Application of percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy in the treatment of acute cholecystitis complicated with diabetes mellitus

Abstract

Objective To investigate the application value of percutaneous transhepatic gallbladder drainage (PTGBD) combined with laparoscopic cholecystectomy (LC) in the treatment of acute cholecystitis complicated with diabetes mellitus. Methods Clinical data of 34 patients with acute cholecystitis complicated with diabetes mellitus who underwent LC in Jiangmen Central Hospital affiliated to Sun Yat-sen University from January 2013 to December 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the surgical methods, the patients were divided into the LC group (n=20) and PTGBD+LC group (n=14). In the LC group, 9 were males and 11 were females, aged (59±9) years old on average. The patients received symptomatic and supportive treatment after admission, and discharged from hospital after the infection was controlled and underwent selective LC within 3 months. In the PTGBD+LC group, 6 were males and 8 were females, aged (62±9) years old on average. The patients underwent PTGBD after admission and received symptomatic and supportive treatment at the same time. The patients discharged from hospital after the infection was controlled and underwent selective LC within 3 months. Intraoperative and postoperative conditions of two groups were observed. Normally-distributed data were compared between two groups using t test. Skewed distributed data were compared using Z test. Results All patients underwent the surgery successfully. The median operation time in the LC group was 70(30-210) min, significantly longer than 53(30-195) min in the PTGBD+LC group (Z=2.038, P<0.05). The median intraoperative blood loss in the LC group was 18(10-50) ml, significantly more than 13(5-50) ml in the PTGBD+LC group (Z=2.049, P<0.05). The percentage of conversion to laparotomy in the LC group was 25%(5/20), while no conversion to laparotomy was observed in the PTGBD+LC group. The postoperative length of hospital stay in the LC group was (4.9±1.8) d, significantly longer than (4.1±1.0) d in the PTGBD+LC group (t=0.432, P<0.05). No perioperative death and complication after LC was observed in both group. Four cases of complications after PTGBD were observed, including 3 cases of bile leakage and 1 of intraperitoneal bleeding, which were cured after conservative therapy. Conclusions PTGBD combined with LC is a safe and effective treatment for acute cholecystitis complicated with diabetes mellitus. It can obviously shorten the operation time, reduce the intraoperative blood loss and accelerate the postoperative recovery of the patients. Key words: Punctures; Drainage; Cholecystectomy, laparoscopic; Cholecystitis, acute; Diabetes mellitus