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Issue Date
2019-04
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Percutaneous cholecystostomy as treatment for acute cholecystitis at Landspitali University Hospital 2010 – 2016Citation
Ísetning á kera við gallblöðrubólgu á Landspítala 2010-2016. 2019, 105(4): 171-75 LæknablaðiðAbstract
Inngangur: Bráð gallblöðrubólga er ein algengasta ástæða bráðainnlagnar á kviðarholsskurðdeild. Meðferðin er gallblöðrutaka en þegar aðgerð er ekki talin fýsileg er gefin íhaldssöm meðferð með sýklalyfjum. Svari sjúklingur ekki meðferð er lagður keri í gallblöðru gegnum húð. Markmið rannsóknarinnar var að skoða ísetningu gallblöðrukera og fylgikvilla þeirrar meðferðar á Landspítala. Efniviður og aðferðir: Afturskyggn rannsókn. Farið var í gegnum sjúkraskrár allra með sjúkdómsgreiningar K80-85 árin 2010-2016 og breytur skráðar í Excel sem einnig var notað við úrvinnslu. Notuð var lýsandi tölfræði. Niðurstöður: Alls fengu 4423 sjúklingar galltengdar sjúkdómsgreiningar á tímabilinu. Þar af voru 1255 (28%) með bráða gallblöðrubólgu og meðalaldur þeirra 58 ár (bil: 18-99). Alls fengu 88 (14%) gallblöðrukera og var meðalaldur þeirra 71 ár (bil: 28-92). Hjá 62 (70%) var kerinn lagður í gegnum lifur. Meðaltímalengd kera var 12 dagar (bil: 0-87). Gerð var gallvegamyndataka um kerann hjá 71 sjúklingi. Sautján sjúklingar voru útskrifaðir heim með kera. Helmingur sjúklinga (n=45, 51%) fór síðar í gallblöðrutöku í kviðsjá, að meðaltali 101 degi frá keraísetningu (bil: 30-258). Breytt var í opna aðgerð hjá 5 sjúklingum (12%). Meðalaðgerðartími kviðsjáraðgerða var 96 mínútur. Tuttugu og sjö sjúklingar (31%) fengu 28 fylgikvilla og voru flestir minniháttar. Algengasti fylgikvillinn var að keri dróst út (n=20) en aðrir voru gallleki (n=3), verkir (n=3) og endurtekin gallblöðrubólga (n=2). Fimm sjúklingar (6%) létust innan 30 daga frá keraísetningu, þrír vegna sýklasóttarlosts en tveir af ástæðum ótengdum sjúkdómnum eða meðferðinni. Ályktun: Ísetning gallblöðrukera er ekki algeng meðferð við bráðri gallblöðrubólgu á Landspítala. Meðferðin er örugg og getur gagnast vel eldri sjúklingum sem ekki er treyst í skurðaðgerð.Introduction: Acute cholecystitis is one of the most common reasons for acute admission in abdominal surgery. The recommended therapy is cholecystectomy but occasionally that is not possible and a conservative treatment with intravenous antibiotics is used. Should the patient not respond to conservative treatment a percutaneous catheter can be placed in the gallbladder (cholecystostomy). The aim of the study was to look at the frequency of which cholecystostomies were used and the complication rates at Landspitali, The National University Hospital of Iceland. Materials and methods: A retrospective study where patient charts of those with ICD – diagnosis numbers K80 – 85 at Landspitali University Hospital looked at and patients who received cholecystostomies were identified in the period from 2010 – 2016. Clinical information was registered in Excel. Descriptive statistics were used. Results: A total of 4423 patients were diagnosed with biliary disease during the study period. 1255 (28%) of them had acute cholecystitis with mean age of 58 years (range: 18 – 99). A cholecystostomy was put in 88 patients (14%), mean age 71 years (range: 28 – 92). A transhepatic route was used for 62 (70%) and the drain was in place for an average of 12 days (range: 0 – 87). A secondary cholangiography was performed in 71 cases. Seventeen patients were discharged home with the cholecystostomy in place. Half of the patients underwent a laparoscopic cholecystectomy 101 days from drain insertion (range: 30 – 258). A total of 28 complications were noted in 27 patients (31%) and the most common complication was dislodgement of the catheter (n=20). Five patients (6%) died within thirty days of the intervention, three from septic shock and two from reasons unrelated to the treatment. Conclusions: Cholecystostomy is not a common choice of treatment for acute cholecystitis at Landspitali, The National University Hospital of Iceland. Few serious complications arise from the treatment and no patients died in relation to the intervention.
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