases of tube dislodge and 1 case of mild bile leakage were the complications of this procedure without significant mortality or morbidity. Percutaneous cholecystostomy is a fast, low risk and effective treatment of acute cholecystitis in poor surgical risk patients.

수술 고위험 중증 환자에게서 발생한 급성 담낭염의 경피적 담낭배액술 단독 치료와 담낭절제술 비교; 단일 기관, 단면 연구

차병효 ( Byung Hyo Cha ),송하헌 ( Ha Hun Song ),김영남 ( Young Nam Kim ),전원중 ( Won Jung Jeon ),이상진 ( Sang Jin Lee ),김진동 ( Jin Dong Kim ),이학현 ( Hak Hyun Lee ),이반석 ( Ban Seok Lee ),이상협 ( Sang Hyub Lee ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.1

Background/Aims: Percutaneous cholecystostomy (PC) is an effective treatment for cholecystitis in high-risk surgical patients. However, there is no definitive agreement on the need for additional cholecystectomy in these patients. Methods: All patients who were admitted to Cheju Halla General Hospital (Jeju, Korea) for acute cholecystitis and who underwent ultrasonography-guided PC between 2007 and 2012 were consecutively enrolled in this study. Among 82 total patients enrolled, 35 underwent laparoscopic cholecystectomy after recovery and 47 received the best supportive care (BSC) without additional surgery. Results: The technical and clinical success rates for PC were 100% and 97.5%, respectively. The overall mean survival was 12.8 months. In the BSC group, mean survival was 5.4 months, and in the cholecystectomy group, mean survival was 22.4 months (p<0.01). However, there was no significant difference between these groups in multivariate analysis (relative risk [RR]=1.92; 95% CI, 0.77-4.77; p=0.16). However, advanced age (RR=1.05; 95% CI, 1.02-1.08; p=0.001) and higher class in the American Society of Anesthesiologists` physical status (RR=3.06; 95% CI, 1.37-6.83, p=0.006) were significantly associated with survival in the multivariate analysis. Among the 47 patients in the BSC group, the cholecystostomy tube was removed in 31 patients per protocol. Recurrent cholecystitis was not observed in either group of patients during the follow-up period. Conclusions: In high-risk surgical patients, PC without additional cholecystectomy might be the best definitive management. Furthermore, the cholecystostomy drainage catheter can be safely removed in certain patients. (Korean J Gastroenterol 2014;63:32-38)

Efficacy of preoperative percutaneous cholecystostomy in the management of acute cholecystitis according to severity grades

( Seong Yeol Kim ),( Kyo-sang Yoo ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.3

Background/Aims: The aim of this retrospective study was to assess the efficacy of percutaneous cholecystostomy (PC) for patients with acute cholecystitis (AC) according to severity. Methods: A total of 325 patients who underwent cholecystectomy between January 2008 and October 2010 were enrolled. Patients were classified into three groups based on severity grade according to the Tokyo guidelines for AC: grade I (mild), grade II (moderate), and grade III (severe). These groups were further classified into two subgroups based on whether or not they underwent preoperative PC. Results: A total of 184 patients were classified into the grade I group (57%), 135 patients were classified into the grade II group (42%), and five patients were classified into the grade III group (1%). In the grade I and II groups, the mean length of hospital stay was significantly shorter in the patients who did not undergo PC than in those who received PC (10.7 ± 4.4 vs. 13.7 ± 5.8, p < 0.001; 11.8 ± 6.5 vs. 16.9 ± 12.5, p = 0.003, respectively). The mean length of preoperative hospital stay was significantly shorter in the patients without PC than in those with PC in the grade I and II groups (5.8 ± 3.3 vs. 8.2 ± 4.6, p = 0.001; 6.0 ± 4.4 vs. 8.8 ± 5.2, p = 0.002). In addition, the operative time was shorter in patients without PC, especially in the grade I group (94.6 ± 36.4 vs. 107.3 ± 33.5, p = 0.034). Conclusions: Preoperative PC should be reserved for only selected patients with mild or moderate AC. No significant benefit of preoperative PC was identified with respect to clinical outcome or complications.

Outcomes of endoscopic retrograde cholangiopancreatography-guided gallbladder drainage compared to percutaneous cholecystostomy in acute cholecystitis

Hassam Ali,Sheena Shamoon,Nicole Leigh Bolick,Swethaa Manickam,Usama Sattar,Shiva Poola,Prashant Mudireddy 한국간담췌외과학회 2023 Annals of hepato-biliary-pancreatic surgery Vol.27 No.1

Backgrounds/Aims: Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients. Methods: We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC. Results: After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707–97,978) compared to PTC, $40,413 (IQR $25,244–65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1–0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29–0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49–0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48–2.54; p < 0.001) with ERGD compared to PTC. Conclusions: ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.

The Efficacy of Preoperative Percutaneous Cholecystostomy for Acute Cholecystitis with Gallbladder Perforation

김보라,조정현,박병호 대한영상의학회 2017 대한영상의학회지 Vol.77 No.6

Purpose: Treatment of acute cholecystitis with gallbladder perforation remains controversial. We aimed to determine the feasibility of percutaneous cholecystostomy (PC) in these patients. Materials and Methods: We retrospectively reviewed patients who had acute cholecystitis with gallbladder perforation at a single institution. Group 1 (n = 27; M:F = 18:9; mean age, 69.9 years) consisted of patients who received PC followed by cholecystectomy, and group 2 (n = 16; M:F = 8:8; mean age 57.1 years) consisted of patients who were treated with cholecystectomy only. Preoperative details, including sex, age, underlying medical history, signs of systemic inflammatory response syndrome (SIRS), laboratory findings, body mass index, presence of gallstone, and type of perforation; treatment-related variables, including laparoscopic or open cholecystectomy, conversion to laparotomy, blood loss, surgical time and anesthesia time; and outcome, including postoperative complications and hospital stay were analyzed. Results: There was no significant difference in preoperative details, treatment-related variables, postoperative complications, and postoperative hospital stay. However, preoperative hospital stay (median, 14 days vs. 8 days; p < 0.05) and total hospital stay (median, 22 days vs. 14.5 days; p < 0.05) were significantly longer in group 1 than in group 2. Conclusion: The preferred treatment of acute cholecystitis with gallbladder perforation might be cholecystectomy without preoperative PC; however, preoperative PC can be a safe, optional treatment in elderly patients with signs of SIRS.