Ultrasound-guided percutaneous hepatobiliary drainage combined with laparoscopic cholecystectomy in the treatment of elderly patients with high-risk acute suppurative cholecystitis

Abstract

Objective To investigate the clinical effect of percutaneous transhepatic gallbladder drainage (PTGD) combined with laparoscopic cholecystectomy (LC) in the treatment of elderly patients with high-risk acute suppurative cholecystitis. Methods The clinical data of 158 elderly patients with acute suppurative cholecystitis treated in the First People’s Hospital of Yangquan from March 2015 to May 2018 were retrospectively analyzed. According to the interval between PTGD and LC, the patients were divided into two groups: control group (LC 30-59 days after PTGD, 79 cases) and observation group (LC 60-89 days after PTGD, 79 cases). The biochemical indexes, including white blood cell (WBC), alkaline phosphatase (ALP), total bilirubin (TBIL), clinical indexes and conversion rate of laparotomy were compared between the two groups. Results In the 158 patients, WBC, ALP and TBIL levels after PTGD were lower than those before PTGD, and the difference was statistically significant (P<0.05). In the observation group, the amount of blood loss during LC was less than that in the control group, and the duration of LC surgery and postoperative hospital stay were both shorter than those in the control group, with statistically significant differences (P<0.05). There was no case of conversion to laparotomy in the observation group; however, rate of coversion to laparotomy was 6.33% in the control group; there was significant difference between the two groups (P<0.05). Conclusions LC operation for elderly patients with high-risk acute suppurative cholecystitis 60-89 days after PTGD can effectively reduce the amount of bleeding during LC operation, shorten the operation time of LC, reduce the conversion rate of laparotomy, and facilitate early recovery of patients. Key words: Acute suppurative cholecystitis; Aged; Percutaneous hepatic and gallbladder drainage; Laparoscopic cholecystectomy; Ultrasound