Study on effects of percutaneous transhepatic gallbladder drainage in treatment of acute biliary pancreatitis

Abstract

Abstract:

ObjectiveTo evaluate retrospectively the clinical efficacy of percutaneous transhepatic gallbladder drainage (PTGBD) in the patients with acute biliary pancreatitis (ABP).MethodsA total of 244 patients with ABP recei-ving treatment in our department from January 2014 to November 2021 were included in this study. There were 76 cases in study group using PTGBD treatment, among them, 41 cases with performed endoscopic retrograde cholangiopancreatography (ERCP) after symptoms remission, and 168 cases without PTGBD in control group with 49 cases using ERCP and 119 cases with conservative treatment. The rate of post-ERCP pancreatitis (PEP) and postoperative adverse events were compared between two groups.ResultsThe rate of PEP was significantly lower in study group (11/41) than in control group (23/49), 26.8%vs.46.9%,P=0.008. The patients in both groups were performed cholecystectomy or cholecystectomy with bile duct drainage in late stage (73 cases in study group and 152 cases in control group). The shorter operative time [(76.3±28.3) minvs.(121.6±34.9) min,P=0.011], less intraoperative blood loss [(65.7±27.6) mLvs.(99.2±60.3) mL,P=0.028], shorter abdominal drainage duration [(3.6±2.5) dvs.(8.9±4.9) d,P=0.016] in study group than in control group. The rate of postoperative sepsis [2.7% (2 cases)vs.5.3% (8 cases),P=0.003], rate of reoperation [1.4%(1 case)vs.3.9%(6 cases),P<0.001], rate of admission to intensive care unit [4.1%(3 cases)vs.7.2%(11 cases),P=0.028], and mortality [0vs.1.3% (2 cases),P<0.001] in study group were lower than those in control group.ConclusionsPTGBD could be simple and effective in the treatment of ABP and consistent with treatment of damage control surgery which should be worthy clinical application.

Key words:Acute biliary pancreatitis,Percutaneous transhepatic gallbladder drainage,Adverse event

CLC Number:

ZHANG Zhen, HAN Jinyan, YU Xiaopeng, DENG Tianlin, WU Xiaodong, WU Shuodong. Study on effects of percutaneous transhepatic gallbladder drainage in treatment of acute biliary pancreatitis[J]. Journal of Surgery Concepts & Practice, 2023, 28(03): 260-266.

Figures/Tables3

Item	Control group (n=168)	Study group (n=76)	t/χ²value	Pvalue
Age (years) Gender [n(%)] Female Male Signs and symptoms Murphy sign [n(%)] Peritonitis [n(%)] Temperature (℃) Heart rate (times/min) SIRS [n(%)] Habits [n(%)] Drinking Smoking Disease history [n(%)] Surgical treatment Cardiovascular disease Neural disease Respiratory disease Diabetes Biochemical indexes WBC (×10⁹cells/L) HT (%) ALB (g/L) ALT (U/L) AST (U/L) ALP (U/L) GGT (U/L) TBIL (μmol/L) DBIL (μmol/L) SCr (μmol/L) Ca²⁺(mmol/L) INR AMY (U/L) LPS (U/L)	73±11 89 (53.0) 79 (47.0) 48 (28.6) 23 (13.7) 36.9±0.8 93±17 82 (48.1) 45 (26.8) 56(33.3) 86(51.2) 69(41.1) 27(16.1) 64(38.1) 20(11.9) 12.2±6.0 38.0±5.3 36.6±3.7 199±203 179±283 194±93 389±229 57.9±50.0 42.9±39.4 74.3±48.3 1.92±0.10 1.0±0.18 578.1±413.6 1296.5±1409.9	68±10 41 (53.9) 35 (46.1) 34 (44.7) 14 (18.4) 37.5±1.2 97±18 38 (50.0) 21 (27.6) 27 (35.5) 35 (46.1) 26 (34.2) 7 (9.2) 31 (40.8) 13 (17.1) 13.3±4.8 39.4±5.3 37.5±5.1 227±214 194±317 218±111 402±251 68.7±60.1 52.2±46.5 78.6±52.9 1.99±0.11 1.2±0.19 669.8±567.3 1 382.7±1 669.8	2.53 0.02 2.05 0.51 0.26 0.98 2.49 1.03 2.17 0.25 3.76 1.48 4.02 1.39 3.84 1.97 2.08 2.51 1.16 3.89 0.32 2.49 2.75 0.23 0.11 0.94 4.07 4.92	0.141 0.856 0.165 0.540 0.811 0.429 0.132 0.274 0.161 0.620 0.069 0.228 0.056 0.241 0.066 0.183 0.210 0.168 0.347 0.063 0.792 0.151 0.127 0.830 0.902 0.495 0.024 0.011

Tab 1

Outcomes	Control group (n=152)	Study group (n=73)	t/χ²value	Pvalue
LC/LCBDE[n(%)] LC to OC or LCBDE to OCBDE[n(%)] OC/OCBDE[n(%)] Operative time (min) Intraoperative blood loss (mL) Abdominal drainage time (d)	131(86.2) 13(8.6) 8(5.3) 121.6±34.9 99.2±60.3 8.9±4.9	70(95.9) 2(2.7) 1(1.4) 76.3±28.3 65.7±27.6 3.6±2.5	4.88 2.68 1.95 5.24 3.17 4.61	<0.001 <0.001 <0.001 0.011 0.028 0.016

Tab 2

Adverse events	Control group (n=152)	Study group (n=73)	χ² value	P value
Sepsis ICU Operation related injury Reoperation Cardiac dysfunction Respiratory dysfunction Renal dysfunction Nerve dysfunction Mortality	8(5.3) 11(7.2) 6(3.9) 6(3.9) 22(14.5) 26(17.1) 18(11.8) 9(5.9) 2(1.3)	2(2.7) 3(4.1) 2(2.7) 1(1.4) 8(11.0) 11(15.1) 8(11.0) 3(4.1) 0	0.74 0.83 0.21 1.09 0.53 0.15 0.04 0.32 0.97	0.003 0.028 0.332 <0.001 0.083 0.524 0.736 0.181 <0.001

Tab 3

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