Akut Kolesistitli Hastaların Tedavisinde Perkütan Kolesistostominin Etkinliği ve Klinik Seyri

Amaç: Akut kolesistitli (AK) hastaların tedavisinde perkütan kolesistostomi’nin (PK) etkinliğinin, güvenilirliğinin ve klinik sonuçlarının değerlendirilmesidir. Materyal ve metod: Ocak 2020 ve Mayıs 2022 tarihleri arasında Mehmet Akif İnan Hastanesi ve Harran Üniversitesi Hastanesi’nde PK uygulanan 18 yaşından büyük tüm hastalar retrospektif olarak analiz edildi. Hastaların demografik verileri (yaş ve cinsiyet), komorbiditeleri, katater çekilme süresi, hastanede yatış süresi, Amerikan Anestezi Derneği (ASA) skoru, interval kolesistektomi ve mortalite gelişme durumu kaydedildi. AK şiddetine göre grade 1 (hafif), grade 2 (orta) ve grade 3 (şiddetli) olmak üzere üçe ayrıldı. Bulgular: Çalışmaya dahil edilen 130 hastanın 76’sı (%58.5) kadın olup hastaların ortalama yaşı 71.9 (aralık: 36-92) yıl idi. En sık eşlik eden hastalıklar hipertansiyon (n=28, % 21.5) ve koroner arter hastalığı (n=26, %20.0) idi. Hastaların 70’inde (%53.8) taşlı kolesistit ve 115’inde (%88.5) hidropik safra kesesi vardı. Hastaların 68’inin (% 52.3) ASA skoru 3-4 ve 14’ü (%10.8) grade 3 kolesistit idi. PK’nın teknik başarısı %100 idi. Hastane içi mortalite oranı %15.4 (n=20) olup ölen hastaların yaş ortalaması taburcu olanlara göre anlamlı olarak daha fazlaydı (81.2 ± 8.5 ve 70.1 ± 13.8 yıl, p<0.001). Mortalite gelişen hastalarda şiddetli (grade 3) AK oranı ve yüksek ASA skoruna (ASA 3 ve 4) sahip olma oranı taburcu olanlara kıyasla anlamlı olarak daha yüksekti (sırasıyla; %40’a %5.5; p<0.001 ve %80’e %47.3; p=0.006). Ölen hastaların hastanede kalış süresi daha uzun (median değer, 28’e 13 gün; p=0.002) ve CRP değeri anlamlı olarak daha yüksekti (86.2 ±23.8 ve 11.4 ± 6.4 g/dl; p=0.032). PK sonrası hastaların %46.2’sine (n=60) kolesistektomi uygulandı. Sonuç: Akut kolesistitli hastaların hem cerrahi öncesi köprüleme tedavisinde hem de kesin tedavisinde PK etkin ve güvenle uygulanabilir. Ayrıca PK uygulanan hastaların ileri yaşta olmasının, eşlik eden hastalıklara bağlı yüksek ASA skoruna sahip olmasının ve şiddetli kolesistit varlığının mortaliteyi arttırdığı görünmektedir.

Anahtar Kelimeler:

perkütan kolesistostomi, akut kolesistit, Tokyo kılavuzu, kolesistektomi, safra kesesi

Efficacy and Clinical Course of Percutaneous Cholecystostomy in the Treatment of Patients with Acute Cholecystitis

Background: In this study, it was aimed to evaluate the efficacy, safety, and clinical results of percutaneous cholecystostomy (PK) in the treatment of patients with acute cholecystitis (AC). Materials and methods: All patients older than 18 years of age who underwent PC in Mehmet Akif Inan Hospital and Harran University Hospital between January 2020 and May 2022 were analyzed retrospectively. Demographic data (age and gender), comorbidities, duration of catheter removal, length of hospital stay, American Society of Anesthesia (ASA) score, interval cholecystectomy, and mortality development status of the patients were recorded. According to the severity of AC, it was divided into three grade 1 (mild), grade 2 (moderate), and grade 3 (severe). Results: Of the 130 patients included in the study, 76 (58.5%) were female, and the mean age of the patients was 71.9 (range: 36-92) years. The most common comorbidities were hypertension (n=28, 21.5%) and coronary artery disease (n=26, 20.0%). Of the patients, 70 (53.8%) had calculous cholecystitis and 115 (88.5%) had hydropic gallbladder. The ASA score of 68 (52.3%) patients was 3-4 and 14 (10.8%) were grade 3 cholecystitis. The technical success of PK was 100%. The in-hospital mortality rate was 15.4% (n=20), and the mean age of patients who died was significantly higher than those who were discharged (81.2 ± 8.5 and 70.1 ± 13.8 years, p<0.001). The rate of severe (grade 3) AC and high ASA score (ASA 3 and 4) were significantly higher in patients who developed mortality compared to those who were discharged (40% vs. 5.5%, p<0.001 vs. 80% vs. 47.3%, p=0.006; respectively). Patients who died had a longer hospital stay (median value, 28 vs 13 days; p=0.002) and a significantly higher CRP (86.2 ±23.8 vs 11.4 ± 6.4 g/dl; p=0.032). Cholecystectomy was performed in 46.2% (n=60) of the patients after PC. Conclusions: PC can be used effectively and safely in both preoperative bridging and definitive treatment of patients with acute cholecystitis. In addition, it was found that the advanced age of the patients who underwent PC, had a high ASA score due to comorbidity diseases, and the presence of severe cholecystitis increased mortality.

Keywords:

percutaneous cholecystostomy, acute cholecystitis, Tokyo guideline, cholecystectomy, gallbladder,

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