Effect of PTGBD combined with early LC in the treatment of elderly patients with high-risk acute cholecystitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiangxiang ¹ ,  LIU Hong ¹ , LIU Fengling ¹ , XIONG Jie ¹ , CHEN Lei ¹ , ZHANG Jun ¹ , LIU Mingzhong ¹ , Chen Gang ²

1. Department of Hepatobiliary Surgery, Dazhou Central Hospital, Dazhou, Sichuan 635000, P. R. China;
2. Department of Hepatobiliary Surgery, Ganmei Hospital Affiliated to Kunming Medical University, Kunming 650011, P. R. China;

Corresponding author：

LIU Hong, Email: 1556853619@qq.com

Keywords：

acute cholecystitis; high risk; percutaneous transhepatic gallbladder drainage; early laparoscopic cholecystectomy

DOI：

10.7507/1007-9424.201903118

Video：

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Objective To investigate the efficacy and safety of percutaneous transhepatic gallbladder drainage (PTGBD) combined with early laparoscopic cholecystectomy (LC) in the treatment of elderly patients with high-risk acute cholecystitis.Methods The clinical data of 128 elderly patients with high-risk acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to January 2019 were retrospectively analyzed. Among them, 62 patients underwent PTGBD combined with early LC treatment (PTGBD+early LC group), 66 patients underwent PTGBD combined with delayed LC treatment (PTGBD+delayed LC group). Comparison was performed on the operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, total hospitalization time, and complication.Results PTGBD was successfully performed in all patients, and the symptoms were relieved within 72 hours. There was no significant difference in operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, and total complication rate between the two groups (P>0.05), but the total hospitalization time of the PTGBD+early LC group was shorter than that of the PTGBD+delayed LC group (P<0.001). There was no second operation and death in both two groups. The 128 patients were followed-up for 2–50 months with a average of 19 months. Results of follow-up after operation showed that the patients did not complain of obvious abdominal pain, abdominal distension, chills, fever, jaundice, and other discomforts.Conclusions For elderly patients with high-risk acute cholecystitis, early LC is a safe and effective treatment for patients with good overall condition after PTGBD. It can not only shorten the total hospitalization time, but also significantly shorten the time of tube-taking and improve the quality of life of patients. It has important clinical application value.

Citation： WANG Xiangxiang, LIU Hong, LIU Fengling, XIONG Jie, CHEN Lei, ZHANG Jun, LIU Mingzhong, Chen Gang. Effect of PTGBD combined with early LC in the treatment of elderly patients with high-risk acute cholecystitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(9): 1061-1066. doi: 10.7507/1007-9424.201903118 Copy

