经皮肝穿刺胆囊引流后择期行腹腔镜胆囊切除术在亚急性期急性胆囊炎中的临床疗效OA

Objective To investigate the clinical efficacy of elective laparoscopic cholecystectomy(LC)following percutaneous transhepatic gallbladder drainage(PTGD)under CT guidance in patients with subacute-phase acute cholecystitis(AC).Methods This retrospective study included 180 patients with moderate-to-severe subacute-phase AC admitted to Beijing Tongren Hospital between March 2021 and January 2025.Patients were divided into an observation group(n=98)and a control group(n=82)based on treatment modality.The observation group underwent PTGD under CT guidance followed by elective LC,while the control group received primary LC immediately after diagnosis.Perioperative clinical parameters,postoperative recovery outcomes,inflammation control levels,and complication incidence rates were comparatively analyzed between groups.Results Analysis demonstrated that,compared with the control group,the observation group exhibited significantly lower rate of conversion to open surgery,operation time,intraoperative blood loss,abdominal drainage volume,total time of hospitalization and total hospitalization cost(all P<0.05).Time to first flatus and time to resumption of oral intake were significantly shorter in the observation group,which also showed significantly reduced preoperative visual analog scale(VAS)before LC compared with the control group(all P<0.05).Intragroup comparison revealed decreasing trends in postoperative white blood cell(WBC),C-reactive protein(CRP),and procalcitonin(PCT)levels over time in both groups(F values for the observation group:62.041,428.402,202.965;F values for the control group:44.736,358.102,240.948;all P<0.01).Intergroup comparison showed:(1)WBC counts were significantly lower in the observation group on postoperative days 1 and 3(P=0.016,0.001);(2)CRP and PCT levels were significantly reduced in the observation group on postoperative days 1,3,and 5(all P<0.001).The incidences of perioperative complications including intra-abdominal infection,biliary tract infection,bile duct injury,and bile leakage were significantly lower in the observation group(all P<0.05),while no significant difference was observed in biliary hemorrhage or gastrointestinal injury between the two groups(P>0.05).Conclusion For subacute-phase AC management,the staged approach combining CT-guided PTGD followed by elective LC offers significant advantages over primary LC,including reduced intraoperative hemorrhage,shortened operation and hospitalization durations,decreased perioperative complication incidence rates,and accelerated functional recovery.These findings provide evidence-based guidance for optimal timing of surgical intervention and individualized treatment strategies.