Clinical Analysis Of Laparoscopic Cholecystectomy In The Treatment Of Acute High-risk Sappurative Cholecystitis After Percutaneous Transhepatic Gallbladder Drainage

Objective:To investigate the effects and potential advantages on percutaneous transhepatic gallbladder drainage (PTGD) and the opportune moment of laparoscopic cholecy stectomy (LC) in the treatment of acute severe cholecyctitis.Methods:Clinical data of 78 patients with acute high-risk sappurative cholecystitis and percutaneous transhepatic gallbladder drainage (PTGD) who hospitalized in the Gastrointestinal Surgery Departmentt of Second Affiliated Hospital of Kunming Medical University from Jun 2013 to Sep 2014 were retrospectively analyzed. Abdominal signs, white blood cells(WBC) and liver function among before PTGD, 3th day after PTGD and 7th day after PTGD were compared and all patients’ discharged after clinical symptoms relieved. All patients returned to hospital and underwent LC in 30-59 days after PTGD,60-89 days after PTGD and 90 days after PTGD respectively and the amount of bleeding, operation time, postoperative hospitalization time and rate of conversion to laparotomy were analyzed.Results:PTGD was performed successfully for all patients and abdominal pain were relieved after the puncture of 24 hours without complications such as biliary fistula,bleeding and others. WBC, alanine aminotransferase(ALT) and aspartate aminotransferase(AST) significantly decreased in 3th day after PTGD and 7th day after PTGD compared with before PTGD (P<0.05), but Serum albumin (ALB) obviously rose (P<0.05), and there was no statistical significance between 3th day after PTGD and 7th day after PTGD (P>0.05). The amount of bleeding, operation time and postoperative hospitalization time were more in 30-59 days after PTGD compared with in 60-89 days after PTGD and 90 days after PTGD (P< 0.05), but there was no statistical significance between in 60-89 days after PTGD and 90 days after PTGD (P>0.05).Finally, All patient had no severe complication or died and discharged after LC.Conclusions:The high-risk patients with acute suppurative cholecystitis treated and PTGD can quickly relieve the symptoms, avoid emergency operation and the risk of anesthesia. The best opportune moment to implement LC after PTGD was 60-89 days after PTGD. During this period, the amount of bleeding of LC, operation time, postoperative hospitalization time and rate of conversion to laparotomy were less.