Analysis On Open Cholecystectomy And Transumbilical Single-port Laparocopic Cholecystectomy Following PTGD In The Elderly Patients With Acute Cholecystitis For 70 Cases

Objective: To compare the therapeutic effectiveness between the emergency open cholecystectomy(OC) and the transumbilical single-port laparocopic cholecystectomy(TUSPLC) following percutaneous transhepatic gallbladder drainage(PTGD) in treatment of elderly patients with acute cholecystitis(AC), investigate the TUSPLC operation significance improvements and feadibility of minimally invasive surgery.Methods: Retrospective analysis of 70 cases of elderly patients with AC, the Department of general surgery 210 Hospital of PLA from January 2012- January 2015. According to clinical manifestations, physical examination, laboratory examination and imaging examination on admission, respectively take emergency OC,TUSPLC following PTGD. Emergency OC in 37 cases, as A group, including 15 cases of male, 22 cases female;TUSPLC following PTGD in 33 cases, as B group, including 14 cases of male, female 19 cases. No significant difference between the two groups of patients in general and Department of internal medicine basic disease complications(P> 0.05). The two groups of patients were observed and compared in terms of operation time, intraoperative bleeding volume, postoperative hospitalization time, complications rate and related indexes.Results: Two groups of patients with different operation methods, Comparing TUSPLC following PTGD with conventional OC, related indexes in the operation time, intraoperative bleeding volume, postoperative hospitalization time, incidence of complications, were obviously reduced.Operation timeA group(n=37):109.32±6.48 minutes, B group(n=33): 83.97±6.72 minutes,A group, operation time was significantly longer than the B group.The difference between Emergency OC and TUSPLC following PTGD was statistically significant(P < 0.05).The bleeding volume in operationthe group A(n=37): 251.62±100.93 ml, B group(n=33): 32.73±11.05 ml,The amount of bleeding in operation of patients in group A were more than those in group B.The difference between Emergency OC and TUSPLC following PTGD was statistically significant(P< 0.05).Hospitalization time after operationgroup A(n=37): 9.15±1.76 days,(one of the patients was in ICU after operation, leading to the longest hospitalization time up to 15 days),B group(n=33):5.76±1.20 days,the postoperative hospitalization time of the patients in A group was significantly longer than the group B. The difference between Emergency OC and TUSPLC following PTGD was statistically significant(P< 0.05).Postoperative complications: there were 7cases in group A,the bile fistula rate was 5.41%(2/37), the incidence of postoperative wound infection in 13.51%(5/37),there was 1case in group B,wound infection rate was 3%(1/33),without biliary fistula and bile duct injury.Patients in group A, the incidence rate of complications was significantly higher than group B.The difference between Emergency OC and TUSPLC following PTGD was statistically significant(P< 0.05).Conclusion:(1)The treatment ofTUSPLCfollowing PTGD in elderly patients with AC can significantly reduce the operation time, intraoperative bleeding volume, postoperative hospitalization time and postoperative complications.(2)Operation treatment of aged patients with AC preferably TUSPLC following PTGD.