One Step Percutaneous Transhepatic Gallbladder Drainage In The Treatment Of Acute Cholecystitis In High-Risk Elderly Patients

Objective:To determine the role of ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGD)in elderly patients of acute cholecystitis by analyzing the clinical manifestations and treatment process of high-risk elderly patients with acute cholecystitis.Materials and methods: 87 high-risk elderly patients with acute cholecystitis treated in Department of hepatobiliary surgery of Shangdong Provincial Hospital from January 2010 to December 2015 were analysed restrospectively,45 cases were males and 42 case were females,aged 60~94 years,with an average of 71.2 years.All cases were treated by PTGD.After the patients’ clinical symptoms were relieved,the definite treatments include cholecystectomy were considered according to the patients’ physical station.Through summarizing the clinical characteristics,treatment methods and prognosis of patients and comparing the preoperative and postoperative laboratory analysis to determine the role of percutaneous transhepatic gallbladder drainage in the treatment of high-risk elderly patients with acute cholecystitis.Results:87 high-risk elderly patients with acute cholecystitis were treated with PTGD,and all of them were performed successfully.On 1-2 days after PTGD,the clinical manifestations of patients including fever,nausea and vomiting,abdominal pain,abdominal local tenderness and Murphy sign were relieved obviously.On 2-5 days after PTGD,leukocyte count,neutrophils ratio,C-reactive protein and total bilirubin were significantly decreased(using paired t test,P < 0.05 showed significant statistical difference),but there were no significant difference between ALT and AST(P > 0.05).After the symptoms were relieved,84 patients were treated with cholecystectomy and partial hepatectomy or cholangiolithotomy.3 cases with noncalculous cholecystitis were treated by removing the drainage tube after the symptoms were relieved.After PTGD,there were happened 5 cases of drainage tube obstruction,3 cases of drainage tube dislocation and 2 cases of drainage tube bleeding.The drainage tube was replaced timely and was not blocked and offed for the cases of drainage tube obstruction and dislocation.the patients were treated with bed rest and proper use of hemostatic drugs for the cases of drainage tube bleeding.After the elective operation,1 patient died of severe pulmonary infection.3 cases of bile leakage,8 cases of incisional infection and 1 case of incision bleeding were cured by conservative treatment.The rest patients recovered smoothly.Conclusion:For high-risk elderly patients with acute cholecystitis,if their physical conditions were not suitable for emergency cholecystectomy,PTGD can be performed first,and then surgical treatment was performed after the clinical symptoms were relieved.PTGD is a minimally invasive method of treatment,which is simple,safe and effective.It is especially suitable for the high-risk elderly patients of acute cholecystitis with ineffectiveness of conservative medical treatment.