Timing Of LC After PTGBD For Acute Cholecystitis

Objectives To investigate the timing of laparoscopic cholecystectomy(LC)after Percutaneous transhepatic gallbladder drainage(PTGBD)in patients with acute cholecystitis(AC).Methods Through a retrospective analysis of the clinical data of 242 patients with acute cholecystitis admitted to Tangshan workers’ hospital from January 2016 to January 2019,among whom,85 patients received LC treatment after PTGBD.Among the 85 patients with acute cholecystitis,54 patients received LC within 5 to 12 days after PTGBD(mean time 7 days),which was the early operation group.31 patients underwent LC within 66 to 100 days(mean time 79 days),which was the delayed operation group.The differences in the degree of gallbladder edema,degree of gallbladder triangle fibrosis,operation time,intraoperative blood loss,rate of conversion to laparotomy,incidence of surgical complications,per capita hospital stay,per capita hospital expenses,and complications related to PTGBD drainage tube were compared between the two groups.Results Grade of gallbladder edema in the early operation group: 28 cases were "+",26 cases were "++".In the delayed operation group,there were 26 cases of "-" and 5 cases of "+".Compared with the two groups,the gallbladder edema in the early operation group was higher than that in the delayed operation group(P < 0.01).Grade of cystic triangle fibrosis in the early operation group: 48 cases "-",6 cases "+";In the delayed operation group,there were 1 cases of "-",12 cases of "+" and 18 cases of "++".Compared with the two groups,the degree of cystic triangle fibrosis in the delayed operation group was higher than that in the early operation group(P < 0.01).The operation time of patients in the early operation group(46.9±9.3)min was shorter than that in the delayed operation group(75.6±9.0)min(P < 0.01).The intraoperative blood loss(21.1±9.3)ml in the early operation group was higher than that in the delayed operation group(12.5±6.4)ml(P < 0.01).Patients in both groups did not switch to laparotomy.There were no surgical complications in the early operation group,1 case of postoperative bile leakage and 1 case of postoperative abdominal hemorrhage in the delayed operation group(P=0.13).The average length of hospitalization of patients in the early operation group(13.6±2.7)d was shorter than that in the delayed operation group(16.7±2.7)d(P < 0.01).The average hospitalization cost of the early operation group was(2.6±0.49)ten thousand yuan,significantly lower than that of the delayed operation group(3.2±0.65)ten thousand yuan(P < 0.01).There were no complications related to PTGBD drainage tube in the early operation group,three cases of tube detachment and one case of blockage in the delayed operation group(P=0.016).Conclusions After PTGBD operation for acute cholecystitis,the inflammation was significantly relieved after standard medical treatment.About 7 days,patients can be treated with LC.At this time,gallbladder inflammation is mainly characterized by congestion and edema as the main pathological changes,with low degree of fibrosis,fragile and easy tissue separation,and relatively small surgical difficulty.Early operation can make the patient be cured completely in one hospitalization cycle,avoid the second hospitalization,and reduce the economic burden of the patient.Figure 5;Table 6;Reference 131.