Clinical Study Of Percutaneous Transhepatic Gallbladder Drainage Sequential Laparoscopic Cholecystectomy For Moderate And Severe Acute Cholecystitis

Background and purposeAC is a common abdominal surgical disease that requires surgical treatment in most patients.LC is currently the preferred treatment for AC.Some patients cannot or are not suitable for emergency surgery because of severe local inflammation of gallbladder.PTGD is widely used to relieve the disease rapidly and help patients get through the critical stage,which can win the opportunity for later surgical treatment.However,it remains controversial when LC should be performed after PTGD.The purpose of this study was to observe the therapeutic effect of PTGD on moderate and severe AC,and to analyze the surgical timing for LC after PTGD.MethodsThis study retrospectively analyzed the clinical data of moderate and severe AC patients treated in the Second Affiliated Hospital of Harbin Medical University from January 2017 to December 2021,and divided them into groups according to the timing of LC after PTGD.Group A underwent LC within 2 weeks after PTGD,and group B underwent LC within 2-4 weeks after PTGD,group C underwent LC 4 weeks after PTGD.Body temperature,WBC count,NEUT %,ALT,AST and other indicators were compared before and 48 h after PTGD.The evaluation results of gallbladder ultrasonography before LC in 3 groups were observed.The indicators related to sequential LC treatment in 3 groups were counted and compared.Results SPSS 25.0statistical software was used for data analysis,and P < 0.05 was considered statistically significant.Results(1)A total of moderate and severe 288 AC patients were included in this study,the number of sequential LC with PTGD cases increased gradually during 5 years.Including 98 cases,103 cases,and 87 cases in each group.There was no significant statistical difference in age,gender,combined underlying diseases(diabetes,hypertension,coronary heart disease,COPD)among the 3 groups.(2)Compared with 48 h after PTGD,body temperature,WBC count,NEUT%,ALT,AST and other aspects were significantly improved before PTGD.(3)The volume of gallbladder before LC decreased significantly compared with that before PTGD.With the passage of time after PTGD,the volume of each group gradually decreased.(4)There were statistically significant differences between group A and group B and between group A and group C in terms of operative time,intraoperative blood loss,duration of abdominal drainage tube indwelling and postoperative hospital stay(P <0.05),while there were no significant differences between group B and group C in terms of the above indicators.ConclusionsPatients with moderate to severe acute cholecystitis were treated with percutaneous transhepatic gallbladder drainage,the curative effect was significant.Laparoscopic cholecystectomy was feasible 2 weeks after the puncture.