Ultrasound-guided Percutaneous Transhepatic Gallbladder Puncture Drainage Combined With Second-stage Laparoscopic Gallbladder Clinical Analysis Of Resection For Moderate To Severe Acute Cholecystitis

Objective:Analysis of ultrasound-guided percutaneous transhepatic gallbladder puncture drainage combined with second-stage laparoscopic cholecystectomyTherapeutic effect of moderate to severe acute cholecystitis and the timing of second-stage laparoscopic cholecystectomy.Methods:A retrospective analysis of 160 patients with moderate to severe acute cholecystitis admitted to our hospital from January 2016 to December 2018.Comparing the patients with percutaneous transhepatic gallbladder drainage(PTGBD),LC(second phase LC group,n=80 cases)and emergency department LC(emergency LC group,n=80 cases)were compared between the two groups.White blood cells,liver enzymes,operative time,postoperative hospital stay,total hospitalization costs,postoperative pathology,conversion to laparotomy,and postoperative complications.In addition,patients were divided into three groups according to the time interval of PTGD in the second stage of cholecystectomy:group A(n=27)was the patient who underwent LC within 4 weeks after PTGD,and group B(n=25)was PTGD.Patients who underwent LC within 4-8 weeks,group C(n=28)were patients who underwent LC after 8 weeks after PTGD.Three groups of preoperative gallbladder wall thickness,gallbladder transverse diameter,and white blood cells before and 3 days after surgery were observed.Count.percentage of neutrophils,liver enzymes.operative time,postoperative complications,conversion to laparotomy,postoperative hospital stay,postoperative pathology.Results:(1)There were no complications such as catheter shedding,bile leakage,hemorrhage,pneumothorax,colon perforation,secondary infection and other complications after PTGD in 80 patients with PTGD.The thickness of gallbladder in patients with PTGD decreased from(0.50 ± 0.20)cm to(0.30±0.10)cm,and the transverse diameter of gallbladder decreased from(10.77±1.46)cm to(5.66±0.96)cm,which was significantly relieved compared with preoperative.Statistical difference(P<0.05).The patient’s body temperature after PTGD was(38.00±1.38)℃ to(36.50 ±1.00)℃(P<0.05);the white blood cell count decreased from(13.33±3.81)x109/L(6.50±2.19)x109/L(P<0.05);the percentage of neutrophils decreased from(84.17±5.76)x109/L to(53.70±9.95)x109/L(P<0.05);total bilirubin decreased from(24.70±27.63)umol(15.84 ±5.13)umol(P<0.05);there was no significant difference in the indexes of aspartate aminotransferase and alanine aminotransferase before and after PTGD(P>0.05).(2)There was a significant difference in the operation time and postoperative hospital stay between the two groups in the PTGD combined with the second-stage LC group(P<0.05).The PTGD combined with the second-stage LC group was performed from the operation time and postoperative hospitalization.The number of days was lower than that of the emergency LC group;the two groups had statistical significance in the conversion to open surgery(P<0.05);the difference in postoperative complications between the two groups was statistically significant(P<0.05);There was no statistical significance(P>0.05).(3)In the PTGD combined with the second-stage LC group,the A,B,and C groups were compared.The patients underwent LC after 4-8 weeks and 8 weeks after PTGD.The operation time was reduced from 90.00±55.00 min in 4 weeks to 70.00±32.50min and 60.00±42.50min,P<0.05;postoperative hospital stay decreased from 4.00±1.00 days to 3.00±1.00 days and 3.00±1.00 days,P<0.05;LC patients underwent PTGD within 4 weeks after operation The conversion rate was 25.9%,which was higher than the conversion rate of LC patients after 4-8 weeks and 8 weeks after PTGD,P<0.05.The operation time of LC was performed after 4-8 weeks and 8 weeks after PTGD.There was no significant difference in postoperative hospital stay and conversion to open rate(P>0.05).The patients were treated with operative time,postoperative hospital stay,and conversion to open rate between 4 and 8 weeks after PTGD.There was no statistical difference(P>0.05).Conclusion:For LC in patients with moderate to severe cholecystitis after PTGD,the LC is more effective than the emergency LC,which can effectively reduce the risk of surgery and reduce the impact on the patient’s body.It is a safe and effective method.For patients undergoing PTGD,the optimal timing for LC after surgery is 2 to 4 months.