腹腔镜与开腹胆囊切除术治疗急性结石性胆囊炎的临床效果

Clinical effect of laparoscopic and open cholecystectomy in the treatment of acute calculouscholecystitis

目的探讨腹腔镜与开腹胆囊切除术治疗急性结石性胆囊炎的临床效果及对患者VAS评分、住院时间的影响。方法将我院2016年3月至2018年3月收治的80例急性结石性胆囊炎患者按照随机数表法分为腹腔镜组(n=40,腹腔镜胆囊切除术)和开腹组(n=40,开腹胆囊切除术)。比较两组患者手术状况、术后疼痛、炎症介质、氧化应激、细胞免疫功能、康复情况、生存质量等情况。结果腹腔镜组患者术中出血量少于开腹组,且术后3、6、12、24 h的VAS评分均显著低于开腹组(P<0.05);术后1 d,两组患者的白细胞介素-6、肿瘤坏死因子-α、丙二醛水平升高,超氧化物歧化酶、CD4+水平、CD4+/CD8+降低,但腹腔镜组均优于开腹组(P<0.05)。腹腔镜组术后康复情况均优于开腹组(P<0.05)。腹腔镜组出院时生存质量评分均显著高于开腹组与术前(P<0.05)。结论腹腔镜胆囊切除术治疗急性结石性胆囊炎患者的效果优于开腹胆囊切除术,其可减轻手术引起的炎症反应、氧化应激、免疫功能下降等情况。

Objective To explore the clinical effect of laparoscopic and open cholecystectomy on acute calculouscholecystitis and its effects on VAS score and hospital stay. Methods A total of 80 patients with acute calculouscholecystitis admitted in our hospital from March 2016 to March 2018 were divided into laparoscopic group(n=40, laparoscopic cholecystectomy) and open group(n=40, open cholecystectomy) according to the randomized digital table method. The operation status, postoperative pain, inflammatory mediators, oxidative stress, cellular immune function, rehabilitation and quality of life in the two groups were compared. Results The intraoperative bleeding volume in the laparoscopic group was less than that in the open group,and VAS scores at 3, 6, 12, 24 h after operation in the laparoscopic group were significantly lower than those in the open group(P<0.05). At 1 day after operation, the levels of interleukin-6, tumor necrosis factor-α, malondialdehyde in both groups increased, the levels of superoxide dismutase,CD4+, CD4+/CD8+decreased, but those of the laparoscopic group were better than the open group(P<0.05). The postoperative rehabilitation of the laparoscopic group were better than that of the open group(P<0.05). The quality of life score in the laparoscopic group was significantly higher than that in open group(P<0.05).Conclusion Laparoscopic cholecystectomy is superior to open cholecystectomy in the treatment effect on patients with acute calculouscholecystitis, and can alleviate inflammation, oxidative stress and immune function decline caused by operation.