不同手术方式对胆囊结石患者机体应激及炎性状态的影响比较

Effects of different surgical methods on physical stress and inflammatory status in patients with cholecystolithiasis: A comparative study

目的比较不同手术方式对胆囊结石患者机体应激及炎性状态的影响。方法将本院收治的70例胆囊结石患者根据手术方式不同分为传统开腹胆囊切除术组(对照组)和腹腔镜胆囊切除术组(观察组),比较2组患者术中情况、临床疗效、手术前后应激及炎性状态相关指标的变化。结果观察组术中出血量、手术时间、住院时间及排气时间均小于对照组(P<0.05);2组患者术后1 d血糖(BG)、C-反应蛋白(CRP)、血浆皮质醇(Cor)、肾上腺素(E)及血清炎性因子(TNF-α、IL-6、IL-8)均较术前明显上升,其中对照组各指标均高于观察组(P<0.05);术后7 d,2组患者各应激指标及血清炎性因子均较术后1 d明显下降,且观察组各指标明显低于对照组(P<0.05)。结论腹腔镜胆囊切除术能够明显降低患者术中创伤,减轻术后应激及炎症反应,较传统开腹胆囊切除术更为安全有效。

Objective To compare the effects of different surgical methods on the physical stress and inflammatory status in patients with cholecystolithiasis. Methods A total of 70 patients, who underwent cholecystolithiasis in our hospital, were included and divided into traditional open cholecystectomy group(control group) and laparoscopic cholecystectomy group(study group). The changes in the intraoperative conditions, clinical efficacy, stress and inflammatory status related indexes before and after operation were compared between the two groups. Results The blood loss, operation time, length of hospital stay, and time to exhaust in the study group were less than those in the control group(P<0.05). The levels of blood glucose(BG), C-reactive protein(CRP), plasma cortisol(Cor), epinephrine(E), and serum inflammatory factors(TNF-α, IL-6, IL-8) in the two groups at 1 d after operation significantly increased compared with those at the baseline, and the indexes in the control group were higher than those in the study group(P<0.05). The levels of stress indexes and serum inflammatory factors in the two groups significantly decreased at 7 d after operation compared with those at 1 d after operation, and the indexes in the study group were lower than those in the control group(P<0.05). Conclusion Laparoscopic cholecystectomy may significantly reduce intraoperative trauma, and relieve postoperative stress and inflammatory response, which is safer and more effective than traditional open cholecystectomy.