The Timing Of The LC After PTGD In Acute Cholecystitis Patients

Object: To investigate the efficacy of high-risk patients with acutecholecystitis by PTGD，and investigatethe timing of further operative opportunity for the treatment of PTGD in patients with acute cholecystitis.Methods: Clinical data of116cases of acute cholecystitis patients with high-risk underwent PTGDtreatment in January2005~June2013of our hospital were analyzed retrospectively.77patients with acutecholecystitis who receivedlaparoscopic cholecystectomy after PTGD were analyzed retrospectively.According to the interval,77cases were divided into3groups.The patients in the first (n=11),second(n=36),third (n=30)group performed LC were within2m,during2~4m,and beyond4m,retrospectively.Therate of conversion to surgery,intraoperative blood,operation time and hospital stay were compared amongthe three groups.Results: PTGD was successfully performed in all patients,symptoms and laboratory results after treatmenthad a significant improvement in a short time. A total of47bacterial strains were isolated during the surveyperiod, which included29Escherichia coli.3patients converted to open surgery because of recurrent acutecholecystitis. Gallbladder drainage was effective in113patients,26patients were cured. Selectivecholecystcetomy was performed in77cases.6patients with choledocholithias is were cured by ERCP afterExtubation.4elderly patients with cardiopulmonary dysfunction did not undergo further treatment. Nopatients died of the complications of PTGD. There was significant difference in the thickness of gallbladderwall before LC,conversion to open surgery,intraoperative blood,operation time,hospital stay andpostoperative complications among3groups(p<0.05).Conclusion: The timing for LC in patients with acute cholecystitis should be after the2m interval afterPTGD, the thickness of gallbladder wall less than or equal to0.4cm and stable condition. PTGD is a safeand an effective treatment, the technique can obviously alleviate the patient’s condition, reduce theincidence of complication,provided the opportunity for further LC treatment.