To Explore The Application Of Ptgd In The Treatment Of Acute Cholecystitis In The High-risk Elderly Patients

Objective: The purpose of this paper is to retrospectively analyze the clinical data of 38 cases of elderly patients with acute cholecystitis who underwent percutaneous transhepatic gallbladder drainage.The clinical data of preoperative and postoperative changes,including abdominal pain relief,the highest body temperature,white blood cell count,total bilirubin,γ-glutamyl transferase,alanine aminotransferase changes in the statistical analysis,so as to provide new ideas for the treatment of high-risk elderly patients with acute cholecystitis.Data: A retrospective analysis was performed on the complete clinical data of 38 elderly patients with high-risk acute cholecystitis who underwent percutaneous transhepatic gallbladder drainage from January2013 to December 2017.Among them,there were 17 males and 21 females,aged 68 to 97,median age: 77.5.Acute cholecystitis disease has the characteristics of pathological changes rapidly,38 cases of clinical manifestations of acute upper abdominal pain,nausea,vomiting,fever,leukocytosis and other symptoms,physical examination in 38 patients had right upper epigastric tenderness,rebound tenderness;Of the 35 cases,Murphy was positive,and two of the 35 patients had access to the enlarged gallbladder.In the 38 patients after admission,the biliary and pancreatic splenic B ultrasonography was observed,swollen gallbladder(≥8cm)was observed,and sediment samples was seen in the gallbladder cavity with thickened gallbladder wall(≥4mm).Gallbladder stones in 36 cases,including gallstone neck incarcerated in 28 cases.At the same time,some basic diseases were merged,including 11 cases of diabetes history,18 cases of hypertension history,10 cases of cerebral infarction sequelae,13 cases of chronic obstructive pulmonary disease,8 cases of arrhythmia history,12 cases of coronary heart disease history,liver dysfunction 28 cases.Methods: The data were analyzed using statistical software SPSS21.0,the measurement data obey the normal distribution with ?X±S,comparing the changes of index before and after operation,analyze the causes of postoperative complications and treatment measures.Results: 38 patients were successfully catheterized once,and the patient had a 24-hour abdominal pain relief rate of 89.5%,and the abdominal pain was reduced by 100% for 72 hours.The biochemical indexes and the maximum body temperature were significantly reduced in the third day after surgery(P<0.05).30 cases(78.9%)of LC were performed between 4~8 weeks after PTGD,among which 3 cases(10%)were converted to laparotomy due to gallbladder exposure difficulty or severe adhesion of gallbladder triangle.2 patients were discharged due to poor physical quality and severe complications,relieved symptoms of abdominal pain,and their relatives gave up surgery.The patients were discharged with drainage tubes at 6 weeks and 8 weeks after the puncture respectively in the local hospital.6 patients improved condition and were discharged from the hospital with drainage tube removal 2~3 weeks after puncture.After surgery,4 patients(10.5%)had postoperative,including 1case of gallbladder hemorrhage,2 cases of drainage tube shedding and 1case of biliary leakage.Bile bacteria culture,bacteria were cultured in 25cases(65.8%).The main pathogenic bacteria causing acute cholecystitis were Escherichia coli in 14 cases(56.0%),Klebsiella pneumoniae in 5cases(20.0%),Staphylococcus epidermidis(12.0%),2 cases of Freund’s lemon coli(2.0%)and 1 case of Proteus mirabilis(4.0%).Elderly patients with biliary tract infections are mainly bacteria Gram-negative bacteria,the third generation of cephalosporins,sulbactam combined antibioticsand aminoglycoside antibiotics high sensitivity.Conclusion: Percutaneous transhepatic gallbladder drainage can excrete infectious bile,relieve the symptoms of poisoning and reduce the incidence of mortality and postoperative complications in elderly patients,as well as provide a good opportunity for elective surgery,it can become a safe and effective clinical treatment for high-risk elderly patients with acute cholecystitis.