Effect of Sequentially Mini-Invasive Method for Elderly Acute Calculous Cholecystitis Patients Combined with Organ Dysfunction Syndrome_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIJun , CHENZhong-hao , WANGZhi-qiang

Department of General Surgery, Tong Ren Hospital, Jiao Tong University School of Medicine, Shanghai 200336, China;

Corresponding author：

LIJun, Email: upinarm@163.com

Keywords：

Acute calculous cholecystitis; Organ dysfunction syndrome; Percutaneous transhepatic gallbladder drainage; Laparoscopic cholecystectomy; Effect

DOI：

10.7507/1007-9424.20150280

Video：

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Objective To explore the curative effect and the appropriate time of sequentially with minimal invasive methods in treatment of elderly acute calculous cholecystitis patients combined with organ dysfunction syndrome (ODS). Methods Clinical data of 67 elderly acute calculous cholecystitis patients combined with ODS who received treatment in our hospital from December 2010 to December 2013 were collected retrospectively. All of the 67 patients were treated with percutaneous transhepatic gallbladder drainage (PTGBD) under the guidance of B ultrasound or CT at first, as well as systemic anti infective therapy, and then underwent laparoscopic cholecystectomy (LC) sequentially when situation of body got well. Results All of the 67 patients (100%) were treated with PTGBD successfully, but only 65 patients finished the latter related test. For the 65 patients, compared with before PTGBD, the patient's pain, abdominal distention, vomiting, leukocyte count, neutrophil ratio, glutamic-pyruvic transaminase, total bilirubin, C-reactive protein, and temperature had gotten obviously better on 1 and 4 d after PTGBD (P<0.05). There were 3 patients dropped LC, 2 patients transferred to mini-incision cholecystectomy, and the rest of 60 patients underwent LC successfully. All of the patients recovery and discharged from hospital in 2-7 days after operation. Conclusion Sequentially mini-invasive method is a simple, easy, safe, effective, mini trauma, and quick recovery method for the elderly acute cholecystitis patients combined with the ODS.

Citation： LIJun, CHENZhong-hao, WANGZhi-qiang. Effect of Sequentially Mini-Invasive Method for Elderly Acute Calculous Cholecystitis Patients Combined with Organ Dysfunction Syndrome. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(9): 1073-1077. doi: 10.7507/1007-9424.20150280 Copy

