老年急性胆囊炎患者PTGBD后LC手术实施时机及其影响因素

目的 探讨老年急性胆囊炎患者经皮经肝胆囊穿刺引流（PTGBD）后安全的LC手术时机和影响因素。方法 选取2020年6月至2022年7月间在新疆维吾尔自治区第三人民医院接受PTGBD+择期LC手术治疗的老年急性胆囊炎患者120例进行前瞻性研究，按照PTGBD后不同时期实施LC手术，将患者随机分为4组：4周组（n=30）、6周组（n=30）、8周组（n=30）和10周组（n=30）。对术前资料、术中困难程度评分、手术相关指标、手术损伤和手术并发症进行组间对比，并分析手术时机的影响因素。结果 4组术前资料的比较，差异无统计学意义（P>0.05）；针对胆囊周围表现、胆囊三角表现、胆囊床表现等单项困难程度评分和术中困难程度总评分，4周组均显著高于6周组、8周组和10周组；针对术中胆囊及其周围其他表现评分，4周组高于8周组和10周组；差异均具有统计学意义（P<0.05）；针对手术时间、术中出血量和腹腔引流量，4周组均显著高于6周组、8周组和10周组；差异均具有统计学意义（P<0.05）。4组胆囊部分切除率、术后排气时间和术后住院时间的比较，差异无统计学意义（P>0.05）;...

The timing and influencing factors of laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis

Objective To explore the safe and feasible operation timing for laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) in elderly patients with acute cholecystitis.Methods A prospective study was performed on 120 elderly patients with acute cholecystitis who underwent PTGBD and selective LC in the Third People’s Hospital of Xinjiang Uygur Autonomous Region between Jun. 2020 and Jul. 2022. Patients were randomly divided into 4 groups according to the time interval of laparoscopic operation after PTGBD: 4-week group (n=30), 6-week group (n=30), 8-week group (n=30) and 10-week group (n=30). The preoperative data, intraoperative difficulty degree score, surgical related indicators, surgical injury and complications were compared and analyzed, and the influencing factors of operation timing were analyzed.Results There was no significant difference in preoperative data among the 4 groups (P>0.05). In terms of single difficulty score such as gallbladder peripheral manifestation, gallbladder triangle manifestation, gallbladder bed manifestation, and the total difficulty score in operation, the scores in 4-week group were significantly higher than those in 6-week group, 8-week group and 10-week group; in terms of other manifestation in gallbladder and its surroundings, the score in 4-week group was significantly higher than those in 8-week group and 10-week group; all P<0.05. In terms of operation time, operation bleeding volumn and abdominal drainage rate in the 4-week group, were significantly higher than those in the 6-week group, 8-week group and 10-week group (P<0.05). In terms of partial cholecystectomy rate, postoperative exhaust time and postoperative hospitalization time, there was no significant difference among the 4 groups (P>0.05). No conversion to laparotomy occurred in the 4 groups. In terms of surgical injury and complications, there was no significant difference among the 4 groups (P>0.05). Cholecystitis with grade Ⅲ, gallbladder wall thickness ≥10 mm, effusion around the gallbladder, combined with pancreatitis or liver cirrhosis were the influencing factors for surgical timing. Conclusion Six weeks after PTGBD is the safe timing for LC in elderly patients with acute cholecystitis; 4 weeks is the feasible timing of LC, and it is recommended to be done by experienced surgeons. Cholecystitis with grade Ⅲ, gallbladder wall thickness ≥10 mm, effusion around the gallbladder, combined with pancreatitis or liver cirrhosis are the influencing factors for surgical timing.