title: Efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients.
abstract: BACKGROUND
  Standards in treatment of acute cholecystitis (AC) in the elderly and high-risk patients has not been established. Our study evaluated the efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) in combination with laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) in elderly and high-risk patients.
  
  
  METHODS
  Our study enrolled 35 elderly and high-risk AC patients, hospitalized between January 2010 and April 2014 at the Wenzhou People's Hospital. The patients underwent B-mode ultrasound-guided PTGD and LC (PTGD + LC group). As controls, a separate group of 35 elderly and high-risk AC patients who underwent LC alone (LC group) during the same period at the same hospital were randomly selected from a pool of 186 such cases. The volume of bleeding, surgery time, postoperative length of stay, conversion rate to laparotomy and complication rates (bile leakage, bleeding, incisional hernia, incision infection, pulmonary infarction and respiratory failure) were recorded for each patient in the two groups.
  
  
  RESULTS
  All patients in the PTGD + LC group successfully underwent PTGD. In the PTGD + LC group, abdominal pain in patients was relieved and leukocyte count, alkaline phosphatase level, total bilirubin and carbohydrate antigen 19-9 (CA19-9) decreased to normal range, and alanine aminotransferase and aspartate aminotransferase levels improved significantly within 72 h after treatment. All patients in the PTGD + LC group underwent LC within 6-10 weeks after PTGD. Our study revealed that PTGD + LC showed a significantly higher efficacy and safety compared to LC alone in AC treatment, as measured by the following parameters: duration of operation, postoperative length of hospital stay, volume of bleeding, conversion rate to laparotomy and complication rate (operation time of LC: 55.6 ± 23.3 min vs. 91.35 ± 25.1 min; hospitalized period after LC: 3.0 ± 1.3 d vs. 7.0 ± 1.7 d; intraoperative bleeding: 28.7 ± 15.2 ml vs. 60.38 ± 16.4 ml; conversion to laparotomy: 3 cases vs. 10 cases; complication: 3 cases vs. 8 cases; all P < 0.05 ).
  
  
  CONCLUSIONS
  Our results suggest that B-mode ultrasound-guided PTGD in combination with LC is superior to LC alone for treatment of AC in elderly and high-risk patients, showing multiple advantages of minimal wounding, accelerated recovery, higher safety and efficacy, and fewer complications.
authors.affiliation: Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China. huyiren2014@163.com.
authors.forename: Yi-Ren
authors.initials: YR
authors.lastname: Hu
authors.affiliation: Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China. panjianghua2014@163.com.
authors.forename: Jiang-Hua
authors.initials: JH
authors.lastname: Pan
authors.affiliation: Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China. tongxiaochun2014@163.com.
authors.forename: Xiao-Chun
authors.initials: XC
authors.lastname: Tong
authors.affiliation: Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China. likeqin2014@163.com.
authors.forename: Ke-Qin
authors.initials: KQ
authors.lastname: Li
authors.affiliation: Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China. chensenrui2014@126.com.
authors.forename: Sen-Rui
authors.initials: SR
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China. huangyi1029@126.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging / Q000601:surgery*; D003131:Combined Modality Therapy; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000601:surgery; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*