| Objective: The acute cholecystitis with high risk in old people is a kind of common disease of general surgery with higher incidence and mortality.It is important to take effective treatment so as to improve curative effect,ensure patients’ quality of life and promote recovery.The paper is based on 117 cases of elderly patients with high-risk acute cholecystitis for further analysis,and to discuss the clinical application value of the PTGBD in the elderly with high-risk acute cholecystitis.Methods: To evaluate the confirmed 117 cases of elderly high-risk patients with acute cholecystitis,which were from January 2012 to June 2016 in The second affiliated hospital of Suzhou University.These patients were divided into control group(57 cases)and observation group(60 cases),according to whether the PTGBD was applied or not.The patients in control group were cured by LC immediately,while the observed patients were treated by PTGBD,and then with LC.It was compared the observation group PTGBD pain score before and after the operative,the white blood cell,the APACHE II score,the body temperature and the CRP.And also the LC surgery complications,operation time,transit open rate,length of hospital stay of the two groups and the body temperature of different times,white blood cell and APACHE II score with control group after LC and observation group after PTGBD were compared.Results: The observation group operated smoothly and the average time was(32.6±3.3)min.Among them 4 cases after many successful tube,1 case of postoperative bile leakage,2 cases of postoperative bleeding,and all of them were better after the conservative treatment.The signs and symptoms of this group relieved or disappeared within 72 hours after drainage,which has the statistical significance(P<0.05).The hospitalized patients were in LC treatment directly in the control group,consequently in smooth operation,no deaths,including 6 cases of conversion to laparotomy,3 cases ofpostoperative biliary fistula,4 cases of postoperative bleeding,1 case of wound infection.Yet these patients became better after conservative treatment and all of them were cured out of the hospital.Observation group after treatment with PTGBD selected the elective LC treatment.In this group LC surgery implemented smoothly,including 1 case of conversion to laparotomy,1 case of postoperative biliary fistula,2 cases of postoperative bleeding,which improved after the conservative treatment and were cured out of the hospital.Comparing with the control group,the surgery complications,operation time,transit open rate and the body temperature of different times,white blood cell and APACHE II score with control group after LC,the observation group after PTGBD were significantly better(P<0.05).Conclusion: 1.The PTGBD possesses the advantages of simplicity and high success rate,which can make signs and symptoms relieve quickly for the elderly and high risk of acute cholecystitis patients.2.The PTGBD effectively reduces the LC transit operation rate and the complications.3.The PTGBD sequentially with the elective LC is a safe and effective treatment in the elderly with high-risk acute cholecystitis. |
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