| ObjectiveThe elderly patients are high-risk group of acute cholecystitis.Low immunity or delay in time of treatment often leads to severe infection and abdominal adhesion.Parts of them usually suffer from poor physical condition and have a large number of basic diseases,so some high-risk patients often cannot accept acute operation.During the attack,the rapid and effective removal of gallbladder edema and the alleviation of infection symptoms are the primary treatment targets for such high-risk patients.In recent years,PTGD in the treatment of acute cholecystitis in elderly patients with high risk are more widely application,this research through to observe the therapeutic effect of PTGD and its effect on elective surgery by grouping comparison,we can analyze the application and value of PTGD among aged and high-risk people.MethodsThe study covers 189 patients with acute cholecystitis treated by general surgery of affiliated hospital of Yangzhou university from March 2016 to March 2018.And 78 patients who were eligible for the screening criteria were selected.According to different treatments in acute term,these cases are divided into two groups.One group accepts PTGD treatment,and the other one each group accepts anti-infection conventional treatment.randomly selected 30 people,respectively for the experimental group and the control group.Compared the time of abdominal pain duration,the time of backing to normal body temperature,and the time for antibiotic usage after the patients were admitted to the hospital first time for treatment.And also compare the number of white blood cell,index of transaminase and total bilirubin between 48h and 72h after admission.And compare the operation time,amount of bleeding in selective LC,total expense of the two operations and complication rate.Results are analyzed by SPSS20.0 medical statistical software,and P<0.05 was considered to be statistically significant.ResultsAbdominal pain duration of patients in group experiment(21.10±3.99 h)is obviously shorter than that of group control(32.50±6.52 h).Time for temperature recovery in group experiment(13.37±3.78 h)is apparently shortened when compared with group control(28.70±9.27 h),White blood cell number of group experiment(8.34±1.80*109/L)48 hours after admitted is smaller than that of patients in group control(19.45±5.17 mmol/L).Alanine aminotransferase and glutamate transaminase index in group experiment(87.50±30.72 U/L,90.57±30.84 U/L)are lower than those of patients in group control(110.33±25.81 U/L,119.93±29.67 U/L).Total bilirubin index in group experiment(15.24±4.43 mmol/L)is lower than that of patient in group control(19.45±5.17 mmol/L).the time for antibiotic usage in group experiment(3.82±0.83 d)is less than that in group control(6.88±1.24 d).All these result are statistically significant(P<0.05).All the patients should be treat by LC after 1?3 months in our hospital.In operation we observed the situation of gallbladder edema and calot triangle adhesion in group experiment is better that group control.But there are no obvious differences between two groups in terms of operation time and amount of bleeding.And there is no obvious difference in terms of expense.The result is statistically meaningless.ConclusionThe study indicates for those high-risk elderly patients who cannot accept operation in acute term,PTGD can reduce the pressure in the gallbladder,control the development of inflammation,relieve symptoms of infection abdominal pain and fever quickly and effectively.PTGD can reduce the risk of serious complications complications such as gallbladder perforation and septic shock.PTGD can accelerate the decrease of transaminase,protect liver,and create certain conditions for elective surgery.And there is no apparent difference in terms of total expense.Patients can get quick and effective treatments with no extra expense.To sum up,PTGD could solve problems in clinical practice.It is worth applying and promoting. |
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