Preliminary Study On The Timing Of PTGD Sequential LC In The Treatment Of Mirizzi Syndrome Type Ⅰ

[Objective] To explore the timing of sequential laparoscopic cholecystectomy for patients with Mirizzi syndrome type Ⅰ undergoing percutaneous transhepatic gallbladder drainage.[Methods] Patients with Mirizzi syndrome type Ⅰ diagnosed in the Second Affiliated Hospital of Kunming Medical University from January 2014 to September 2022 were collected and divided into groups according to the time of sequential LC after PTGD:those who performed LC within 15-30 days after PTGD were in group A;Those who performed LC within 31-60 days after PTGD were group B,and those who performed LC within 61-90 days after PTGD were group C.Compare the observation indicators of the three groups of cases between groups and within groups:(1)First admission index:(1)General data: gender,age.(2)Gallbladder wall thickness and gallbladder size measured by B-ultrasound at admission.(3)Laboratory indexes at admission: ALT,AST,PCT,IL-6,CRP,TBil,DBil;(2)Secondary admission index:(1)Compare the changes of gallbladder wall thickness and size before and after PTGD in three groups;(2)Compare the differences of laboratory indicators such as ALT,AST,PCT,IL-6,CRP,TBil and DBil before and after PTGD in three groups;(3)Compare the operation time and intraoperative bleeding volume of LC in three groups;(4)Compare the placement rate of drainage tubes in three groups;(5)Compare the conversion rate of the three groups;(3)Postoperative index:(1)postoperative hospitalization days after LC;(2)Compare the differences of PCT,IL-6 and CRP in the three groups on the first day after operation;(3)The incidence of complications after LC.All data were analyzed by SPSS26.0 statistical software,expressed as mean((?)± s),measurement data were t-test,and counting data were x~2 The difference was statistically significant(P<0.05).[Results] A total of 1005 patients with Mirizzi syndrome were collected in the magnetic resonance room and medical record room of our hospital.After screening,120 patients met the inclusion criteria,including 40 in Group A,40 in Group B,and40 in Group C.The observation indicators of the three groups of cases were compared between groups and within groups:(1)The first admission index: there was no significant difference in gender,age,gallbladder wall thickness,gallbladder size,and related laboratory indicators such as ALT,AST,TBIL,DBIL,PCT,IL-6,CRP among the three groups at admission(P>0.05);(2)Secondary admission index:(1)The gallbladder wall thickness and size of patients in Groups A,B,and C decreased to varying degrees after PTGD and before returning to hospital for surgery compared to those before PTGD.The decrease was not significant in Groups A and B,while the decrease was most significant in Group C,The difference was statistically significant(gallbladder wall thickness: 0.49 ± 0.15vs0.36 ± 0.20,0.57 ± 0.20vs0.44 ± 0.22,0.54 ±0.26vs0.29 ± 0.23,P=0.04;gallbladder size: 10.54 ± 0.39vs9.72 ± 1.21,10.54 ±0.37vs9.32 ± 1.42,10.62 ± 0.36vs7.28 ± 2.69,P<0.001);(2)All laboratory indexes of patients in group A,B and C after PTGD and before returning to the hospital for surgery have the most obvious changes compared with those in group C before PTGD,and the difference is statistically significant(Group A: ALT: 34.32 ± 27.87 vs 24.90 ±17.75,AST: 29.84 ± 18.97 vs 22.35 ± 12.93,TBIL: 23.22 ± 20.38 vs 18.82 ± 9.00,DBIL: 8.95 ± 7.42 vs 7.29 ± 6.21,IL-6: 88.65 ± 7.00 vs 34.33 ± 7.27pg/ml,PCT: 0.24± 0.03 vs 0.18 ± 0.03ng/ml,CRP: 62.69 ± 6.61 vs36.55 ± 