急性坏疽性胆囊炎腹腔镜切除术对机体C反应蛋白,前白蛋白和胆红素的影响

Impact of Acute Gangrenous Cholecystitis with Laparoscopic Surgery on the Levels of C-reactive,Prealbumin and Bilirubin

目的观察急性坏疽性胆囊炎腹腔镜切除术的疗效,并观察此手术方法对机体血清C反应蛋白(CRP),前白蛋白(PA)和总胆红素(TBIL)的影响。方法选择2012年1月至2013年6月在上海市浦东新区周浦医院诊治的急性坏疽性胆囊炎患者113例,按照手术方式不同,分为腹腔镜胆囊切除术组(LC组)65例和开腹胆囊切除术组(OC组)48例。观察两组手术时间、术中出血量、术后视觉模拟评分法(VAS)评分和并发症发生率的情况,以及两组治疗前后CRP,PA和TBIL水平的变化。结果 LC组65例中3例中转开腹,中转率为4.62%,其并发症发生率为9.68%,OC组并发症发生率为27.08%,可见LC组并发症发生率明显低于OC组(P<0.05)。手术时间LC组较OC组延长,而术中出血率LC组较OC组明显减少(P<0.01),术后VAS评分和住院时间LC组明显低于OC组(P<0.01)。两组CRP和TBIL水平较治疗前均明显降低(P<0.01),PA水平较治疗前明显升高(P<0.01)。LC组的降低或者升高水平更为明显(P<0.01)。结论急性坏疽性胆囊炎腹腔镜切除术的疗效确切,具有创伤小、恢复快的特点。

Objective To observe the efficacy of acute gangrenous cholecystitis with laparoscopic surgery and its impact on the levels of C-reactive protein （CRP）, prealbumin （PA） and total bilirubin （TBIL）. Methods 113 patients with acute gangrenous cholecystitis, from January 2012 to June 2013, were divided laparoscopic cholecystectomy group （LC group, 65 cases） and open cholecys- tectomy surgery group （OC ,group, 48 cases） in accordance with the modus operandi. The operative time, blood loss, postoperative visual analog scale （VAS） score and incidence of complications were observed in each group; the levels of CRP, PA and TBIL were detected in two groups before and after treatment. Results The transit rate of LC group were 4.62% （3/65 cases）, the complication rate was 9.68% in LC group, it was significantly lower than 27.08% in OC group （P 〈0.05）. The operative time and blood loss was significantly longer or decreased than those in OC group （ P 〈 0.01 ） , while the VAS score and postoperative hospital stay were signifi- cantly lower compared with the OC group （P 〈 0.01 ）. After treatment, the levels of CRP, and TBIL were significantly lower than those before treatment （P 〈 0.01 ）, the PA level was significantly higher than those before treatment （P 〈 0.01 ）, while the reduced or ele- vated levels were more significant in LC group （P 〈 0.01 ）. Conclusions The efficacy of acute gangrenous cholecystitis with laparo- scopic surgery were obvious, with less trauma and quicker recovery, it may be associated with the levels of lower CRP, TBIL and ele-vated PA.