Study On Indications For Extubation Of Percutaneous Transhepatic Gallbladder Drainage

Objective：Study on indications for extubation of percutaneous transhepatic gallbladderdrainage(PTGD).Methods：Between January2009and December2013,PTGD were performed on104patientswith acute cholecystitis. The clinical data were analyzed retrospectively. Including regularpatient follow-up data filled in at the time," gallbladder puncture and drainage in patientswith clinical data tables " in and after discharge, major review of the project include:Observed traits and bile bile drainage fluid drainage, abdominal B ultrasound, blood analysis,liver function, bile culture. Ask the patient to the clinic early clamping drainage tube morethan2h and fasting to the hospital review. If the patient is in the process of reviewing therelevant inspection indicators have reached a certain standard, Drainage tubes were removedwhen the candidate can pinch24~48h,without any discomfort you can disconnect thedrainage tube, if fever, abdominal distension, abdominal pain and other symptoms willcontinue to remain open drainage tube drainage. After disconnecting PTGD drainage tubecontinued follow-up of patients, according to the patient’s condition after the removal ofdrainage tube1to2months to the First Affiliated Hospital of Shihezi University, laparoscopiccholecystectomy, and detailed records before surgery, surgery, post-operative patient’scondition changes.Results：PTGD were performed on all104patients successfully. In all the patients, afterdrainage the abdominal pain was relieved within0.5to8hours and mean time was（2.3±1.9）h. The temperature decreased to normal in1days after drainage. The time of drainage wasfrom7to49days,(22.4±10.3)days on average.13patients＇tubes were accidentally offduring between3to12days,5patients were performed PTGD again, and8patients weregiven anti-infection, fluid infusion and other symptomatic treatments and all these patientswere back to normal in time. Re-intubation rate was4.8%. In78patients laparoscopiccholecystectomy (LC) were performed1to2months after PTGD. Operation time wasbetween35to95min and mean time was(52.7±15.0）min. There were6patients done openoperation and the conservation rate was7.7%.A mount of blood during LC was30to150ml,（61.7±31.0）ml on average. No operative deaths occurred during therapeutic session.Indications for extubation were as follows.1st,time of drainage should not less than7days.2nd, abdominal pain, fever and jaundice were all relieved and returned tonormal.3rd,drainage of gallbladder became clean.4th,the results of bacterial culture of bilewas negative.5th,the thickness of gallbladder wall was no more than5mm, and gallbladderwas constricted than before.6th,peripheral white blood cells,peripheral blood neutrophils,serum alanine aminotransferase and serum total bilirubin were all turned to normal.1to4points in the mentioned before were imperative indications and the another fifth and sixthpoints were relative indications.Conclusions：LC following PTGD would be a safe and minimally invasive option for patients with severe AC. Patients who formed PTGD obey these indications can extubate intime and reduce retrograde infection and skin irritation, also shorten the time during hospitaland have a positive impact about LC.