1.	许军, 翟博, 关英辉, 等. 急性胆囊炎腹腔镜手术时机选择. 中国实用外科杂志, 2011, 31(6):511-513.
2.	王庚壮, 李霆, 石利国. 老年急性胆囊炎手术时机和方式的选择. 中国老年学杂志, 2013, 33(6):1272-1274.
3.	吴在德,吴肇汉. 外科学. 第7版,北京:人民卫生出版社,2008:46-64.
4.	Na BG, Yoo YS, Mun SP, et al. The safety and efficacy of percutan-eous transhepatic gallbladder drainage in elderly patients with acute cholecystitis before laparoscopic cholecystectomy. Ann Surgical Treat Res, 2015, 89(2):68-73.
5.	吕海龙, 姜玉峰, 彭心宇, 等. 经皮经肝胆囊穿刺置管引流术后并发症的防治. 中国普通外科杂志, 2012, 21(2):235-237.
6.	Morse BC, Smith JB, Lawdahl RB, et al. Management of acute cholec-ystitis in critically ill patients:contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg, 2010, 76(7):708-712.
7.	Yokoe M, Takada T, Strasberg SM, et al. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci, 2012, 19(5):578-585.
8.	李军, 张辉, 朱雷鸣, 等. 急性结石性胆囊炎行LC术难易程度的相关因素分析. 中国普通外科杂志, 2009, 18(8):782-785.
9.	Choi SB, Han HJ, Kim CY, et al. Early laparoscopic cholecystectomy is the appropriate management for acute gangrenous cholecystitis. Am Surg, 2011, 77(4):401-406.
10.	Lee SI, Na BG, Yoo YS, et al. Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients. Ann Surg Treat Res, 2015, 88(3):145-151.
11.	Kuy S, Sosa JA, Roman SA, et al. Age matters:a study of clinical and economic outcomes following cholecystectomy in elderly Americans. Am J Surg, 2011, 201(6):789-796.
12.	Kim IG, Kim JS, Jeon JY, et al. Percutaneous transhepatic gallbladder drainage changes emergency laparoscopic cholecystectomy to an elective operation in patients with acute cholecystitis. J Laparoendosc Adv Surg Tech A, 2011, 21(10):941-946.
13.	Komatsu S, Tsukamoto T, Iwasaki T, et al. Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis. J Dig Dis, 2014, 15(12):669-675.
14.	李正起, 陈灵丽. PTGD治疗急性胆囊炎的临床疗效观察. 海南医学院学报, 2012, 18(1):71-73.
15.	张辉, 陈琪, 王涛, 等. 胆囊穿刺造瘘后双通道胆道镜保胆取石与腹腔镜胆囊切除术治疗老年患者结石性胆囊炎疗效的比较. 中国微创外科杂志, 2014, 20(12):1092-1096.
16.	Kuhn JP, Busemann A, Lerch MM, et al. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts. ATR AM J Roentgenol, 2010, 195(4):851-857.
17.	Chang YR, Ahn YJ, Jang JY, et al. Percutaneous cholecystostomy for acute cholecystitis in patients with high comorbidity and reeva-luation of treatment efficacy. Surgery, 2014, 155(4):615-622.
18.	朱斌, 张展志, 张能维, 等. 急性胆囊炎"延期"腹腔镜胆囊切除的手术技巧及并发症预防. 中华肝胆外科杂志, 2011, 17(10):820-822.
19.	袁德汉, 陈应军, 卫洪波, 等. 腹腔镜胆囊切除术所致胆道损伤的相关危险因素分析. 中国内镜杂志, 2013, 19(5):492-495.
20.	谷化剑, 冯贤松, 辛小燕. 医源性胆道损伤的原因分析与防治策略. 中国普通外科杂志, 2013, 22(2):192-196..
21.	杨波, 周文平, 吕东文, 等. 经皮经肝胆囊穿刺引流术联合LC治疗伴发MODS的急性胆囊炎. 肝胆胰外科杂志, 2011, 23(5):411-412.
22.	Han IW, Jang JY, Kang MJ, et al. Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. J Hepatobiliary Pancreat Sci, 2012, 19(2):187-193.
23.	胡志鹏. PTGD联合LC治疗高原地区老年急性胆囊炎. 中国普通外科杂志, 2014, 23(8):1152-1153.
24.	于浩, 刘武, 姜洪磊, 等. 超声引导下经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗急性胆囊炎117例临床报道. 中国普外基础与临床杂志, 2014, 21(8):951-953.
25.	邵青龙, 李全福, 刘建辉, 等. PTGBD治疗高龄高危急性胆囊炎的应用. 肝胆外科杂志, 2011, 19(3):208-211.
26.	Khasawneh MA, Shamp A, Heller S, et al. Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube place-ment. J Trauma Acute Care Surg, 2015, 78(1):100-104.

