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.	中華醫學會外科學分會膽道外科學組. 急性膽道系統感染的診斷和治療指南(2021版). 中華外科雜志, 2021, 59(6): 422-429.
2.	馬勝海, 王悅華, 劉東斌, 等. 老年急性膽囊炎的診療進展. 腹腔鏡外科雜志, 2020, 25(6): 467-470.
3.	張宗明, 趙月, 林方才, 等. 高齡膽道疾病患者圍手術期安全防治措施. 中華肝膽外科雜志, 2020, 26(2): 108-114.
4.	李征, 鄭亞民. 急性膽囊炎東京指南與歐洲世界急診外科協會指南的比較. 中華肝膽外科雜志, 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.	張崇, 沈思思, 王明輝, 等. 直接行腹腔鏡膽囊切除術與聯合經皮經肝膽囊穿刺引流治療急性重癥膽囊炎的薈萃分析. 中華肝膽外科雜志, 2019, 25(12): 910-914.
8.	楊佳, 閆沛靜, 司牟博, 等. 腹腔鏡膽囊切除術后放置腹腔引流隨機對照試驗的Meta分析. 腹腔鏡外科雜志, 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.	韓景釗, 脫紅芳, 王澤普, 等. 經皮膽囊造瘺術治療急性膽囊炎的研究進展. 臨床肝膽病雜志, 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.	劉洪, 甘雪梅, 熊杰, 等. PTGBD序貫早期LC治療老年高危中度急性膽囊炎的療效研究. 中國普外基礎與臨床雜志, 2020, 27(11): 1365-1370.
13.	史國星, 楊菲, 張云昌. 經皮肝膽囊穿刺置管引流術治療創傷后中重度急性非結石性膽囊炎. 肝膽胰外科雜志, 2022, 34(3): 134-137.
14.	宋黎明, 李學民, 楊鵬生. 經皮經肝膽囊穿刺引流術后序貫行LC治療急性膽囊炎手術時機的探討. 中華肝膽外科雜志, 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.	鄒玉鋒, 于意, 王達, 等. Ⅱ~Ⅲ級急性膽囊炎穿刺引流術后腹腔鏡膽囊切除手術時機的多中心隨機對照研究. 中華肝膽外科雜志, 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.	吳鋼, 蔡端. 急性膽囊炎的膽囊引流方法及引流后擇期LC的手術時機. 肝膽胰外科雜志, 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, 劉翀, 何靜妮, 等. 急性膽囊炎經皮經肝膽囊穿刺引流術后擇期腔鏡膽囊切除術最佳時間的選擇. 中國普通外科雜志, 2022, 31(2): 176-183.
21.	陳達偉, 張芳霞, 劉雙海. 經皮經肝膽囊穿刺引流術后行腹腔鏡膽囊切除術的手術時機. 肝膽胰外科雜志, 2021, 33(1): 36-38.
22.	張樹彬, 周新博, 馮峰, 等. 基于加速康復外科理念的腹腔鏡胰十二指腸切除術腹腔引流管拔管指征的臨床價值研究. 中華肝膽外科雜志, 2022, 28(4): 250-253.
23.	尤和誼, 蔣飛照, 鄭志海. 腹腔鏡膽總管探查T管引流后竇道形成的觀察. 肝膽胰外科雜志, 2019, 31(6): 366-367, 373.
24.	劉亞奇, 許方婧偉, 王欣, 等. 急性期膽囊穿刺引流后擇期腹腔鏡膽囊切除術治療膽囊炎的效果評價. 中華普通外科雜志, 2022, 37(6): 430-433.
25.	段希斌, 李學民, 馬超, 等. 高齡急性重癥膽囊炎患者PTGBD術后LC手術時機選擇. 中國現代普通外科進展, 2022, 25(3): 207-209, 213.
26.	全國細菌耐藥監測網. 全國細菌耐藥監測網2014–2019年膽汁細菌耐藥監測報告. 中國感染控制雜志, 2021, 20(1): 76-84.
27.	吳自友, 吳向嵩, 姚文衍, 等. 急性膽道感染患者膽汁病原菌分布及耐藥率變遷. 中華外科雜志, 2021, 59(1): 24-31.

