[Evaluation of percutaneous transhepatic gallbladder drainage (PTGBD) for acute cholecystitis]

We performed percutaneous transhepatic gallbladder drainage (PTGBD) in 71 of 129 patients with acute cholecystitis. In 70 of 71 patients, clinical symptoms and laboratory data were rapidly improved by PTGBD. In order to evaluate the degree of acute cholecystitis, the clinical symptoms, laboratory data and ultrasonographic findings of these patients were analyzed by the quantification theory of Hayashi. As a result, irregular thickening of the gallbladder wall and gallbladder swelling presented by US and physical findings with Blumberg's sing or defence in the abdomen were most important findings to assess the severity of acute cholecystitis. Based on these data, we originally introduced the Severity Score of this disease and used it a criterion of PTGBD indication. The patients with the score above 0.5 were considered to be indicative for emergent PTGBD. In high risk patients (e.g., the aged or of diabetes mellitus) with the score above 0, this procedure should be indicated. In 24 of 71 patients, Percutaneous Transhepatic Gallbladder Scope (PTGBS) were attempted to retrieve stones, and it was completely successful in 16 patients.