腹腔镜手术治疗急性胆囊炎的疗效及对血清细胞间黏附分子-1、人基质金属蛋白酶-9和血管内皮生长因子的影响

Curative effect of laparoscopic surgery in the treatment of acute cholecystitis and its effect on ICAM-1,MMP-9 and VEGF

目的探讨腹腔镜手术治疗急性胆囊炎的疗效及对血清细胞间黏附分子-1(intercellular cell adhesion molecule-1,ICAM-1)、人基质金属蛋白酶-9(proteins of the matrix metalloproteinase-9,MMP-9)和血管内皮生长因子(vascular endothelial growth factor,VEGF)的影响。方法急性胆囊炎病人100例,采取随机数字表法将其分为两组,腹腔镜胆囊切除组(LC组) 50例,给予腹腔镜胆囊切除手术;开腹胆囊切除组(OC组) 50例,给予开腹胆囊切除术治疗。对照组50例,为健康体检者。观察两组病人临床疗效、术后并发症及治疗前后血清ICAM-1、MMP-9和VEGF水平变化。结果 LC组手术时间(48. 34±10. 50)分钟、术中出血量(51. 36±7. 42) ml、肠道功能恢复时间(43. 47±5. 62)小时,术后住院时间(4. 89±1. 06)天; OC组分别为(73. 91±11. 68)分钟、(92. 45±8. 63) ml、(71. 59±8. 15)小时和(9. 12±1. 45)天,两组比较差异有统计学意义(P <0. 05); LC组切口感染2例,胆管损伤0例,腹腔积液和吸入性肺炎各1例,并发症人数低于OC组(P <0. 05); LC组病人术后血清ICAM-1、MMP-9和VEGF含量分别为(0. 34±0. 04) ng/ml、(12. 08±1. 74) ng/ml和(164. 52±15. 74) pg/ml,OC组分别为(0. 40±0. 03) ng/ml、(15. 65±1. 68)ng/ml和(197. 86±15. 64) pg/ml,两组比较差异有统计学意义(P <0. 05)。结论腹腔镜手术治疗急性胆囊炎临床疗效好,术后并发症发生率低,可改善病人血清ICAM-1、MMP-9和VEGF的表达。

Objective To investigate the efficacy of laparoscopic surgery in the treatment of acute cholecystitis and its effects on intercellular adhesion molecule-1（ ICAM-1）,proteins of the matrix metalloproteinase-9（ MMP-9） and vascular endothelial growth factor（ VEGF）. Methods 100 patients with acute cholecystitis admitted to our hospital were divide them into two group with the random number table.50 cases were treated with laparoscopic cholecystectomy（ group LC） and other 50 cases were treated with open cholecystectomy（ group OC）. At the same time,50 healthy subjects were selected as the control group. The curative effect,postoperative complications,serum ICAM-1,MMP-9 and VEGF concentrations in patients before and after surgery were observed. Results The operation time（ 48. 34 ± 10. 50） min,intraoperative blood loss（ 51. 36 ± 7. 42） ml,intestinal function recovery time（ 43. 47 ± 5. 62） h and postoperative hospital stay（ 4. 89 ± 1. 06） d were significantly shorter in the LC group than in the OC group[（ 73. 91 ± 11. 68） min,（ 92. 45 ± 8. 63） ml,（ 71. 59 ± 8. 15） h and（ 9. 12 ± 1. 45） d,P〈0. 05]. The number of complications such as incision infection in 2 cases,0 cases of bile duct injury,1 case of ascites and 1 case of aspiration pneumonia in the LC group were significantly lower than those in the OC group（ P〈0. 05）. The serum levels of ICAM-1 was（ 0. 34 ± 0. 04） ng/m L,MMP-9 was（ 12. 08 ± 1. 74） ng/m L and VEGF was（ 164. 52 ± 15. 74） pg/m L were significantly lower in the LC group than in the OC group[（ 0. 40 ± 0. 03） ng/ml,（ 15. 65 ± 1. 68） ng/ml and（ 197. 86 ± 15. 64） pg/ml,P〈0. 05]. Conclusion Laparoscopic surgery has a good clinical efficacy in the treatment of acute cholecystitis,and the incidence of postoperative complications is low. It can effectively improve the expression of ICAM-1,MMP-9 and VEGF in patients.