关键词: 急性结石性胆囊炎, 经皮经肝胆囊穿刺引流术, 腹腔镜胆囊切除术, 治疗

Abstract: Objective The aim of this study was to explore the shortly or a little longer laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of patients with acute calculous cholecystitis (ACC). Methods 107 patients with ACC were encountered in our hospital between March 2019 and January 2022, and were divided into group A (n=51), receiving LC within two months after PTGD, and group B (n=56), receiving LC two months after PTGD. The thickness of gallbladder wall and diameter of gallbladder were detected by using color Doppler ultrasound. Serum procalcitonin (PCT) level was measured by semi-quantitative solid-phase immunoassay, and serum C-reactive protein (CRP) and norepinephrine (NE) levels were assayed by ELISA. Serum adrenocorticotropic hormone (ACTH) and cortisol (Cor) levels were detected by chemiluminescence. Results The gallbladder wall thickness before LC in group B was (3.8±0.4) mm, significantly thinner than [(4.1±0.5) mm, P<0.05] in group A; the surgical time, total hospital stay, and intraoperative blood loss in group B were(78.2±9.5)min, (7.9±1.3)d and (53.4±6.9)mL, significantly shorter or less than [(98.7±10.8)min, (10.2±2.1)d and (87.5±9.2)mL, respectively, P<0.05] in group A; after LC operation, the white blood cell counts, serum PCT and CRP levels in group B were (6.4±0.7)×10⁹/L,(0.0±0.0)ng/ml and (4.7±1.7)mg/L, all significantly lower than [(7.2±0.8)×10⁹/L,(1.3±0.2)ng/ml and (61.2±5.8)mg/L, respectively, P<0.05] in group A; 72 hours after LC, serum ACTH level in group B was (84.3±2.8)ng/L, much lower than [(110.4±4.1)ng/L, P<0.05] in group A. Conclusion The relatively late LC after PTGD in the treatment of patients with ACC might get a better efficacy, which could shorten the surgical time and relieve the postoperative inflammatory stress response.

Key words: Acute calculous cholecystitis, Percutaneous transhepatic gallbladder drainage, Laparoscopic cholecystectomy, Therapy