Objective: To investigate the efficacy of the sequential therapy of percutaneous transhepatic gallbladder drainage (PTGBD) followed by laparoscopic cholecystectomy (LC) in treatment of acute cholecystitis (AC) and the timing selection. 
Methods: The clinical data of 582 patients with AC treated in the Department of Hepatobiliary Surgery of the Affiliated Hospital of Chengde Medical College from December 2010 to December 2018 were retrospectively analyzed. Of the patients, 456 cases underwent direct LC treatment (LC group) and 126 cases underwent  PTGBD before LC (sequential therapy group). According to the time from onset to operation, the patients were divided into early AC patients (≤7 d) and late AC patients (>7 d). Using propensity score matching method, 115 pairs of patients were selected, which included 62 pairs of early AC patients and 53 pairs of late AC patients. The main clinical variables between LC group and sequential therapy group in early and late AC patients were compared, respectively.
Results: In the early AC patients, the intraoperative blood loss, hospitalization cost and the operative time were reduced compared with those in sequential therapy group (all P<0.05), and no significant differences were noted in terms of open conversion and complication rates between the two group (both P>0.05). In late AC patients, the intraoperative blood loss, operative time and open conversion rate were increased, while the hospitalization cost was decreased in LC group than those in sequential therapy group (all P<0.05), and the incidence rates of complications showed no significant difference between the two groups (P<0.05).
Conclusion: LC alone treatment is superior to that of sequential therapy of PTGBD plus LC in AC patients with the time span from onset to operation ≤7 d, while the sequential treatment of PTGBD plus LC is safe and feasible in those with the time span from onset to operation >7 d.