Clinical Effect of Ultrasound-guided Percutaneous Transhepatic Gallbladder Drainage in Treatment of Acute Cholecystitis in Critically ill Elderly Patients
LEIYan-jun, XIAOYan, PANXiao-ji
Department of intensive Medicine, Hunan Provincial people's Hospital, Changsha, Hunan, 410005
Abstract：【Objective】 To investigate the clinical effect of ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of acute cholecystitis in critically ill elderly patients. 【Methods】 The clinical data of 56 patients with acute cholecystitis treated with PTGD in Hunan Provincial people's Hospital from January 2012 to January 2018 were analyzed retrospectively. The puncture complications (bleeding, bile leakage, intestinal perforation, hemopneumothorax) were recorded. Body temperature, white blood cell count, (WBC), procalcitonin (PCT), alanine aminotransferase (ALT) and Apache Ⅱ score were recorded before and 1 day ,3days , 5 days after operation, followed up 3 months after operation, and the postoperative condition and mortality were recorded and counted.【Results】 All the 56 patients were successfully punctured at one time, and no complications occurred. There was no significant difference in body temperature between before and after operation (t=0.78,P<0.194), but the body temperature decreased to normal on the 3rd ,.5th day after operation (P<0.05). On the 5th day after operation ,WBC and PCT returned to normal; on the 3rd day after operation, ALT returned to normal; WBC,PCT and ALT were significantly lower than those before operation on the 1st ,3rd and 5th day after operation (P<0.05). The scores of APACHE Ⅱ decreased gradually on the 5th day after operation, which were significantly lower than those before operation (P<0.05). The hospitalization period was 5~17 (9.2 ±3.8) days. No bleeding, bile leakage, intestinal perforation and hemopneumothorax were found in all patients within 3 months after puncture and drainage. There was no recurrent cholecystitis in 3 cases at the time of 3- month follow-up even with the tube. One patient was accidentally extubated 1 month after surgery and underwent open cholecystectomy. One patient died of multiple organ failure within 1 month after operation.【Conclusion】 In the early critical elderly patients with acute cholecystitis, timely treatment with PTGD can effectively alleviate the condition and reduce the perioperative risk. It has the advantages of simple operation, less postoperative complications and good clinical effect.
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2018, Vol. 35 
