Clinical Study On The Timing Of LC Treatment Of Advanced Acute Cholecystitis After PTGBD

Objectives To explore the timing of laparoscopic cholecystectomy(LC)after percutaneous transhepatic gallbladder drainage(PTGBD)for the treatment of advanced acute cholecystitis(AC),to provide clinical reference.Methods A multi-center prospective randomized controlled study was adopted.From July 2018 to February 2020,120 patients with advanced AC who received PTGBD treatment and elective LC in four hospitals were selected as the research objects,including Tangshan Workers’ Hospital(tertiary),Qian’an people’s Hospital(secondary),Tangshan Hongci Hospital(secondary),and Tangshan Central Hospital(tertiary).According to the computer random number table method,they were randomly divided into two groups.The experimental group(60 cases)underwent LC early after PTGBD(7 days after PTGBD),and the control group(60 cases)underwent delayed LC after PTGBD(1 month after PTGBD).The LC surgery status,postoperative recovery were statistically compared,as well as the peripheral blood white blood cell count(WBC),serum procalcitonin(PCT),alanine aminotransferase(ALT),aspartate aminotransferase(AST)1 day before LC,1 day,3 days,and 7 days after operation,the Visual Analogue Scale(VAS)scores and Acute Physiology and Chronic Health Evaluation II(APACHE)scores between the two groups.And the incidence of complications between the two groups was statistically compared.Results 1 Surgery status of the two groups: the conversion rate of the experimental group was 11.67%(7/60)and that of the control group was 3.33%(2/60).There was no statistically significant difference(P>0.05).The blood loss during operation in the experimental group was greater than that in the control group,and the operation time was longer than that in the control group.The difference was statistically significant(P<0.05).2 Postoperative recovery of the two groups: the expiration time,defecation time,and drainage time of the experimental group were longer than those of the control group.The total hospital stay was shorter than the control group,and the total hospitalization expenses were lower than the control group.The difference was statistically significant(P<0.05).3Peripheral blood WBC and serum PCT levels before and after the operation of the two groups: compared with the group on the 1st day before the operation,the peripheral blood WBC and serum PCT of the two groups increased at first and then decreased on the 1st,3rd,and 7th day after the operation,and both reached the highest peak on the 1st day after the operation(P<0.05).Compared between the groups,the peripheral blood WBC and serum PCT of the experimental group were higher than those of the control group 1 day before operation and 1 day after operation.The difference was statistically significant(P<0.05).There was no significant difference in peripheral blood WBC and serum PCT in the experimental group at 3 and 7 days after operation(P>0.05).4 Serum ALT and AST levels before and after the operation of the two groups: compared with the group,serum ALT and AST of the two groups increased first and then decreased on the 1st,3rd and 7th day after the operation compared with the 1st day before the operation,and both reached the highest peak on the 1st day after the operation(P<0.05).Compared between the groups,there was no significant difference in serum ALT and AST between the two groups at 1day before operation,1 day,3 days,and 7 days after operation(P>0.05).5 VAS and APACHEII scores before and after the operation of the two groups: compared with the group and 1 day before operation,the VAS scores of the two groups on the 1st,3rd,and7 th day after operation increased first and then decreased,and all reached the highest peak at 1 day after operation(P<0.05).Compared with 1 day before operation,the APACHEII scores of the two groups showed a continuous decreasing trend on the 1st,3rd and 7th day after operation(P<0.05).Compared between the groups,the VAS and APACHEII scores of the experimental group were higher than those of the control group at 1 day before and 1day after operation,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the VAS and APACHEII scores of the experimental group at 3 and 7 days after operation(P>0.05).6 The incidence of complications in the two groups: there was no significant difference in the incidence of complications between 3.77%(2/53)in the experimental group and 1.72%(1/58)in the control group(P>0.05).Conclusions Performing LC surgery at 7 days after PTGBD will increase the amount of intraoperative blood loss,prolong operation time and postoperative recovery time,but can avoid secondary hospitalization,which has obvious advantages in shortening the total length of hospital stay and reducing the total hospitalization cost.In addition,although the degree of early postoperative pain and stress response are relatively serious,it does not affect the postoperative condition improvement,liver function recovery,and does not increase the risk of postoperative complications,which may be the best clinical treatment for patients with advanced AC.Figure 6;Table 7;Reference 146...