Application of percutaneous transhepatic gallbladder drainage for acute calculous cholecystitis in special population

Abstract

Objective To evaluate the application of percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of acute calculous cholecystitis in 3 kinds of special population including the elderly, cirrhosis or mid and late-stage pregnant women. Methods Clinical data of 292 patients with acute calculous cholecystitis among 3 kinds of special population who underwent PTGD in Baoji Central Hospital of Shaanxi between January 2009 and December 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 105 males and 187 females, aged from 22-91 and with a median age of 47 years old. 176 cases were elderly patients, 77 were with cirrhosis and 39 were mid and late-stage pregnant women. Ultrasound-guided PTGD was performed in the patients to relieve gallbladder tension rapidly, and laparoscopic cholecystectomy (LC) was performed according to the patient's condition. Efficacy of cholecystitis control in elderly patients before and after PTGD as well as the efficacy of surgical treatment in patients with liver cirrhosis or mid and late-stage pregnant women were observed. Cholecystitis indexes before and after PTGD were compared using t test. Results Symptoms of elderly patients significantly improved 3 d after PTGD. The average WBC, C-reactive protein and procalcitonin were (9.8±0.5)×109/L, (22.0±1.3) μg/L and (0.15±0.02) μg/L, which were significantly lower than preoperative (12.5±0.4)×109/L, (35.0±2.8) μg/L and (0.25±0.03) μg/L, respectively (t=-18.725, -29.062, -21.287; P<0.05). Cholecystitis in 77 patients with liver cirrhosis were effectively controlled within 1 week after PTGD, including 66 received sequential LC and 1 converted to open cholecystectomy, witha length of operation (31±9) min, intraoperative blood loss (21±5) ml and postoperative length of hospital stay (4.3±0.6) d. Cholecystitis in 39 mid and late-stage pregnant women were effectively controlled 1 week after PTGD. These patients received elective LC during the period after PTGD to 1 month after delivery, including 1 converted to open cholecystectomy. Conclusions For patients with acute calculous cholecystitis in3 kinds of special population including the elderly, those with cirrhosis or mid and late-stage pregnant women, PTGD can effectively control the cholecystitis with the advantages of simple operation, minimally invasive, safety and effectiveness, and sequential elective LC can reduce the risk of emergent surgery. Key words: Drainage; Aged; Liver cirrhosis; Pregnancy; Cholecystectomy, laparoscopic