Further Discussion On Operation Opportunity Of Senile Acute Cholecystitis Along With Choledocholithiasis

Objective: Patients with senile acute cholecystitis along with Choledocholithiasiswho receiving emergency treatment are traditionally regarded as also suffering frominternal medicine diseases, such as cardia-cerebrovascular disease, diabetes and chronicrespiratory disease,etc. and are advised to take the conservative treatment, but if thecurative effect of which is unsatisfied, the emergency operation shall be adopted thoughthe death rate of which is higher. The main objective of this research is to furtherdiscuss the best operation opportunity for cholecystectomy and laparoscopic commonbile duct exploration and T-tube drainage for patients with senile acute cholecystitisalong with choledocholithiasis.Methods: Retrospectively analyze the clinical data on cholecystectomy andlaparoscopic common bile duct exploration and T-tube drainage for123patients agedmore than60(including60) and with senile acute cholecystitis along withcholedocholithiasis who were treated at general surgery department of Jinzhou districtFirst People’s Hospital from March2004to March2014. The patients are divided into3groups, namely early-phase operation group(within72hours), mid-phase operationgroup (from72hours to7days) and later-phase group (more than7days) according tothe time from the attack to the operation. Analyze and compare the differences inoccurrence rate of operative complications (biliary fistula, incision infection,pneumonitisgeneral and infectious shock), operation duration, post operation hospitalization duration, total hospitalization duration and post operation pathology(simple cholecystitis, purulent cholecystitis, gangrenous cholecystitis andpericholecystic abscess) to investigate the best operation opportunities.Result: The comparative differences in occurrence rate of all groups ofcomplications (biliary fistula, incision infection, pneumonitisgeneral and infectiousshock) are not statistically significant.(p>0.05)The operation duration of mid-phaseoperation group is longer than that of early-phase group and later-phase group (p<0.05).I have observed that the post operation hospitalization duration and total hospitalizationduration of patients gradually increase in the order of early-phase,mid-phase andlater-phase. The post operation hospital stay of the early-phase operation group is4-23days, with an average of13.0days;the post operation hospital stay of the mid-phaseoperation group is10-60days, with an average of16.1days;The post operation hospitalstay of the later-phase operation group is15-62days, with an average of20.3days. Theoccurrence ratio of purulent cholecystitis and gangrenous cholecystitis in post operationpathology of patients of early-phase operation group is higher (65.9%), mid-phasegroup is the highest(90.5%) and the later-group takes the third place (65.5%).Conclusion:1. Take the operative treatment as early as possible within72hours of the course ofdisease. Laparoscopic choledocholithotomy T-tube drainage is the best choice.2. Avoid emergency treatment if the course of disease exceeds72hours andaccompanied by cardiovascular and cerebrovascular diseases and chronic obstructivepulmonary disease and if the common duct obstruction is not obvious and other bodyconditions allowed; If the effect of conservative treatment is not obvious, I advise toremove intestinal obstruction by using endoscopic sphincterotomy(EST) orpercutaneous transhepaticcholangial drainage (PTCD).3. In case that the patient’s course of disease exceeds7days and the conservativetreatment is effective and the condition has improved, I still advise to undergo selectiveoperation, the reasons are (1) Disease symptoms repeat attacking;(2) A possiblemalignant transformation in biliary ducts.