1. 中華醫學會外科學分會膽道外科學組. 急性膽道系統感染的診斷和治療指南(2021版). 中華外科雜志, 2021, 59(6): 422-429.
2. 馬勝海, 王悅華, 劉東斌, 等. 老年急性膽囊炎的診療進展. 腹腔鏡外科雜志, 2020, 25(6): 467-470.
3. 張宗明, 趙月, 林方才, 等. 高齡膽道疾病患者圍手術期安全防治措施. 中華肝膽外科雜志, 2020, 26(2): 108-114.
4. 李征, 鄭亞民. 急性膽囊炎東京指南與歐洲世界急診外科協會指南的比較. 中華肝膽外科雜志, 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. 張崇, 沈思思, 王明輝, 等. 直接行腹腔鏡膽囊切除術與聯合經皮經肝膽囊穿刺引流治療急性重癥膽囊炎的薈萃分析. 中華肝膽外科雜志, 2019, 25(12): 910-914.
8. 楊佳, 閆沛靜, 司牟博, 等. 腹腔鏡膽囊切除術后放置腹腔引流隨機對照試驗的Meta分析. 腹腔鏡外科雜志, 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. 韓景釗, 脫紅芳, 王澤普, 等. 經皮膽囊造瘺術治療急性膽囊炎的研究進展. 臨床肝膽病雜志, 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. 劉洪, 甘雪梅, 熊杰, 等. PTGBD序貫早期LC治療老年高危中度急性膽囊炎的療效研究. 中國普外基礎與臨床雜志, 2020, 27(11): 1365-1370.
13. 史國星, 楊菲, 張云昌. 經皮肝膽囊穿刺置管引流術治療創傷后中重度急性非結石性膽囊炎. 肝膽胰外科雜志, 2022, 34(3): 134-137.
14. 宋黎明, 李學民, 楊鵬生. 經皮經肝膽囊穿刺引流術后序貫行LC治療急性膽囊炎手術時機的探討. 中華肝膽外科雜志, 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. 鄒玉鋒, 于意, 王達, 等. Ⅱ~Ⅲ級急性膽囊炎穿刺引流術后腹腔鏡膽囊切除手術時機的多中心隨機對照研究. 中華肝膽外科雜志, 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. 吳鋼, 蔡端. 急性膽囊炎的膽囊引流方法及引流后擇期LC的手術時機. 肝膽胰外科雜志, 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, 劉翀, 何靜妮, 等. 急性膽囊炎經皮經肝膽囊穿刺引流術后擇期腔鏡膽囊切除術最佳時間的選擇. 中國普通外科雜志, 2022, 31(2): 176-183.
21. 陳達偉, 張芳霞, 劉雙海. 經皮經肝膽囊穿刺引流術后行腹腔鏡膽囊切除術的手術時機. 肝膽胰外科雜志, 2021, 33(1): 36-38.
22. 張樹彬, 周新博, 馮峰, 等. 基于加速康復外科理念的腹腔鏡胰十二指腸切除術腹腔引流管拔管指征的臨床價值研究. 中華肝膽外科雜志, 2022, 28(4): 250-253.
23. 尤和誼, 蔣飛照, 鄭志海. 腹腔鏡膽總管探查T管引流后竇道形成的觀察. 肝膽胰外科雜志, 2019, 31(6): 366-367, 373.
24. 劉亞奇, 許方婧偉, 王欣, 等. 急性期膽囊穿刺引流后擇期腹腔鏡膽囊切除術治療膽囊炎的效果評價. 中華普通外科雜志, 2022, 37(6): 430-433.
25. 段希斌, 李學民, 馬超, 等. 高齡急性重癥膽囊炎患者PTGBD術后LC手術時機選擇. 中國現代普通外科進展, 2022, 25(3): 207-209, 213.
26. 全國細菌耐藥監測網. 全國細菌耐藥監測網2014–2019年膽汁細菌耐藥監測報告. 中國感染控制雜志, 2021, 20(1): 76-84.
27. 吳自友, 吳向嵩, 姚文衍, 等. 急性膽道感染患者膽汁病原菌分布及耐藥率變遷. 中華外科雜志, 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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