The Effect Of PTGBD On Patients With Moderate And Severe Acute Cholecystitis In TG18 Classification Doing LC

Purpose:AC is one of the more ordinary acute abdominal disease in the emergency word.Among the patients admitted to hospital because of diseases of the biliary system,20% suffer from acute cholecystitis,and most of the patients can get better after medication and surgical treatment.According to the latest Tokyo Guidelines 2018(TG18),it is recommended that all people with AC should be provided with laparoscopic cholecystectomy regardless of their age,unless the risk of the operation is too high.Therefore,early or emergency LC is asked for patients with AC.However,for some elderly or critically ill patients with AC,if they undergo early or acute gallbladder surgery,the possibility of serious complications is relatively high,and even life-threatening.When encountering such patients,TG18 recommends percutaneous transhepatic gallbladder drainage(PTGBD)as the preferred treatment.Compared with drainage methods such as ETGBD and EUS-GBD,PTGBD is currently used as a bridging therapy for critically ill patients with AC and has been accepted by doctors.However,PTGBD cannot completely cure AC,so further surgical treatment is nominated for those who can postpone the operation.This article collects the clinical data of patients undergoing inchoate or emergency LC and PTGBD combined with delayed LC in the Department of Hepatobiliary Surgery,Dalian Friendship Hospital,to study the effect of PTGBD on patients with moderate and severe AC in the TG18 classification.Methods: Bedsied datum of patients who accepted LC in the Hepatobiliary Surgery of our hospital from October 2014 to October 2019 were retrospectively studied.AC was diagnosed according to the diagnostic criteria of TG18,and we use the guidelines to grade the patients.and according to whether or not to undergo PTGBD we divide patients into PTGBD+LC group and LC group.The data collected include:age,gender,body temperature,laboratory examinations,comorbidities,transposition to laparotomy,operation time,postoperatiue period hospital day,total hospital day,postoperatiue period complications,whether or not drainage.We use the statistical methods to analyze the datum of the two groups’ patients to research the influence of PTGBD on LC.Results: From October 2014 to October 2019,a total of 58 patients with PTGBD+LC and emergency or pure LC were in the Department of Hepatobiliary Surgery in our hospital,including 14 in the PTGBD+LC group and 44 in the LC group.Among them,43 cases were moderate(98%)and 1 case was severe(2%)in the LC group;in the PTGBD+LC group,12 cases(86%)were moderate and 2 cases(14%)were severe.On admission,all 58 patients had upper abdominal pain and Murphy sign was positive.In the control group,4 people had hypertension,10 had diabetes,2 had heart disease,and 1 had COPD;in the experimental group,1 had high blood pressure,and 3 had diabetes.All 58 patients completed LC without conversion to laparotomy or postoperative complications.Compared with the LC group,the PTGBD+LC group had longer operation time(p=0.021)and longer total hospital day(p=0.023).The diversity was statistically meaning.There was no significant diversity in postoperatiue period hospital day between the two groups(p=0.497),and the diversity was not statistically meaning.There was not significant diversity in postoperatiue period drainage(p=0.652),and the diversity was not statistically meaning.Conclusion: For patients with acute cholecystitis,if the condition is severe or the risk of surgery is high,then PTGBD is one of the safe and effective treatments that can relieve acute cholecystitis.However,the operation time and total hospital stay for elective LC are longer than that of early LC.Therefore,if there are no obvious surgical contraindications,we should perform early LC for patients with moderate to severe acute cholecystitis classified by TG18.