• 한국간담췌외과학회지
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• 제27권1호
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• pp.56-62
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• 2023

Backgrounds/Aims: Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients. Methods: We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC. Results: After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707-97,978) compared to PTC, $40,413 (IQR $25,244-65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1-0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29-0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49-0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48-2.54; p < 0.001) with ERGD compared to PTC. Conclusions: ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.

• 대한약리학회지
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• 제12권2호
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• pp.1-6
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• 1976

The effects of phenoxybenzamine and other related drugs were studied for their interaction with caerulein on gallbladder contraction in anesthetized animals and isolated gallbladder strips. Cholecystostomy and cystic duct ligation were made on anesthetized dog, cat and pig. Pressure changes of gallbladder were measured by a physiological pressure transducer connected to polygraph recorder. Isolated rabbit gallbladder strips were placed in a muscle chamber containing Locke-Ringer solution maintained at $38^{\circ}C$. The contractile responses were measured by a force-displacement transducer connected to polygraph recorder. Caerulein ($30{\sim}200$ ng/kg i.v.) produced marked contraction of gallbladder in situ and the cholecystokinetic potencies appear in decreasing order; dog, cat and pig. The response of caerulein was abolished by the large doses of phenoxybenzamine (15 mg/kg i.v.) but not affected with dibenamine, phentolamine or tolazoline. Cholecystokinetic effect of methacholine or barium chloride was also partially inhibited by phenoxybenzamine and the effect of caerulein was weakly inhibited intravenous injection of cyclophosphamide or papaverine. In isolated rabbit gallbladder strips, the response of contraction to caerulein were progressively inhibited by pretreatment of phenoxybenzamine along with time exposed. These results lead to the conclusion that phenoxytenzamine may inherently inhibit the contractile response of gallbladder to caerulein, and this effect was not related with ${\alpha}-adrenergic$ receptor blocking action.