A Clinical Comparative Study Of PTCD Damage Control Strategy And Emergent Laparotomy On Elderly Patients With Acute Cholangitis Of Severe Type

Objection:This study compared the effectiveness between two groups accepteddifferent treatment strategy of aged acute severe cholangitis patients. Agroup of patients underwent PTCD damage control strategy, and anotherunderwent emergency laparotomy strategy. Aims to demonstrate theadvantage of the emergency PTCD damage control strategy of elder acutecholangitis patients.Method:Retrospective studied110elder patients received emergency PTCDor laparotomy elder patients from December2001to December2012inthe Second Hospital of Jilin University. All involved patients weredivided into PTCD group (28cases) and laparotomy group (82cases),according to treatment strategy. We comparatively analysis the efficacy ofinfection control and jaundice subsided after biliary drainage. Choosingbody temperature and leucocyte count as indicators of the degree ofinfection and selecting the total bilirubin as indicators of the degree ofjaundice, we recorded each variable data and depicting different variabletrends preoperative and postoperative7days. Depicting different variabletrends, analysis two sets of the variable to compare the difference. Theincidence rate of complications, mortality rate, hospital stay, and theamount of bleeding in operation were compared between these twogroups. Results:The temperature, WBC count, total bilirubin appeared a decreasingtendency after biliary drainage in two groups. The average temperature ofPTCD group is lower than laparotomy group in the1st day after theoperations（P＜0.05）, and no difference from the3rd to7th day（P＞0.05）. The WBC count in two groups were no significant difference inthe1st day after the operations（P＞0.05）. PTCD group is lower thanlaparotomy group from the3rd to5th day（P＜0.05）,and there is nosignificant difference in the7th day（P＞0.05）. Total bilirubin count intwo groups were no significant difference in the1st day after theoperations（P＞0.05）. Total bilirubin of laparotomy group is lower thanPTCD group from the3rd day to the7th day after the operations （P＜0.05）. Compare to the incidence rate of complications, mortality rate, theaverage hospital stay, and the average amount of bleeding in operationbetween PTCD group after derministic operation and laparotomy group.The results show that the average amount of bleeding in operation ofPTCD group is lesser than laparotomy group（P＜0.05）. The incidencerate of complications of PTCD group is lower than laparotomy group（P＜0.05）. The average hospital stay of PTCD group is longer thanlaparotomy group（P＜0.05）.There is no significant difference inmortality rate in the two groups（P＞0.05）.Conclusions:1. PTCD damage control strategy is effective in controlling the acuteinfection for elderly patients with severe cholangitis, and the effect issimilar to emergent laparotomy. 2. PTCD damage control strategy is effective in reducing totalbilirubin for elderly patients with severe cholangitis, but the effect is lesssignificant than laparotomy for bile drainage.3. PTCD damage contral strategy have significant advantages inaspect of the amount of bleeding in operation and the incidence rate ofcomplications, but it need longer hospital stay.4. PTCD damage contral strategy haven’t significant advantages inaspect of mortality rate for elderly patients with severe cholangitis.