腹腔镜与开腹胆囊切除治疗急性结石性胆囊炎的临床分析

Clinical analysis of laparoscopic and open cholecystectomy in treatment of acute calculous cholecystitis

目的探讨腹腔镜与开腹胆囊切除治疗急性结石性胆囊炎的临床疗效及对机体炎症反应的影响。方法回顾性分析2015年1月至2017年6月收治的117例急性结石性胆囊炎的临床资料,根据手术方式分为腹腔镜组(61例)和开腹组(56例),采用SPSS17.0软件对所有临床数据进行统计学分析,两组患者术前术后各项指标、疼痛视觉模拟评分(VSA)及炎症相关指标等计量资料以(±s)表示,采用独立t检验;全身炎症反应综合征(SIRS)发生率及并发症发生率等组间比较采用χ~2检验,均以P<0.05为差异有统计学意义。结果腹腔镜组患者手术时间、切口长度、术中出血量、肛门首次排气时间、VSA评分、下床活动时间、恢复饮食时间以及平均住院时间均明显优于开腹组(均P<0.05);两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。腹腔镜组患者术后1 d、3 d、5 d的血清中C-反应蛋白(CRP)、白介素-6(IL-6)水平和7 d内全身炎症反应综合征(SIRS)发生率均明显低于开腹组(P<0.05)。结论腹腔镜胆囊切除治疗急性结石性胆囊炎是安全可行的,具有手术时间短、术中出血少、术后恢复快及炎症反应轻的优势,值得在临床中进一步推广应用。

Objective To investigate the clinical efficacy and impacts on inflammatory reaction of laparoscopic and open cholecystectomy in treatment of acute calculous cholecystitis. Methods Clinical data of 117 patients with acute calculous cholecystitis from January 2015 to June 2017 were analyzed retrospectively. In these patients,61 patients were allocated in the laparoscopic group and 56 patients in the open group. Statistical analysis was performed by using SPSS17. 0 software. Perioperative measurement data and score of visual analogue scale（ VAS） and inflammatory reaction related indicators were expressed as（X± s）,and were examined by using t test. The SIRS rate and postoperative complication rate was examined by Chi-square test,P〈0. 05 was considered as statistically significant difference. Results The operation time,length of incision,intraoperative blood loss,first anal exhaust time,VAS score,ground activity time,diet recovery time and average hospitalization time in laparoscopic group were significantly better than those in open group（ P〈0. 05）; There was no significant difference of postoperative complication rate between the two groups（ P〉0. 05）. The levels of CRP,IL-6 in serum at 1 st,3 rd,5 th day and SIRS rate within 7 days after the operation in laparoscopic group were significantly lower than those in open group（ P〈0. 05）.Conclusion Laparoscopic cholecystectomy in treatment of acute calculous cholecystitis is feasible and safe with the advantage of shorter operative time,less intraoperative bleeding,faster postoperative recovery and light inflammatory reaction,which is valuable to be applied in clinic.