Optimal surgical timing for sequential laparoscopic cholecystectomy following percutaneous cholecystostomy for acute cholecystitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Yu , WANG Yiming , WANG Hai , Ashat Kwantai ,  CHEN Kai

1. Department of Hepatobiliary Pancreatic Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, P. R. China;

Corresponding author：

CHEN Kai, Email: 289090306@qq.com

Keywords：

acute cholecystitis; percutaneous cholecystostomy; laparoscopic cholecystectomy; surgical timing

DOI：

10.7507/1007-9424.202308013

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the optimal surgical timing of sequential laparoscopic cholecystectomy (LC) following percutaneous cholecystostomy (PC) in the patients with acute cholecystitis, so as to provide a clinical reference. Methods The patients who underwent PC and then sequential LC in the Fifth Affiliated Hospital of Xinjiang Medical University from March 2021 to July 2023 were selected based on the inclusion and exclusion criteria, who were categorized into 3 groups: the short interval group (3–4 weeks), the intermediate interval group (5–8 weeks), and the long interval group (>8 weeks) based on the time interval between the PC and LC. The gallbladder wall thickness before LC, operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs were compared among the 3 groups. Results A total of 99 patients were enrolled, including 25 in the short interval group, 41 in the intermediate interval group, and 33 in the long interval group. The data of patients among the 3 groups including demographic characteristics, blood routine, C-reactive protein, interleukin-6, fibrinogen, international standardized ratio, liver function indicators, and comorbidities had no statistical differences (P>0.05). The gallbladder wall thickness before LC and the operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs during and after LC had statistical differences among the 3 groups (P<0.05). These indicators of the intermediate interval group were better than those of the other two groups by the multiple comparisons (P<0.05), but which had no statistical differences except total hospitalization costs (P=0.019) between the short interval group and the long interval group (P>0.05). Conclusion According to the results of this study, the optimal surgical timing of sequential LC following PC is 5–8 weeks, however, which needs to be further validated by large sample size and multicenter data.

Citation： ZHANG Yu, WANG Yiming, WANG Hai, Ashat Kwantai, CHEN Kai. Optimal surgical timing for sequential laparoscopic cholecystectomy following percutaneous cholecystostomy for acute cholecystitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(1): 80-84. doi: 10.7507/1007-9424.202308013 Copy

