Τίτλος:
Two-center prospective comparison of the trocar and seldinger techniques for percutaneous cholecystostomy
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
OBJECTIVE: The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). SUBJECTS AND METHODS: This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the trocar group; 53 patients [28 men and 25 women]; mean [± SD] age, 74.31 ± 16.19 years) with the US- and fluoroscopy-guided Seldinger technique for PC (the Seldinger group; 52 patients [26 men and 26 women], mean age, 79.92 ± 13.38 years) in consecutive patients undergoing PC at two large tertiary university hospitals. The primary endpoints were technical success and procedure-related complication rates. Secondary endpoints included procedural duration, pain assessment, and clinical success after up to 3 months of follow-up. RESULTS: PC was successfully performed for all 105 patients. The clinical success rate was similar between the two study groups (86.8% in the trocar group vs 76.9% in the Seldinger group; p = 0.09). Mean procedural time was significantly lower in the trocar group than in the Seldinger group (1.77 ± 1.62 vs 4.88 ± 2.68 min; p < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; p = 0.02). Among patients in the Seldinger group, bile leak occurred in 7.7%, abscess formation in 1.9%, and gallbladder rupture in 1.9%. No procedure-related death was noted. Minor bleeding occurred in one patient (1.9%) in the trocar group, but the bleeding resolved on its own. The mean pain score during the procedure was significantly lower in the Seldinger group than in the trocar group (3.2 ± 1.77 vs 4.76 ± 2.17; p = 0.01). At 12 hours after the procedure, the mean pain score was significantly lower for patients in the trocar group (0.78 ± 1.0 vs 3.12 ± 1.36; p = 0.0001). CONCLUSION: Use of the bedside US-guided trocar technique for PC was equally effective as the Seldinger technique but was associated with fewer procedure-related complications, required less procedural time, and resulted in decreased postprocedural pain, compared with fluoroscopically guided PC using the Seldinger technique. © American Roentgen Ray Society.
Συγγραφείς:
Reppas, L.
Arkoudis, N.-A.
Spiliopoulos, S.
Theofanis, M.
Kitrou, P.M.
Katsanos, K.
Palialexis, K.
Filippiadis, D.
Kelekis, A.
Karnabatidis, D.
Kelekis, N.
Brountzos, E.
Περιοδικό:
AJR. AMERICAN JOURNAL OF ROENTGENOLOGY
Εκδότης:
American Roentgen Ray Society
Λέξεις-κλειδιά:
abscess; acute cholecystitis; aged; Article; bedside ultrasound guided trocar technique; bile leakage; bleeding; cholecystostomy; controlled study; echography; female; fluoroscopy; fluoroscopy guided Seldinger technique; follow up; gallbladder disease; human; intermethod comparison; major clinical study; male; operation duration; pain assessment; patient safety; percutaneous cholecystostomy; postoperative complication; postoperative pain; priority journal; prospective study; surgical technique; tertiary care center; treatment outcome; ultrasound guided Seldinger technique; university hospital; cholecystostomy; clinical trial; comparative study; controlled clinical trial; devices; middle aged; multicenter study; procedures; surgical equipment; very elderly, Aged; Aged, 80 and over; Cholecystostomy; Female; Humans; Male; Middle Aged; Prospective Studies; Surgical Instruments
DOI:
10.2214/AJR.19.21685