1. 许军, 翟博, 关英辉, 等. 急性胆囊炎腹腔镜手术时机选择. 中国实用外科杂志, 2011, 31(6):511-513.
2. 王庚壮, 李霆, 石利国. 老年急性胆囊炎手术时机和方式的选择. 中国老年学杂志, 2013, 33(6):1272-1274.
3. 吴在德,吴肇汉. 外科学. 第7版,北京:人民卫生出版社,2008:46-64.
4. Na BG, Yoo YS, Mun SP, et al. The safety and efficacy of percutan-eous transhepatic gallbladder drainage in elderly patients with acute cholecystitis before laparoscopic cholecystectomy. Ann Surgical Treat Res, 2015, 89(2):68-73.
5. 吕海龙, 姜玉峰, 彭心宇, 等. 经皮经肝胆囊穿刺置管引流术后并发症的防治. 中国普通外科杂志, 2012, 21(2):235-237.
6. Morse BC, Smith JB, Lawdahl RB, et al. Management of acute cholec-ystitis in critically ill patients:contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg, 2010, 76(7):708-712.
7. Yokoe M, Takada T, Strasberg SM, et al. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci, 2012, 19(5):578-585.
8. 李军, 张辉, 朱雷鸣, 等. 急性结石性胆囊炎行LC术难易程度的相关因素分析. 中国普通外科杂志, 2009, 18(8):782-785.
9. Choi SB, Han HJ, Kim CY, et al. Early laparoscopic cholecystectomy is the appropriate management for acute gangrenous cholecystitis. Am Surg, 2011, 77(4):401-406.
10. Lee SI, Na BG, Yoo YS, et al. Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients. Ann Surg Treat Res, 2015, 88(3):145-151.
11. Kuy S, Sosa JA, Roman SA, et al. Age matters:a study of clinical and economic outcomes following cholecystectomy in elderly Americans. Am J Surg, 2011, 201(6):789-796.
12. Kim IG, Kim JS, Jeon JY, et al. Percutaneous transhepatic gallbladder drainage changes emergency laparoscopic cholecystectomy to an elective operation in patients with acute cholecystitis. J Laparoendosc Adv Surg Tech A, 2011, 21(10):941-946.
13. Komatsu S, Tsukamoto T, Iwasaki T, et al. Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis. J Dig Dis, 2014, 15(12):669-675.
14. 李正起, 陈灵丽. PTGD治疗急性胆囊炎的临床疗效观察. 海南医学院学报, 2012, 18(1):71-73.
15. 张辉, 陈琪, 王涛, 等. 胆囊穿刺造瘘后双通道胆道镜保胆取石与腹腔镜胆囊切除术治疗老年患者结石性胆囊炎疗效的比较. 中国微创外科杂志, 2014, 20(12):1092-1096.
16. Kuhn JP, Busemann A, Lerch MM, et al. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts. ATR AM J Roentgenol, 2010, 195(4):851-857.
17. Chang YR, Ahn YJ, Jang JY, et al. Percutaneous cholecystostomy for acute cholecystitis in patients with high comorbidity and reeva-luation of treatment efficacy. Surgery, 2014, 155(4):615-622.
18. 朱斌, 张展志, 张能维, 等. 急性胆囊炎"延期"腹腔镜胆囊切除的手术技巧及并发症预防. 中华肝胆外科杂志, 2011, 17(10):820-822.
19. 袁德汉, 陈应军, 卫洪波, 等. 腹腔镜胆囊切除术所致胆道损伤的相关危险因素分析. 中国内镜杂志, 2013, 19(5):492-495.
20. 谷化剑, 冯贤松, 辛小燕. 医源性胆道损伤的原因分析与防治策略. 中国普通外科杂志, 2013, 22(2):192-196..
21. 杨波, 周文平, 吕东文, 等. 经皮经肝胆囊穿刺引流术联合LC治疗伴发MODS的急性胆囊炎. 肝胆胰外科杂志, 2011, 23(5):411-412.
22. Han IW, Jang JY, Kang MJ, et al. Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. J Hepatobiliary Pancreat Sci, 2012, 19(2):187-193.
23. 胡志鹏. PTGD联合LC治疗高原地区老年急性胆囊炎. 中国普通外科杂志, 2014, 23(8):1152-1153.
24. 于浩, 刘武, 姜洪磊, 等. 超声引导下经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗急性胆囊炎117例临床报道. 中国普外基础与临床杂志, 2014, 21(8):951-953.
25. 邵青龙, 李全福, 刘建辉, 等. PTGBD治疗高龄高危急性胆囊炎的应用. 肝胆外科杂志, 2011, 19(3):208-211.
26. Khasawneh MA, Shamp A, Heller S, et al. Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube place-ment. J Trauma Acute Care Surg, 2015, 78(1):100-104.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Sequentially Mini-Invasive Method for Elderly Acute Calculous Cholecystitis Patients Combined with Organ Dysfunction Syndrome

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