1.	中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南(2021版). 中华外科杂志, 2021, 59(6): 422-429.
2.	马胜海, 王悦华, 刘东斌, 等. 老年急性胆囊炎的诊疗进展. 腹腔镜外科杂志, 2020, 25(6): 467-470.
3.	张宗明, 赵月, 林方才, 等. 高龄胆道疾病患者围手术期安全防治措施. 中华肝胆外科杂志, 2020, 26(2): 108-114.
4.	李征, 郑亚民. 急性胆囊炎东京指南与欧洲世界急诊外科协会指南的比较. 中华肝胆外科杂志, 2021, 27(11): 875-880.
5.	Karakas HM, Yildirim G, Fersahoglu MM, et al. Percutaneous cholecystostomy: an update for the 2020s. North Clin Istanb, 2021, 8(5): 537-542.
6.	Sakamoto T, Fujiogi M, Matsui H, et al. Timing of cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis: a nationwide inpatient database study. HPB (Oxford), 2020, 22(6): 920-926.
7.	张崇, 沈思思, 王明辉, 等. 直接行腹腔镜胆囊切除术与联合经皮经肝胆囊穿刺引流治疗急性重症胆囊炎的荟萃分析. 中华肝胆外科杂志, 2019, 25(12): 910-914.
8.	杨佳, 闫沛静, 司牟博, 等. 腹腔镜胆囊切除术后放置腹腔引流随机对照试验的Meta分析. 腹腔镜外科杂志, 2019, 24(6): 433-441.
9.	Okamoto K, Suzuki K, Takada T, et al. Tokyo guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci, 2018, 25(1): 55-72.
10.	韩景钊, 脱红芳, 王泽普, 等. 经皮胆囊造瘘术治疗急性胆囊炎的研究进展. 临床肝胆病杂志, 2021, 37(8): 1983-1987.
11.	Kokoroskos N, Peponis T, Lee JM, et al. Gallbladder wall thickness as a predictor of intraoperative events during laparoscopic cholecystectomy: a prospective study of 1 089 patients. Am J Surg, 2020, 220(4): 1031-1037.
12.	刘洪, 甘雪梅, 熊杰, 等. PTGBD序贯早期LC治疗老年高危中度急性胆囊炎的疗效研究. 中国普外基础与临床杂志, 2020, 27(11): 1365-1370.
13.	史国星, 杨菲, 张云昌. 经皮肝胆囊穿刺置管引流术治疗创伤后中重度急性非结石性胆囊炎. 肝胆胰外科杂志, 2022, 34(3): 134-137.
14.	宋黎明, 李学民, 杨鹏生. 经皮经肝胆囊穿刺引流术后序贯行LC治疗急性胆囊炎手术时机的探讨. 中华肝胆外科杂志, 2021, 27(10): 753-756.
15.	Cirocchi R, Amato L, Ungania S, et al. Management of acute cholecystitis in high-risk patients: percutaneous gallbladder drainage as a definitive treatment vs. emergency cholecystectomy-systematic review and meta-analysis. J Clin Med, 2023, 12(15): 4903.
16.	邹玉锋, 于意, 王达, 等. Ⅱ~Ⅲ级急性胆囊炎穿刺引流术后腹腔镜胆囊切除手术时机的多中心随机对照研究. 中华肝胆外科杂志, 2022, 28(7): 515-519.
17.	Woodward SG, Rios-Diaz AJ, Zheng R, et al. Finding the most favorable timing for cholecystectomy after percutaneous cholecystostomy tube placement: an analysis of institutional and national data. J Am Coll Surg, 2021, 232(1): 55-64.
18.	吴钢, 蔡端. 急性胆囊炎的胆囊引流方法及引流后择期LC的手术时机. 肝胆胰外科杂志, 2023, 35(2): 65-70.
19.	Liu P, Liu C, Wu YT, et al. Impact of B-mode-ultrasound-guided transhepatic and transperitoneal cholecystostomy tube placement on laparoscopic cholecystectomy. World J Gastroenterol, 2020, 26(36): 5498-5507.
20.	殷鑫, 刘翀, 何静妮, 等. 急性胆囊炎经皮经肝胆囊穿刺引流术后择期腔镜胆囊切除术最佳时间的选择. 中国普通外科杂志, 2022, 31(2): 176-183.
21.	陈达伟, 张芳霞, 刘双海. 经皮经肝胆囊穿刺引流术后行腹腔镜胆囊切除术的手术时机. 肝胆胰外科杂志, 2021, 33(1): 36-38.
22.	张树彬, 周新博, 冯峰, 等. 基于加速康复外科理念的腹腔镜胰十二指肠切除术腹腔引流管拔管指征的临床价值研究. 中华肝胆外科杂志, 2022, 28(4): 250-253.
23.	尤和谊, 蒋飞照, 郑志海. 腹腔镜胆总管探查T管引流后窦道形成的观察. 肝胆胰外科杂志, 2019, 31(6): 366-367, 373.
24.	刘亚奇, 许方婧伟, 王欣, 等. 急性期胆囊穿刺引流后择期腹腔镜胆囊切除术治疗胆囊炎的效果评价. 中华普通外科杂志, 2022, 37(6): 430-433.
25.	段希斌, 李学民, 马超, 等. 高龄急性重症胆囊炎患者PTGBD术后LC手术时机选择. 中国现代普通外科进展, 2022, 25(3): 207-209, 213.
26.	全国细菌耐药监测网. 全国细菌耐药监测网2014–2019年胆汁细菌耐药监测报告. 中国感染控制杂志, 2021, 20(1): 76-84.
27.	吴自友, 吴向嵩, 姚文衍, 等. 急性胆道感染患者胆汁病原菌分布及耐药率变迁. 中华外科杂志, 2021, 59(1): 24-31.

