Timing Of Percutaneous Transhepatic Gallbladder Drainage Combined With Laparoscopic Cholecystectomy Affects Therapeutic Effect For Acute Cholecystitis

Objectives:Acute cholecystitis(AC)is one of the most common acute abdomen in clinical practice.The cause is acute inflammation of gallbladder caused by stones,parasites and bacterial infections.At present,the main surgical treatment methods for AC are: laparoscopic cholecystectomy(LC)and percutaneous transhepatic gallbladder drainage(PTGBD).According to statistics,among patients with other underlying diseases,patients with acute calculous cholecystitis have an LC mortality rate of 19% in emergency department and 30% in acute acalculous cholecystitis.And the incidence of complications and mortality of patients with advanced LC were higher.However,if only conservative treatment of antibiotics is selected,it is reported in the literature that the recurrence rate of AC within 92 days is as high as 92%.In recent years,with the development of minimally invasive interventional techniques,the efficacy of PTGBD in the treatment of acute cholecystitis has been widely recognized.PTGGD can quickly alleviate the symptoms of patients with acute cholecystitis,reduce the incidence of complications,reduce the mortality rate of patients,and improve the survival of patients.quality.PTGBD can effectively reduce the pressure in the gallbladder,drain the pus,and control the biliary infection,thus avoiding the risk of emergency surgery for AC patients.However,due to the high recurrence rate of AC after PTGBD,for most patients with AC,LC is an ideal choice after PTGBD.Post-surgical treatment of PTGBD is a treatment plan proposed in recent years.PTGGD effectively reduces the inflammation of the tissues around the gallbladder and reduces the rate of conversion to laparotomy of LC.It also provides doctors with time to diagnose the underlying diseases of patients.Therefore,this study was designed to investigate the effect of timing of sequential treatment of percutaneous transhepatic gallbladder drainage(PTGBD)combined with laparoscopic cholecystectomy(LC)in patients with acute cholecystitis(AC).Methods:1.Clinical dataPatient source: clinical data of 582 AC patients admitted to hepatobiliary surgery department of affiliated hospital of chengde medical college from December 2010 to December 2018 were selected.Patients were divided into early AC and late AC according to the time from AC onset to surgery(?7 d/ > 7 d).A total of 115 patients with early AC and 115 patients with late AC were selected by propensity score matching.Grouping scheme: the patients were divided into the initial LC group(direct LC)and the initial sequential treatment group(LC after PTGBD treatment)according to different treatment methods.Late LC group(direct LC)and late sequential treatment group(LC after PTGBD treatment).2.Date:(1)patients' first admission information was collected,including age,gender,ultrasound examination of gallbladder thickness,gamagglutinin transferase(gam-gt),white blood cell(WBC)count,prothrombin time(PT),ASA grade,and previous medical history.(2)evaluation of relevant indicators of different treatment methods,including intraoperative blood loss in LC,operative time,conversion rate to laparotomy,postoperative complications,total length of stay,and total hospital expenses.3.Treatment methods: all AC patients were treated with general supportive therapy(antibiotics,fasting,oxygen monitoring,intravenous fluid rehydration)and analgesic drugs when necessary.All AC patients in the initial and late sequential treatment group received PTGBD after admission and were given supportive treatment,and LC was given within 1 to 3 months after the remission of symptoms and basic diseases.4.Statistical methods: SPSS 22.0 software was used for statistical analysis.Propensity score matching method(PSM)was used to carry out 1:1 matching and balance the confounding factors between groups.T test was used for comparison of measurement data between groups,and X2 test or Fisher exact probability test was used for enumeration data.Bilateral alpha =0.05 was taken as the test level,and P < 0.05 was considered statistically significant.Results:1.Comparison of patients before and after matched baseline data of AC patients is shown in table 1?4.Before matching,there were statistically significant differences in age and ASA classification between groups of AC patients at the initial stage(P < 0.00).There were statistical differences in age and cerebrovascular history between groups of AC patients in later stage(P < 0.00).After adopting the propensity score(PSM)method,the sequential treatment group was used as the benchmark,and the matching ratio was LC group: the sequential treatment group = 1:1.The matching results were 62 pairs of AC patients in the initial stage and 53 pairs of AC patients in the later stage.No statistical significance was found in the above variables after matching(P > 0.05).In the early and late sequential treatment group,230 AC patients successfully completed PTGBD.After treatment,the symptoms of acute cholecystitis were significantly relieved,and no recurrence occurred during hospitalization.There were no postoperative complications such as catheter shedding,no bleeding,and no emergency surgical cases.All patients had their gallbladder drainage tube removed within 1 month.2.Compared with the initial sequential treatment group,the initial LC group had less intraoperative bleeding and lower hospitalization costs(all P < 0.05),while the difference in operative time,postoperative complications and conversion rate was not statistically significant(P>0.05).Compared with the late-stage sequential treatment group,the late-stage LC group had more intraoperative bleeding,longer operative time,and lower hospitalization costs(all P < 0.05).There was no statistically significant difference in conversion rate to laparotomy and postoperative complications(P > 0.05).One patient in the initial sequential treatment group had pulmonary infection after LC operation.There was 1 case of bile leakage and 1 case of atrial fibrillation in the late LC group after surgery.One case of pulmonary infection occurred after LC operation in the later sequential treatment group.Two cases of pulmonary infection were cured after effective antibacterial treatment.One case of atrial fibrillation was cured by antiarrhythmic drugs.Biliary leakage was cured after 2 weeks of effective drainage.No postoperative complications occurred in the initial-LC group.Conclusions:For patients with AC from onset to surgery ? 7 days,LC is better than PTGBD combined with LC sequential therapy.For AC patients with onset to 7 days after surgery,PTGGD combined with LC sequential therapy is safer.feasible.