A Clinical Timing Study Of Percutaneous Transhepatic Gallbladder Puncture And Drainage Combined With Selective Laparoscopic Cholecystectomy For The Treatment Of Acute Cholecystitis

Background:Acute cholecystitis(AC)is a common surgical disease,and its incidence rate ranks second in acute abdomen.The main clinical symptoms of AC are right upper abdominal pain,accompanied by symptoms such as nausea,vomiting,and fever.AC has the characteristics of rapid onset,rapid changes in the condition,and severe pain.If the patient’s condition cannot be treated in a timely manner or improperly,it can cause serious complications such as gallbladder abscess,gallbladder perforation,and biliary fistula.This not only causes damage to the digestive system,but in severe cases,it can also cause multiple organ failure and even endanger the patient’s life.At present,emergency surgery is often used to treat AC clinically.Laparoscopic cholecystectomy(LC)has become the main scheme for AC treatment,but LC is only applicable to patients with mild AC symptoms.For patients with severe clinical symptoms or multiple organ dysfunction,emergency surgery is difficult,the anatomy of the gallbladder triangle is unclear,the risk of biliary system damage is high,and postoperative recovery is slow,Complications that may endanger the patient’s life may occur.Percutaneous transhepatic gallbladder drainage(PTGD)is a simple and effective clinical treatment method for AC.For some patients,PTGD is performed first,followed by LC surgery,which can reduce the difficulty and risk of surgery and improve the treatment effect of the disease.However,there is currently no consensus among domestic and foreign scholars on when to perform LC after PTGD surgery,and there is controversy over the timing of the surgery.Objective:To clarify the different effects of LC treatment for AC at different stages after PTGD surgery,and provide reference for selecting the surgical timing of LC after PTGD surgery in clinical practice.Methods:The clinical and postoperative follow-up data of 86 patients with AC admitted to the Affiliated Hospital of Dalian Medical University from 2017 to 2020were retrospectively collected.They were divided into two groups according to the timing of LC treatment after PTGD.Among them,45 patients in observation group 1received LC treatment within 2-4 months after PTGD;In observation group 2,41patients were treated with LC within 1-2 months after PTGD;Diagnose the patient according to the diagnostic criteria for AC in the Tokyo Guidelines 2018,TG18;Classify the severity of AC patients according to the Tokyo Guidelines for Acute Biliary Tract Infection;Based on age;Time of onset;AC diagnostic criteria;Completeness of clinical data;Have you had any previous abdominal surgery history;Including and excluding data based on severity classification.Compare the general situation of the two groups of patients,and the laboratory related examination results before and after PTGD;The postoperative complications of PTGD and the relief time of abdominal pain after puncture were compared between the two groups;Data such as LC surgery time,intraoperative conversion rate to laparotomy,intraoperative blood loss,hospital stay,and total incidence of complications after LC surgery;SPSS 22.0statistical software was used for statistical analysis of the detected data.If continuous variables conform to a normal distribution,they are expressed as mean±standard deviation(Mean±SD)and analyzed using independent sample t-tests;If the data does not conform to a normal distribution,the M(P25,P75)percentile is generally used for descriptive statistics with non normal distribution data,and the non parametric test method is used for data analysis.The classification variable is represented by the number of use cases(n)or percentage(%),usingχ~2.Test and compare the data.When P<0.05,the difference is statistically significant.Results:In this study,we retrospectively included a total of 86 AC patients who visited our hospital from January 2017 to December 2020.They were divided into two groups based on the timing of LC treatment after PTGD surgery.Among them,45patients in observation group 1 received LC treatment within 2-4 months after PTGD surgery;A total of 41 patients in observation group 2 underwent LC treatment within1-2 months after PTGD surgery.We compared the basic conditions of two groups of patients,including liver function indicators before and after PTGD surgery,incidence of postoperative complications,and time to relieve abdominal pain.We found no significant differences between the two groups;Further comparing the LC surgery time,intraoperative conversion rate,intraoperative blood loss,hospital stay,and overall incidence of surgical complications between the two groups of patients,we found that early LC surgery after PTGD significantly reduced the LC surgery time,hospital stay,and overall incidence of surgical complications.Conclusions:Early postoperative(1-2 months)LC surgery for AC after PTGD can effectively shorten the surgical time and hospital stay,significantly reduce the risk of complications,have high safety,and have high clinical value.