关键词: 急性重症胆囊炎, 经皮经肝胆囊穿刺引流术, 腹腔镜胆囊切除术, 手术时机, 治疗

Abstract: Objective The aim of this study was to investigate the perfect timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of patients with acute severe cholecystitis (ASC). Methods 45 patients with ASC were admitted to our hospital between January 2022 and March 2025, and all underwent emergent PTGD for amelioration of acute body inflammatory reaction. For LC, patients were randomly assigned to have the operation within 50 days after PTGD in 20 cases (group A) or 70 days after PTGD in 25 cases (group B). Serum interleukin (IL)-6 and C-reactive protein (CRP) levels were detected by ELISA. Results The operation time of LC, postoperative first exhaust time, intraoperative blood loss and hospital stay after surgery in group B were(81.2±9.5)min, (21.6±4.0)h, (67.3±8.2)mL and (4.4±1.3)d, all significantly shorter or less than [(93.4±10.6)min, (28.7±5.1)h, (87.5±9.3)mL and (6.6±1.7)d, respectively, P＜0.05] in group A; at admission for LC, serum bilirubin, ALT and AST levels in group B were (27.4±3.5)μmol/L, (65.1±7.0)U/L and (54.2±10.7)U/L, all much lower than [(46.7±3.8)μmol/L, (94.5±6.3)U/L and (83.6±10.2)U/L, respectively, P＜0.05] in group A; serum IL-6, CRP levels and white blood cell count in group B were (15.1±5.3)pg/mL, (9.6±2.4)mg/L and (8.9±1.6)×10⁹/L, all significantly lower than [(34.8±4.6)pg/mL, (19.3±2.1)mg/L and (13.6±3.2)×10⁹/L, respectively, P＜0.05] in group A; incidence of adverse effects after LC in group B was 12.0%, much lower than 30.0%(P＜0.05) in group A. Conclusion Timing of LC 2 months after PTGD has more advantages in the treatment of patients with ASC, which could shorten operation time, with less post-operational complications, and might be related to alleviation of body inflammatory reaction.

Key words: Acute severe cholecystitis, Percutaneous transhepatic gallbladder drainage, Laparoscopic cholecystectomy, Surgical timing, Therapy