Comparison of the efficacy of emergency laparoscopic cholecystectomy and elective surgery after PTGBD for high-risk grade Ⅱ acute cholecystitis
Objective To evaluate the efficacy and safety of elective Lap-C after percutaneous transhepatic gallbladder drainage(PTGBD)and emergency laparoscopic cholecystectomy(Lap-C)for grade Ⅱ acute cholecystitis.Methods Totally 105 patients with high-risk grade Ⅱ acute cholecystitis were selected from January 2021 to January 2023.66 patients underwent emergency Lap-C surgery after onset,and 39 patients underwent elective Lap-C surgery after PTGBD treatment.The clinical data and surgical results of the two groups were compared,and the influencing fac-tors of perioperative complications were analyzed.Results Totally the male ratio,SCr and PCT levels in the emergency group were lower than those in the delay group.BMI,platelet levels,positive rates of vomiting and Murphy sign,ultra-sound gallbladder adhesion and increased gallbladder wall thickness were higher than those of the delay group.There were no significant differences in operation time,intraoperative blood loss,conversion to laparotomy,incidence of com-plications,postoperative extubation time,analgesic need and postoperative hospital stay between the two groups.Ad-vanced age and more intraoperative blood loss were independent risk factors for major perioperative complications,while CCI ≥6 or ASA-PS≥3 alone and emergency cholecystectomy were not risk factors.Conclusion Emergency Lap-C in high-risk patients with grade Ⅱ acute cholecystitis does not increase complications and length of hospital stay,and may be more beneficial than selective LC after PTGBD.
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