1.	中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南 (2011版). 中华消化外科杂志, 2011, 10(1): 9-13.
2.	Kannan T. ASA grading: a step forward. J Perioper Pract, 2017, 27(3): 54-58.
3.	殷强, 胡勇军, 晏华军, 等. 经皮经肝胆囊穿刺置管引流术治疗老年急性胆囊炎的疗效分析. 中国普外基础与临床杂志, 2017, 24(12): 1521-1523.
4.	Ke CW, Wu SD. Comparison of emergency cholecystectomy with delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with moderate acute cholecystitis. J Laparoendosc Adv Surg Tech A, 2018, 28(6): 705-712.
5.	Komatsu S, Tsukamoto T, Iwasaki T, et al. Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis. J Dig Dis, 2014, 15(12): 669-675.
6.	Radder RW. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging, 1980, 49(6): 330-333.
7.	Jia B, Liu K, Tan L, et al. Evaluation of the safety and efficacy of percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for treating acute complicated cholecystitis. Am Surg, 2018, 84(1): 133-136.
8.	Ni Q, Chen D, Xu R, et al. The efficacy of percutaneous transhepatic gallbladder drainage on acute cholecystitis in high-risk elderly patients based on the Tokyo guidelines: a retrospective case-control study. Medicine (Baltimore), 2015, 94(34): e1442.
9.	Na BG, Yoo YS, Mun SP, et al. The safety and efficacy of percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis before laparoscopic cholecystectomy. Ann Surg Treat Res, 2015, 89(2): 68-73.
10.	Jia B, Liu K, Tan L, et al. Percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy versus emergency laparoscopic cholecystectomy in acute complicated cholecystitis: comparison of curative efficacy. Am Surg, 2018, 84(3): 438-442.
11.	Lee R, Ha H, Han YS, et al. Percutaneous transhepatic gallbladder drainage followed by elective laparoscopic cholecystectomy for patients with moderate to severe acute cholecystitis. Medicine (Baltimore), 2017, 96(44): e8533.
12.	Jung BH, Park JI. Impact of scheduled laparoscopic cholecystectomy in patients with acute cholecystitis, following percutaneous transhepatic gallbladder drainage. Ann Hepatobiliary Pancreat Surg, 2017, 21(1): 21-29.
13.	Yamada K, Yamashita Y, Yamada T, et al. Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis. J Hepatobiliary Pancreat Sci, 2015, 22(12): 855-861.
14.	Inoue K, Ueno T, Douchi D, et al. Risk factors for difficulty of laparoscopic cholecystectomy in grade Ⅱ acute cholecystitis according to the Tokyo guidelines 2013. BMC Surg, 2017, 17(1): 114.
15.	Iino C, Shimoyama T, Igarashi T, et al. Comparable efficacy of endoscopic transpapillary gallbladder drainage and percutaneous transhepatic gallbladder drainage in acute cholecystitis. Endosc Int Open, 2018, 6(5): E594-E601.
16.	Chan JHY, Teoh AYB. Current status of endoscopic gallbladder drainage. Clin Endosc, 2018, 51(2): 150-155.
17.	Hu YR, Pan JH, Tong XC, et al. Efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients. BMC Gastroenterol, 2015, 15: 81.
18.	El-Gendi A, El-Shafei M, Emara D. Emergency versus delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in grade Ⅱ acute cholecystitis patients. J Gastrointest Surg, 2017, 21(2): 284-293.
19.	柯昌伟, 吴硕东, 李勇男. 中度急性胆囊炎行急诊胆囊切除与经皮经肝胆囊穿刺引流术加择期胆囊切除的疗效对比分析. 中华医学杂志, 2018, 98(10): 768-772.
20.	Yoshiya S, Minagawa R, Kamo K, et al. Usability of intraoperative fluorescence imaging with indocyanine green during laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. World J Surg, 2019, 43(1): 127-133.
21.	Choi JW, Park SH, Choi SY, et al. Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis. Korean J Hepatobiliary Pancreat Surg, 2012, 16(4): 147-153.
22.	陈辉, 章旭明, 洪重, 等. PTGD序贯腹腔镜胆囊切除术在高危急性胆囊炎患者中的治疗作用. 温州医科大学学报, 2018, 48(3): 185-188, 193.
23.	Siddiqui T, MacDonald A, Chong PS, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg, 2008, 195(1): 40-47.
24.	Tan HY, Jiang DD, Li J, et al. Percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Laparoendosc Adv Surg Tech A, 2018, 28(3): 248-255.
25.	Han IW, Jang JY, Kang MJ, et al. Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. J Hepatobiliary Pancreat Sci, 2012, 19(2): 187-193.