1. 中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南(2021版). 中华外科杂志, 2021, 59(6): 422-429.
2. 马胜海, 王悦华, 刘东斌, 等. 老年急性胆囊炎的诊疗进展. 腹腔镜外科杂志, 2020, 25(6): 467-470.
3. 张宗明, 赵月, 林方才, 等. 高龄胆道疾病患者围手术期安全防治措施. 中华肝胆外科杂志, 2020, 26(2): 108-114.
4. 李征, 郑亚民. 急性胆囊炎东京指南与欧洲世界急诊外科协会指南的比较. 中华肝胆外科杂志, 2021, 27(11): 875-880.
5. Karakas HM, Yildirim G, Fersahoglu MM, et al. Percutaneous cholecystostomy: an update for the 2020s. North Clin Istanb, 2021, 8(5): 537-542.
6. Sakamoto T, Fujiogi M, Matsui H, et al. Timing of cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis: a nationwide inpatient database study. HPB (Oxford), 2020, 22(6): 920-926.
7. 张崇, 沈思思, 王明辉, 等. 直接行腹腔镜胆囊切除术与联合经皮经肝胆囊穿刺引流治疗急性重症胆囊炎的荟萃分析. 中华肝胆外科杂志, 2019, 25(12): 910-914.
8. 杨佳, 闫沛静, 司牟博, 等. 腹腔镜胆囊切除术后放置腹腔引流随机对照试验的Meta分析. 腹腔镜外科杂志, 2019, 24(6): 433-441.
9. Okamoto K, Suzuki K, Takada T, et al. Tokyo guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci, 2018, 25(1): 55-72.
10. 韩景钊, 脱红芳, 王泽普, 等. 经皮胆囊造瘘术治疗急性胆囊炎的研究进展. 临床肝胆病杂志, 2021, 37(8): 1983-1987.
11. Kokoroskos N, Peponis T, Lee JM, et al. Gallbladder wall thickness as a predictor of intraoperative events during laparoscopic cholecystectomy: a prospective study of 1 089 patients. Am J Surg, 2020, 220(4): 1031-1037.
12. 刘洪, 甘雪梅, 熊杰, 等. PTGBD序贯早期LC治疗老年高危中度急性胆囊炎的疗效研究. 中国普外基础与临床杂志, 2020, 27(11): 1365-1370.
13. 史国星, 杨菲, 张云昌. 经皮肝胆囊穿刺置管引流术治疗创伤后中重度急性非结石性胆囊炎. 肝胆胰外科杂志, 2022, 34(3): 134-137.
14. 宋黎明, 李学民, 杨鹏生. 经皮经肝胆囊穿刺引流术后序贯行LC治疗急性胆囊炎手术时机的探讨. 中华肝胆外科杂志, 2021, 27(10): 753-756.
15. Cirocchi R, Amato L, Ungania S, et al. Management of acute cholecystitis in high-risk patients: percutaneous gallbladder drainage as a definitive treatment vs. emergency cholecystectomy-systematic review and meta-analysis. J Clin Med, 2023, 12(15): 4903.
16. 邹玉锋, 于意, 王达, 等. Ⅱ~Ⅲ级急性胆囊炎穿刺引流术后腹腔镜胆囊切除手术时机的多中心随机对照研究. 中华肝胆外科杂志, 2022, 28(7): 515-519.
17. Woodward SG, Rios-Diaz AJ, Zheng R, et al. Finding the most favorable timing for cholecystectomy after percutaneous cholecystostomy tube placement: an analysis of institutional and national data. J Am Coll Surg, 2021, 232(1): 55-64.
18. 吴钢, 蔡端. 急性胆囊炎的胆囊引流方法及引流后择期LC的手术时机. 肝胆胰外科杂志, 2023, 35(2): 65-70.
19. Liu P, Liu C, Wu YT, et al. Impact of B-mode-ultrasound-guided transhepatic and transperitoneal cholecystostomy tube placement on laparoscopic cholecystectomy. World J Gastroenterol, 2020, 26(36): 5498-5507.
20. 殷鑫, 刘翀, 何静妮, 等. 急性胆囊炎经皮经肝胆囊穿刺引流术后择期腔镜胆囊切除术最佳时间的选择. 中国普通外科杂志, 2022, 31(2): 176-183.
21. 陈达伟, 张芳霞, 刘双海. 经皮经肝胆囊穿刺引流术后行腹腔镜胆囊切除术的手术时机. 肝胆胰外科杂志, 2021, 33(1): 36-38.
22. 张树彬, 周新博, 冯峰, 等. 基于加速康复外科理念的腹腔镜胰十二指肠切除术腹腔引流管拔管指征的临床价值研究. 中华肝胆外科杂志, 2022, 28(4): 250-253.
23. 尤和谊, 蒋飞照, 郑志海. 腹腔镜胆总管探查T管引流后窦道形成的观察. 肝胆胰外科杂志, 2019, 31(6): 366-367, 373.
24. 刘亚奇, 许方婧伟, 王欣, 等. 急性期胆囊穿刺引流后择期腹腔镜胆囊切除术治疗胆囊炎的效果评价. 中华普通外科杂志, 2022, 37(6): 430-433.
25. 段希斌, 李学民, 马超, 等. 高龄急性重症胆囊炎患者PTGBD术后LC手术时机选择. 中国现代普通外科进展, 2022, 25(3): 207-209, 213.
26. 全国细菌耐药监测网. 全国细菌耐药监测网2014–2019年胆汁细菌耐药监测报告. 中国感染控制杂志, 2021, 20(1): 76-84.
27. 吴自友, 吴向嵩, 姚文衍, 等. 急性胆道感染患者胆汁病原菌分布及耐药率变迁. 中华外科杂志, 2021, 59(1): 24-31.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Optimal surgical timing for sequential laparoscopic cholecystectomy following percutaneous cholecystostomy for acute cholecystitis

Abstract Full text Figures/Tables Video References Cited by

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