Percutaneous Transhepatic Gallbladder Drainage Applied To Very Old Patients With Acute Calculous Cholecystitis

Objective:Evaluate the value of percutaneous transhepatic gallbladder drainage in the treatment of very old patients with acute calculous cholecystitis.Methods:Retrospectively analyze clinical data of very old patients(?80 years old)with acute calculous cholecystitis in the Second Hospital of Jilin University and China-Japan Union Hospital of Jilin University from January 2013 to May 2018.Divide them into two groups according to different treatments,LC+PTGD group for elective laparoscopic cholecystectomy after ultrasound guided gallbladder drainage,LC group for directly laparoscopic cholecystectomy.General clinical data(sex,age,time from presentation,etc.)of two groups has no statistically significant difference.Compare the two groups in changes of body temperature and white blood cell count,MEWS score,ASA risk,intraoperative conditions(operative time,intraoperative blood loss,number of conversion to laparotomy),incidence of complications and postoperative conditions(days of abdominal drainage,postoperative days of exhaust,postoperative hospitalization time,total hospitalization days).T test was used for the measurement data,in terms of mean±standard deviation.c~2 test was used for enumeration data.Taking P<0.05 for the difference was statistically significant.Results:(1)Body temperature and white blood cell count after PTGD of PTGD+LC group and after LC of LC group were both lower than those before the operation(P<0.05).There was no significant difference in body temperature and white blood cell count between after PTGD in PTGD+LC group and after LC in LC group(P>0.05).(2)On admission,MEWS score of PTGD+LC group(3.52±1.31)was higher than that of LC group(2.82±1.04),P<0.05.The MEWS score of PTGD+LC group at 24 h after puncture(1.92±1.51)was significantly lower than that before surgery,P<0.05.Preoperative ASA risk of PTGD+LC group(2.39±0.5)was lower than that of LC group(2.79±0.55),P<0.05.(3)Comparison of intraoperative conditions between the two groups showed no statistically significant difference in the operation time(78.00±21.47 min,75.33±28.10 min),intraoperative blood loss(36.83±11.34 ml,36.91±11.30 ml)and the number of conversion to laparotomy(2,3)(P>0.05).(4)The incidence of complications in PTGD+LC group was lower than that in LC group,but the difference was not statistically significant.(5)As for postoperative situations comparison,abdominal drainage days(3.65±1.15 d,4.76±1.23 d),postoperative exhaust days(2.78±0.80 d,3.70±0.59 d)of PTGD+LC group are lower than those of LC group.The total length of stay in PTGD+LC group(11.74±3.39 d,9.21±2.06 d)was longer than that in LC group.Postoperative hospitalization time(8.22±2.58 d,7.73±1.89 d)and postoperative death(1,1)showed no significant difference between the two groups(P>0.05).Conclusions:PTGD can effectively control the inflammatory response and relieve symptoms of acute cholecystitis.PTGD bring with lower ASA risks for patients with higher MEWS scores and reduces anesthesia risk.Compared with direct LC,PTGD sequential LC treatment can shorten the period of abdominal drainage and postoperative exhaust days,but also prolongs the total hospital stay.In terms of operation time,intraoperative blood loss,postoperative hospitalization time,cases of conversion to laparotomy,incidence of complications,and postoperative mortality,thetwomethodsshowthesameperformance.Therefore,PTGD sequential LC in treatment of elderly patients with ACC can reduce the risk of anesthesia and accelerate the recovery of gastrointestinal function.