1. 中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南 (2011版). 中华消化外科杂志, 2011, 10(1): 9-13.
2. Kannan T. ASA grading: a step forward. J Perioper Pract, 2017, 27(3): 54-58.
3. 殷强, 胡勇军, 晏华军, 等. 经皮经肝胆囊穿刺置管引流术治疗老年急性胆囊炎的疗效分析. 中国普外基础与临床杂志, 2017, 24(12): 1521-1523.
4. Ke CW, Wu SD. Comparison of emergency cholecystectomy with delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with moderate acute cholecystitis. J Laparoendosc Adv Surg Tech A, 2018, 28(6): 705-712.
5. Komatsu S, Tsukamoto T, Iwasaki T, et al. Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis. J Dig Dis, 2014, 15(12): 669-675.
6. Radder RW. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema. Diagn Imaging, 1980, 49(6): 330-333.
7. Jia B, Liu K, Tan L, et al. Evaluation of the safety and efficacy of percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for treating acute complicated cholecystitis. Am Surg, 2018, 84(1): 133-136.
8. Ni Q, Chen D, Xu R, et al. The efficacy of percutaneous transhepatic gallbladder drainage on acute cholecystitis in high-risk elderly patients based on the Tokyo guidelines: a retrospective case-control study. Medicine (Baltimore), 2015, 94(34): e1442.
9. Na BG, Yoo YS, Mun SP, et al. The safety and efficacy of percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis before laparoscopic cholecystectomy. Ann Surg Treat Res, 2015, 89(2): 68-73.
10. Jia B, Liu K, Tan L, et al. Percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy versus emergency laparoscopic cholecystectomy in acute complicated cholecystitis: comparison of curative efficacy. Am Surg, 2018, 84(3): 438-442.
11. Lee R, Ha H, Han YS, et al. Percutaneous transhepatic gallbladder drainage followed by elective laparoscopic cholecystectomy for patients with moderate to severe acute cholecystitis. Medicine (Baltimore), 2017, 96(44): e8533.
12. Jung BH, Park JI. Impact of scheduled laparoscopic cholecystectomy in patients with acute cholecystitis, following percutaneous transhepatic gallbladder drainage. Ann Hepatobiliary Pancreat Surg, 2017, 21(1): 21-29.
13. Yamada K, Yamashita Y, Yamada T, et al. Optimal timing for performing percutaneous transhepatic gallbladder drainage and subsequent cholecystectomy for better management of acute cholecystitis. J Hepatobiliary Pancreat Sci, 2015, 22(12): 855-861.
14. Inoue K, Ueno T, Douchi D, et al. Risk factors for difficulty of laparoscopic cholecystectomy in grade Ⅱ acute cholecystitis according to the Tokyo guidelines 2013. BMC Surg, 2017, 17(1): 114.
15. Iino C, Shimoyama T, Igarashi T, et al. Comparable efficacy of endoscopic transpapillary gallbladder drainage and percutaneous transhepatic gallbladder drainage in acute cholecystitis. Endosc Int Open, 2018, 6(5): E594-E601.
16. Chan JHY, Teoh AYB. Current status of endoscopic gallbladder drainage. Clin Endosc, 2018, 51(2): 150-155.
17. Hu YR, Pan JH, Tong XC, et al. Efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients. BMC Gastroenterol, 2015, 15: 81.
18. El-Gendi A, El-Shafei M, Emara D. Emergency versus delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in grade Ⅱ acute cholecystitis patients. J Gastrointest Surg, 2017, 21(2): 284-293.
19. 柯昌伟, 吴硕东, 李勇男. 中度急性胆囊炎行急诊胆囊切除与经皮经肝胆囊穿刺引流术加择期胆囊切除的疗效对比分析. 中华医学杂志, 2018, 98(10): 768-772.
20. Yoshiya S, Minagawa R, Kamo K, et al. Usability of intraoperative fluorescence imaging with indocyanine green during laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. World J Surg, 2019, 43(1): 127-133.
21. Choi JW, Park SH, Choi SY, et al. Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis. Korean J Hepatobiliary Pancreat Surg, 2012, 16(4): 147-153.
22. 陈辉, 章旭明, 洪重, 等. PTGD序贯腹腔镜胆囊切除术在高危急性胆囊炎患者中的治疗作用. 温州医科大学学报, 2018, 48(3): 185-188, 193.
23. Siddiqui T, MacDonald A, Chong PS, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg, 2008, 195(1): 40-47.
24. Tan HY, Jiang DD, Li J, et al. Percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Laparoendosc Adv Surg Tech A, 2018, 28(3): 248-255.
25. Han IW, Jang JY, Kang MJ, et al. Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. J Hepatobiliary Pancreat Sci, 2012, 19(2): 187-193.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of PTGBD combined with early LC in the treatment of elderly patients with high-risk acute cholecystitis

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