Percutaneous Transhepatic Gallbladder Drainage For Treatment Of Acute Cholecystitis In High-risk Clinical Analysis And Follow-up

Objective: To evaluate the safety,efficacy and clinical status of percutaneous transhepatic gallbladder drainage (PTGD) treatment of high-risk acute cholecystitis,to discussion the feasibility and related factors of it as a radical treatment of high-risk acute cholecystitis.Methods: A retrospective analysis in January 2006 - January 2010 in PTGD line in our hospital were followed up with complete information on the treatment of 76 cases of high-risk acute cholecystitis in patients with clinical data,through the success rate of surgery,perioperative mortality, preoperative and postoperative laboratory analysis to determine the comparison between PTGD the safety and effectiveness of drainage;to investigate the feasibility of PTGD as a means of radical treatment of the high-risk acute cholecystitis through a simple analysis of the patients were followed up and analysis the risk factors of further recurrence after PTGD through logistic regression.Results: 76 patients underwent PTGD,the success rate was 100% (76 / 76),does not appear with the puncture-related bleeding,bile leakage,catheter slippage and other complications.5 / 76 patients died during hospitalization after operation,1 patient death of peritonitis caused by postoperative drain off after laparotomy,the other 4 patients died of multiple organ failure caused by primary disease progression,no direct relation with the intervention operation.Long-term follow-up of 71 cases, 17 patients after 1-3 months accepted the second phase routine cholecystectomy (laparotomy or laparoscopy);15 patients after PTGD can not be extubated or accepted cholecystectomy because of recurrent cholecystitis;39 patients without cholecystectomy and no recurrence of the performance of cholecystitis.Logistic regression analysis showed that the only risk factors of the ecurrence affect PTGD is cystic duct stones.Conclusion: Percutaneous transhepatic gallbladder drainage is a safe and effective treatment adaptable for patient with high-risk acute cholecystitis,some patients can achieve the purpose of replacement surgery,cystic duct stones is a risk factor for recurrence after PTGD.