Clinical Analysis Of Early Sequential LCBDE Combined With LC In The Treatment Of Choledocholithiasis With Grade Ⅱ Acute Cholecystitis After PTGD

Objective(s):To compare the safety and clinical effects between sequential treatment of PTGD(percutaneous transhepatic gallbladder drainage)+LCBDE(laparoscopic common bile duct exploration)+LC(laparoscopic cholecystectomy)+T tube drainage and direct treatment of LCBDE+LC+T tube drainage in treating choledocholithiasis combined with grade Ⅱ acute cholecystitis.Methods:The clinical data of 95 cases of patients diagnosed with choledocholithiasis combined with grade Ⅱ acute cholecystitis in our hospital from September 2018 to September 2020 were retrospectively collected and analyzed.According to with or without PTGD,we divide the data into one-stage operation group(LCBDE+LC,n=45)and two-stage operation group(PTGD+LCBDE+LC,n=50),Both groups of patients were treated with,among other basic treatment santi-inflammatory therapy.LCBDE+LC+T drainage are completed within 24 hours in the one-stage operation group,while PTGD is applied three days before LCBED+LC+T drainage.Comparing the perioperative data of the two groups,comparing results of the two-stage operation group before and three days after PTGD is applied and comparing operation time,total intraoperative blood loss,rate of conversion to laparotomy,total hospitalization costs,hospital stay and rate of complications between the two groups.Results:General clinical information including age(41.71±12.43/40.1±9.47 years),gender ratio(male/female,20/25、22/28)basic diseases and comorbidities are not statistically different with P>0.05.Results of the time before and three days after PTGD is applied in the two-stage operation group show that ALT decreases from 63.22±27.84U/L to 50.78±22.38U/L,while DBIL decreases from 53.62±48.38umol/L to 31.36±36.07umol/L respectively,with statistical significance and P<0.05,indicating improved liver function,and temperature,IL-6,white blood cell count and neutrophil ratio decrease from 37.47±1.13℃、61.44±20.31ng/L、10.85±4.24×10^9/L、0.73±0.08 to 37.01±0.67℃、30.36±21.12ng/L、8.70±3.16×10^9/L、0.69±0.07 respectively,with statistical significance and P<0.05,indicating improved systemic inflammation,and PLT increases from 88.65±40.1×10^9/L to 186.54±54.63×10^9/L and PT decreases from 14.21±1.34 seconds to 12.37±1.08 seconds,with statistical significance and P<0.05,indicating improved coagulation function,and length of gall bladder decreases from 10.02±2.04 cm to 6.44±0.94 cm with statistical significance but the thickness of gall bladder wall is of no statistical significance with P>0.05.Operation time and intraoperative blood loss of the two groups are between 127.72±14.2min、78.12±21.64mL and 58.401±11.96min、30.29±8.94mL,with the two-stage operation group better than the one-stage operation group(P<0.05).One-stage operation group has eight cases(17.8%)of conversion to laparotomy,higher than the two such cases(2%)in two-stage operation group with P<0.05.Time to T tube removal,postoperative bed time,exhaust time,hospital stay and hospitalization costs of the two groups are between 20.62±1.98h、30.03±4.61h、34.85±3.08h、10.63±1.03d、14243.47± 1557.58yuan and 13.78± 1.79h、25.94±4.02h、32.4±3.47h、7.52±0.56d、12891.88±1498.28yuan,with statistical significance and P<0.05.One-stage operation group has six cases(13.3%)of incision infection and five cases(11.1%)of bile leakage,while two-stage operation group has one cases(2%)of incision infection and no case of bile leakage,higher the rate of incision infection and bile leakage in the one-stage operation group,with statistical significance and P<0.05.One-stage operation group has two cases(4.4%)of bile duct residual calculi and one case(2.2%)of bile duct injury,while the two-stage operation group has no case of both,with no statistical significance and P>0.05.Conclusion(s):Compared to one-stage operation group,two-stage operation group has the advantages of shorter operation time,less rate of intraoperative blood loss,incision infection,bile leakage and conversion to laparotomy,shorter time to recovery and less hospital stay and hospitalization costs,considered as a safe and effective treatment to choledocholithiasis combined with grade Ⅱ acute cholecystitis.