Study On Timing Of Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage Of Acute Cholecystitis

Objective: We performed this clinical research to identify the optimal timing of laparoscopic cholecystectomy after percutaneous gallbladder drainage for acute cholecystitis,to provide references for clinical work.Methods: We used Hospital Information System to collect the clinical information of the cases in the department of general surgery of Shengjing Honpital of China Medical University who were performed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage because of cholecystitis from 2013 to 2019.These cases were divided into non-difficult cholecystectomy(group A)and difficult cholecystectomy(group B)using retrospective analysis in the light of the surgery difficulty.We analyzed the age,interval between symptom onset and PTGD,WBC,LEU,Hb,Plt,Tbil,AST,ALT when the patients’ symptom were first observed before PTGD.We also analyzed the interval between PTGD and LC,and surgery operating time,wall thickness of gall bladder and hospital stay after surgery.Receiver Operator Characteristic Curve and linear regression analysis were utilized to analysis the optimal timing of laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage.Results: Nighty-eight patients who underwent either laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis were enrolled from 2013 to 2019.The interval between percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in Group A was longer than that in Group B(69.0(48.0)days VS.39.5(80.3)days;P=0.043).The difficulty of laparoscopic cholecystectomy was significantly lower when the interval was more than 40.5 days than that with shorter interval(22(66.7%)VS.20(30.8%);P=0.001).But the difficulty didn’t decrease as the interval reached 61.7 days.Conclusion: According to the result of ROC curve,the Cut-off of the ROC curve was 40.5 days.Surgery difficulty will obviously decrease when the interval of percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy is more than 40.5 days.According to the result of the fitted curve,the proportion of the difficult group at 61.7 days was the lowest,which can be considered that the surgery is the least difficult at this time.With respect to surgical difficulty and patients’ quality of life,the optimal timing of laparoscopic cholecystectomy is between 40.5 days and 61.7 days after percutaneous gallbladder drainage.