| Background: Acute cholecystitis is a common clinical emergency in the abdomeninal surgery.With the improvement of living standards,the incidence of cholecystitis increases,as well as the aging of our population,making the elderly patients(over the age of 60)also showed an upward trend.Elderly patients often have more underlying diseases,early clinical symptoms are not obvious,physical and chemical tests are not sensitive,prone to perforation,gangrene and other adverse events.Emergency laparoscopic cholecystectomy(LC)has a higher surgical risk,with a higher incidence of complications and conversion to laparotomy.In the acute phase,critically ill elderly patients should not operate with LC,and the percutaneous transhepatic gallbladder drainage(PTGD)is a safer alternative to surgery.According to the latest Tokyo guidelines(TG18),diagnostic flow chart of acute cholecystitis,PTGD could effectively reduce the mortality rate in the acute phase,until the inflammatory control and then elective LC.However,the Tokyo Guideline(TG18)did not elucidate the best timing for cholecystectomy in patients with acute cholecystitis after PTGD.No randomized controlled trials have been conducted to address this issue.Objective: To investigate the timing of operation for LC in patients with senile acute cholecystitis in our hospital after PTGD and the effect of Qingrelidan granules.Methods: The clinical data of 96 elderly patients(≥60 years old)with acute cholecystitis admitted from January 2010 to December 2017 in the First Affiliated Hospital of Dalian Medical University Medical University were collected.The general clinical data,blood routine and body temperature before and after PTGD in patients were analyzed and compared,and the time(in month unit)between PTGD and LC surgery was compared.The differences of the general information and operation time,intraoperative blood loss,postoperative hospital stay,gallbladder wall thickness and other indicators between each group were observed.At the same time,the thickness of gallbladder wall before PTGD and preoperative LC were detected by B-type ultrasonography,and the effect of B-mode ultrasonography on the operation time,intraoperative blood loss and postoperative hospital stay was analyzed.At the same time,the thickness of gallbladder wall before PTGD and preoperative LC were detected by Bmode ultrasonography,and the effect of B-ultrasonography on the operation time,intraoperative blood loss and postoperative hospital stay was analyzed.In addition,the effect of oral administration of Qingrelidan granules on LC during postoperative PTGD to LC surgery also was observed.Results: A total of 96 elderly patients with acute cholecystitis were collected,including 49 males and 47 females,the odds ratio was 1.04 :1,with an average age of 71.9 ± 7.5 years.The temperature of 72 hours after PTGD in elderly patients with acute cholecystitis was significantly lower than that before operation(P<0.01),and the leukocyte count was significantly decreased at 72 hours after operation(P<0.01).The percentage of neutrophils at 72 hours after operation was significantly higher than that before operation Decreased(P<0.01).In terms of timing of LC surgery,bleeding in patients who underwent LC more than 1 month after PTGD was significantly increased than less 1 month after PTGD(P<0.05),and there were no significant difference in operation time,gallbladder wall thickness and postoperative hospital days have(P> 0.05).There was no significant difference in bleeding time,operation time,gallbladder wall thickness between more than two months after cholecystectomy and patients undergoing PTGD and ≤2 months(P> 0.05),the length of hospital stay in patients,after PTGD > 2 months then LC were significantly longer than ≤2 months(P<0.05).Compared with bleeding,duration of surgery,gallbladder wall thickness and postoperative hospital days,there were no significant differences betwen the patients undergoing LC after PTGD ≤3 months and the patients after PTGD >3 months,≤4 months and >4 months,≤5 months and >5 months(P>0.05).The effect of gallbladder wall thickness after PTGD on LC : The operative time of LC in patients the gallbladder wall was less than 4mm was significantly shorter than more than > 4mm(P<0.05),and there was no significant difference in the amount of bleeding and hospital stay after LC(P>0.05).The operation time of LC in patients the gallbladder wall was less than or equal to 6mm was significantly shorter than the gallbladder wall was more than 6mm(P<0.05),and there was no significant difference in the amount of LC bleeding and postoperative hospital stay(P>0.05).There was no significant difference in the amount of bleeding in LC,operation time and hospital stay after operation between the gallbladder wall thickness ≤8mm and >8mm(P>0.05).Compared with the control group,the LC operation time and postoperative hospital stay in TCM group were significantly shorter than those in control group(P<0.05),the amount of LC bleeding was significantly decreased(P<0.05),and the thickness of gallbladder wall was not significantly different(P>0.05).Conclusions:(1)In patients with high-risk senile acute cholecystitis who are not eligible for LC in acute stage,PTGD could quickly relieve the infection index and reduce the body temperature,white blood cell count and neutrophil percentage.(2)For elderly patients with acute cholecystitis within 1 month after PTGD,LC can reduce the amount of intraoperative bleeding in line with LC could shorten the length of stay in hospital days.Gallbladder wall thickness ≤ 4mm could reduce the operation time.(3)After PTGD in Acute cholecystitis patient,Qingrelidan granules,coud shorten the LC operation time、intraoperative bleeding and hospital stay,it should be worth recommending clinically. |
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