腹腔镜与开腹胆囊切除对胃肠激素、炎症因子和血清淀粉酶的影响

The effect of laparoscopic cholecystectomy and traditional open cholecystectomy on gastrointestinal hormones,inflammatory factors and serum amylase in patients with acute calculous cholecystitis

目的评估腹腔镜胆囊切除术(LC)与传统开腹胆囊切除术治疗急性结石性胆囊炎(ACC)对胃肠激素、炎症因子以及血清淀粉酶的影响。方法选择2015年4月~2017年4月本院收治的ACC患者93例作为研究对象,根据治疗方式的不同将其分为LC组46例(给予LC治疗)和对照组47例(给予传统开腹胆囊切除术治疗),记录手术过程中各项指标、胃泌素(GAS)、胃动素(MTL)、肿瘤坏死因子-ɑ(TNF-ɑ)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C反应蛋白(CRP)及血清淀粉酶并进行比较。结果 LC组手术时间、术中出血量、肠鸣音恢复正常时间、术后肛门排气时间、术后首次排便时间、住院时间显著少于对照组,但LC组住院费用显著高于对照组,具有统计学差异(t值依次为3.691、4.274、5.179、3.458、3.132、3.533、2.919,均P<0.05);经手术治疗后,两组患者GAS、MTL均显著降低,TNF-ɑ、IL-6、IL-8、CRP以及血清淀粉酶均显著升高,具有统计学差异(均P<0.05);手术后LC组GAS、MTL显著高于对照组,TNF-ɑ、IL-6、IL-8、CRP以及血清淀粉酶均显著低于对照组,具有统计学差异(t值依次为3.138、2.863、6.262、2.964、5.137、4.681、8.765,均P<0.05);LC组手术并发症发生率4.35%(2/46)显著低于对照组12.77%(6/47),具有统计学差异(χ~2=4.657,P<0.05)。结论 LC治疗ACC疗效可靠,患者住院时间短、胃肠道功能恢复快、炎症因子水平改善明显,可降低术后并发症发生率,值得在临床进行推广应用。

Objective To discuss the effect of LC and traditional open cholecystectomy on gastrointestinal hormones, inflam- matory factors and serum amylase in patients with ACC. Methods A total of 93 patients with ACC in our hosipital form Apt 2015 to Apr 2017 were selected as the research object, according different treatment divided into LC group 46 cases （ treated with LC） and con- trol group group 47 cases （ treated with Traditional open cholecystectomy ）, recorded and compared the indicators of the operation proeess,GAS,MTL, TNF-o,IL-6,IL-8,CRP and serum amylase. Results The operation time, intraoperative blood loss, bowel sound recovery time, postoperative anal exhaust time, first defecation time after operation, hospitalization time of the LC group were signifi- cantly less than the control group, but hospitalization costs of LC group was significantly higher than the control group, with statistical difference（ the value of t were 3. 691,4. 274,5. 179,3.458,3. 132,3. 533,2. 919, respectively, all P 〈 0. 05 ） ; After surgical treat- ment, GAS and MTL of the two group were significantly decreased, TNF-α, IL-6, IL-g,CRP and serum amylase were increased signifi- cantly, with statistical difference （ P 〈 0.05 ） ; After the operation, the GAS and MTL of LC group were significantly higher than the control group, TNF-α, IL-6, IL-8, CRP and serum amylase of LC group were significantly lower than the control group, the difference were statistically significant （the value of t were 3. 138,2. 863, 6. 262,2. 964,5. 137,4. 681,8. 765 respectively,all P 〈0. 05 ）. The incidence of operative complications in LC group 4. 35% （2/46） was significantly lower than that in control group 12. 77% （6/47）, and there was statistical differeneex2 = 4. 657, P 〈 0. 05）. Conclusion LC for the treatment of ACC is reliable curative effect, can short hospitalization time, quick recovery of gastrointestinal function and obvious improvement of inflammatory factors. It can reduce the incidence of postoperative complications and is worthy of popularization and application in clinic.