The Clinical Analysis Of The Timing For Elective Laparoscopic Cholecystectomy After The Percutaneous Transhepatic Gallbladder Drainage On The Elder Patients With Acute Severe Cholecystitis

Objective:Analysis the timing for elective laparoscopic cholecystectomy after the percutaneous transhepatic gallbladder drainage(PTGD)on the elder patients with acute severe cholecystitis.Methods:Retrospectively analysis 70 cases of elder patients with acute severe cholecystitis from January 2013 to June 2017.the PTGD was given firstly because of being unable to tolerate the risk of surgery and anesthesia,then the LC was done.According to the interval of PTGD and LC time,70 cases are divided into three groups:group A(n = 24)LC was done 2 months after PTGD;group B(n = 25)LC was done during 2-4 months after PTGD;group C(n = 21)LC was done 4 months after PTGD.The preoperative gallbladder wall thickness,intraoperative blood loss,postoperative hospitalization days,postoperative complications,postoperative pathological type,operative time and the rate of transfer were compared and analysed in order to provide the optimal timing of LC.Results:(1)All of the 70 patients had successful PTGD,and the success rate was 100%.No biliary fistula,bleeding,pneumothorax,colonic perforation,catheter shedding,secondary infection and other related complications occurred.(2)After PTGD,symptoms and signs of 24-72 h patients were significantly relieved.According to the variance analysis of repeated measures,the patients’ temperature,white blood cell count,neutrophils percentage,AST,ALT and TBIL showed significant improvement over time after surgery(Ftime was 20.668,120.877,121.243,25.050,20.688,32.622,P <0.001).A,B,C three groups of preoperative gallbladder wall thickness,operation time,intraoperative blood loss,postoperative hospitalization days,the rate of transfer laparotomy,A statistically significant difference were observed in the incidence of postoperative complications(H value were20.359,28.897,35.022,44.104,χ2value were 7.600,8.465,P values respectively,P< 0.001,P < 0.001,P < 0.001,P < 0.001,P = 0.022,P = 0.015).With B and C group of patients with preoperative gallbladder wall thickness,operation time,intraoperative blood loss,postoperative hospitalization days were lower than group A,differences were statistically significant(P<0.05),group B postoperative complications,postoperative hospitalization days,operation time significantly less than group C(P < 0.05).Conclusion:(1)PTGD is a safe and effective treatment method for elder Patients with acute severe cholecystitis,it makes the risk emergency surgery into secure elective surgery.(2)2-4 months after PTGD is the o Ptimal timing for LC on the elder Patients with acute severe cholicystitis.