Application of percutaneous transhepatic gallbladder drainage in aged and high-risk patients with acute cholecystitis

Abstract

Objective To observe the therapeutic effect of percutaneous transhepatic gallbladder drainage(PTGD)and its effect on elective surgery by grouping comparison, and to analyze the application value of PTGD among aged and high-risk patients with acute cholecystitis. Methods A total of 189 patients with acute cholecystitis were analyzed retrospectively in Affiliated Hospital of Yangzhou University from March 2016 to March 2018.And 78 patients who were eligible for the screening criteria were selected.According to different treatments in acute term, these patients were divided into two groups.One group accepted PTGD treatment, and the other one accepted anti-infection conventional treatment.Thirty patients were randomly selected respectively in each group as the experimental group and the control group.The time of abdominal pain duration, the time of backing to normal body temperature and the time for antibiotic usage of the two groups were compared after the patients were admitted to the hospital first time for treatment.The number of white blood cell, transaminase and total bilirubin between 48 h and 72 h after admission were compared.In addition, the operation time of elective laparoscopic cholecystectomy, peroperative bleeding, total expense of the two operations and complication rate were compared. Results Abdominal pain duration of patients in the experimental group [(21.10±3.99)h]was obviously shorter than that in the control group [(32.50±6.52)h]. Time for temperature recovery(36.5 ℃≤T≤37.2 ℃)in the experimental group [(13.37±3.78)h]was apparently shorter than that in the control group [(28.70±9.27)h]. White blood cell number in the experimental group [(8.34±1.80)×109/L]48 hours after admitted was lower than that in the control group [(11.78±2.09)×109/L]. Alanine transaminase and glutamic oxaloacetic transaminase in the experimental group [(87.50±30.72)U/L, (90.57±30.84)U/L]were lower than those in the control group [(110.33±25.81)U/L, (119.93±29.67)U/L]. Total bilirubin in the experimental group [(15.24±4.43)mmol/L]was lower than that in the control group [(19.45±5.17)mmol/L]. The time for antibiotic usage in the experimental group [(3.82±0.83)d]was shorter than that in the control group [(6.88±1.24)d]. All the differences of these results were statistically significant(P<0.05). All the patients were treated by laparoscopic cholecystectomy after 1-3 months in our hospital.There were no obvious differences between the two groups in terms of operation time [(58.17±10.92)min vs.(58.00±11.73)min]and amount of bleeding [(25.67±6.02)ml vs.(24.67±5.62)ml]. And there was no obvious difference in terms of expense. Conclusion For those high-risk elderly patients, PTGD can reduce the pressure in the gallbladder, control the development of inflammation, relieve symptoms of infection abdominal pain and fever quickly and effectively.PTGD can reduce the risk of serious complications such as gallbladder perforation and septic shock.PTGD also can accelerate the decrease of transaminase, protect liver function and create certain conditions for elective surgery. Key words: Acute cholecystitis; Elder; Elective surgery; Percutaneous transhepatic gallbladder drainage