7.52mg/L);(Group B: ALT: 34.87 ± 17.50 vs28.70 ± 17.77,AST: 31.03 ± 8.73 vs25.17 ± 8.80,TBIL: 21.48 ± 5.42 vs20.36 ± 5.41,DBIL: 9.02 ± 5.83 vs7.87 ± 5.84,IL-6: 86.25 ±7.70 vs31.24 ± 8.41 pg/ml,PCT: 0.26 ± 0.03 vs0.19 ± 0.03ng/ml,CRP: 64.99 ± 6.86vs39.40 ± 7.80 mg/L);(Group C: ALT: 34.33 ± 20.27 vs 16.40 ± 11.33,P<0.05,AST:30.07 ± 12.15 vs 16.03 ± 7.42,P<0.05,TBIL: 20.85 ± 6.47 vs 15.33 ± 4.77,P<0.05,DBIL: 7.50 ± 4.21 vs 3.93 ± 1.67,P<0.05,IL-6: 86.50 ± 8.09 vs 6.95 ± 4.89 pg/ml,P<0.05,PCT: 0.25 ± 0.03 vs 0.05 ± 0.03 ng/ml,P<0.05,CRP: 62.43 ± 6.47 vs 9.82 ±6.52 mg/L,P<0.01)(3)Group C The operation time and intraoperative bleeding volume were shorter and less than those of group A and group B,The difference was statistically significant(operation time: 103.83 ± 37.93 vs 139.16 ± 56.00 vs 116.57 ±58.03 min,P=0.029;intraoperative bleeding volume:8.13±5.51mlvs21.63±9.09mlvs14.63±7.28 ml,P<0.05);(4)Among the three groups,the drainage tube placement rate in group C was lower,and the difference was statistically significant(72.50% vs50.0% vs32.50%),(P=0.002);(5)Among the three groups,12 patients in Group A converted to laparotomy(30.0%),7 patients in Group B(17.50%),and 1 patient in Group C(2.50%).The difference was statistically significant(x~2= 6.31,P<0.05)。(3)Postoperative indexes:(1)Postoperative hospitalization days: The postoperative hospitalization days of patients in Group C were significantly shorter than those in Group A and Group B,and the difference was statistically significant(3.27 ± 1.53 vs 9.06 ± 7.44 vs 3.63 ± 2.48 days,P<0.05)(2)Comparison of the differences in PCT,IL-6 and CRP among the three groups on the first day after operation: The above indexes of patients in Group C were lower than those in Group A and Group B,The difference was statistically significant(PCT: 0.09± 0.04 vs 0.10 ± 0.03 vs 0.04 ± 0.03 ng/ml;IL-6: 13.28 ± 6.78 vs 10.97 ± 7.26 vs 5.77± 2.63 ng/ml;CRP: 15.58 ± 7.42 vs 18.61 ± 7.07 vs 6.40 ± 3.96 mg/L,P<0.01)(3)Postoperative complication rate: no complications occurred in group C(0%),5 bile duct injuries(12.50%)and 9 bile duct strictures(22.50%)in group A,5 bile duct strictures(12.50%)in group B The incidence of complications in group B was significantly higher than that in group C(0%)(P<0.05).[Conclusion] For patients with Mirizzi syndrome type Ⅰ,LC within 15-30 days after PTGD has a higher operative time,intraoperative bleeding,conversion rate to laparotomy,and complication rate than the other two groups,indicating that LC is not a reasonable choice during this period;Although the above aspects of LC performed within 31-60 days after PTGD were decreased compared with those in group A,it was still difficult to dissect the gallbladder triangle during the operation,so the choice of LC performed within this time period was not ideal;Among the patients in the 61-90 day group,the operation time,intraoperative bleeding,conversion to laparotomy,and complication rate were significantly lower than those in the A and B groups,and the difficulty of intraoperative operation was also significantly lower.Therefore,this study believed that compared with the current clinical practice,LC treatment for Mirizzi syndrome type Ⅰ after three months of PTGD was more preferred.LC treatment within 61-90 days after PTGD can not only greatly shorten the operation time and reduce intraoperative bleeding,It can also effectively reduce the incidence of complications,shorten the time for patients to take tubes,reduce pain,and ensure the safety of surgery,so it is recommended to perform LC within 61-90 days after PTGD.