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KMID : 0378120030300020257
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Chungnam Medical Journal
2003 Volume.30 No. 2 p.257 ~ p.265
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Percutaneous Cholecystostomy : Evaluation of Complication with Regard to the Access Route and Technique
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Shin Kyung-Sook
Cho Joon-Sik
Shin Byung-Suk
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Abstract
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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.
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KEYWORD
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Cholecystostomy, Gallbladder, Interventional procedures, Abdomen, therapeutic radiology
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