| Objective: Research by group comparison to observe the effect of Percutaneous Transhepatic Gallbladder Drainage(PTGD)in the treatment of Grade II acute calculous cholecystitis(ACC)and effect of PTGD on Laparoscopic Cholecystectomy(LC),evaluation of the effectiveness of PTGD in the treatment of Grade II ACC over 72 h.Methods: To retrospectively analyze the clinical data of Grade II ACC patients who were admitted to the Department of Hepatobiliary Surgery,Chengdu Military General Hospital from August 2016 to December 2017 whose onset time exceeded 72 h.According to the inclusion criteria and discharge criteria of this study,the clinical data of 106 patients were selected.According to the different treatment method,patients were divided into 3 groups,group 1: emergency LC treatment(n=40),group 2: patients who underwent LC treatment within 1-2 months after conservative treatment(n=30),and group 3:patients who underwent LC therapy within 1-2 months after PTGD(n=36).By comparing the duration of abdominal pain and the time of antibiotic use in group 2 and group 3,the white blood cell count and the percentage of neutrophils before and after PTGD in group 3 patients to observe the efficacy of PTGD;The efficacy of PTGD in the treatment of Grade II ACC with a course of more than 72 hours was observed by comparing the number of patients who underwent conversion,operative time,intraoperative blood loss,complication rate,and length of hospital stay in group 1 and group 3.The data were analyzed by SPSS 22.0 statistical software,P<0.05 was considered statistically significant.Results:(1)The duration of abdominal pain(0.8±0.3 h vs 2.5±1.39 h)and the duration of antibiotic use(3.3±0.66 h vs 7.2±2.3 h)were significantly shorter in group 3 patients than in group 2,and the difference was statistically significant.(P<0.001);(2)after PTGD the white blood cell count,the percentage of neutrophils of the patients in group 3 was significantly lower,and the data before and after the PTGD were statistically different(P<0.001);(3)comparison of emergency LC with elective LC,the number of cases who underwent conversion(2 cases vs 1 case vs 10 cases),operation time(56.5±9.1 min vs 55.1±6.5 min vs 92.1±9.2 min),intraoperative blood loss(22.8±15.7 ml vs 21.9±13.9 ml vs 43.2±33.9 ml)and hospital stay(2.3±0.5 d vs 2.3±0.7 d vs 5.1±0.7 d),both Group 2 and Group 3 were lower than Group 1(P<0.05);complication rate(0.0% vs 20.0%),group 3 was significantly lower than group 1(P<0.05);(4)there were no significant differences in group 2 and group 3 between conversion,operative time,intraoperative blood loss,hospital stay,complication rate,and hospitalization cost(P>0.05),but it was visible during surgery,the majority of group 3 patients had lower gallbladder wall thickness and triangular adhesion than group 2 patients.Conclusion: In summary,our study suggests that for patients with Grade II ACC with an onset time of more than 72 h,the gallbladder triangle may be severely adhered due to gallbladder inflammation and gallbladder effusion,which is not suitable for emergency LC.PTGD can reduce gallbladder decompression through external drainage,relieve the tension of gallbladder,reduce the absorption of toxins,improve inflammatory symptoms,and create favorable conditions for elective LC.Selective LC after PTGD can not only reduce LC conversion rate,reduce intraoperative blood loss,shorten operation time and postoperative hospital stay,but also reduce the incidence of surgery-related complications and improve the quality of life of patients.Moreover,the PTGD technique in this study did not increase the additional hospitalization costs.Therefore,PTGD has a high clinical value for Grade II ACC patients with an onset time of more than 72 h. |
PDF Full Text Request