腹腔镜下行胆囊切除术治疗急性胆囊炎并发胆结石的临床安全性及预后效果

Clinical Safety and Prognosis of Laparoscopic Cholecystectomy for Acute Cholecystitis Complicated with Gallstone

目的探讨腹腔镜胆囊切除术治疗急性胆囊炎并发胆结石的临床效果。方法按随机数字表法将2017年1月-2018年2月就诊于该院的72例急性胆囊炎并发胆结石患者分为两组,各36例。对照组行开腹手术,研究组行腹腔镜下胆囊切除术。对比两组术中、术后相关指标、血清炎性因子及术后并发症发生情况。结果研究组切口长度、术中失血量、手术用时分别为(3.28±0.26)cm、(30.48±8.65)mL、(38.79±8.22)min,对照组分别为(10.48±3.42)cm、(75.28±14.30)mL、(49.30±7.20)min,差异有统计学意义(t=12.595、16.084、5.771,P=0.000);研究组术后首次排气时间、住院时间、疼痛持续时间、下床活动时间、引流管留置时间分别为(28.59±6.41)h、(4.28±0.59)d、(25.68±4.71)h、(29.30±4.24)h、(26.38±3.72)h,均短于对照组的(42.95±6.87)h、(9.61±1.58)d、(36.21±7.08)h、(45.86±7.48)h、(32.50±6.60)h,差异有统计学意义(t=9.170、18.962、7.430、11.556、4.847,P=0.000);研究组术后白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平分别为(78.80±9.97)mmol/L、(70.68±20.87)mmol/L、(41.75±6.05)mmol/L,对照组为(99.62±11.89)mmol/L、(49.38±17.60)mmol/L、(73.38±9.30)mmol/L,差异有统计学意义(t=8.051、4.681、17.106,P=0.000);研究组术后并发症发生率为5.56%,低于对照组的25.00%,差异有统计学意义(χ^2=5.258,P=0.022)。结论对急性胆囊炎并发胆结石患者行腹腔镜下胆囊切除术可有效减轻机体损伤,缩短术后恢复时间,减轻炎症反应,减少术后并发症,安全性较高。

Objective To investigate the clinical effect of laparoscopic cholecystectomy in the treatment of acute cholecystitis complicated with gallstones.Methods 72 patients with acute cholecystitis complicated with gallstones who were admitted to our hospital from January 2017 to February 2018 were randomLy divided into two groups,36 cases each.The control group underwent open surgery and the study group underwent laparoscopic cholecystectomy.The intraoperative and postoperative related indexes,serum inflammatory factors and postoperative complications were compared between the two groups.Results The length of incision,intraoperative blood loss and operation time of the study group were(3.28±0.26)cm,(30.48±8.65)mL,(38.79±8.22)min,and the control group were(10.48±3.42)cm,(75.28±14.30)m L,(49.30±7.20)min,the difference was statistically significant(t=12.595,16.084,5.771,P=0.000);the first exhaust time,hospitalization time,pain duration,and time of getting out of bed,the indwelling time of the drainage tube in the study group were(28.59±6.41)h,(4.28±0.59)d,(25.68±4.71)h,(29.30±4.24)h,(26.38±3.72)h,both shorter than the control group(42.95±6.87)h,(9.61±1.58)d,(36.21±7.08)h,(45.86±7.48)h,(32.50±6.60)h,the difference was statistically significant(t=9.170,18.962,7.430,11.556,4.847,P=0.000);the levels of interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in the study group were(78.80±9.97)mmol/L,(70.68±20.87)mmol/L,(41.75±6.05)mmol/L,control group(99.62±11.89)mmol/L,(49.38±17.60)mmol/L,(73.38±9.30)mmol/L.The difference was statistically significant(t=8.051,4.681,17.106,P=0.000).The postoperative complication rate was 5.56%in the study group,which was lower than that in the control group(25.00%).The difference was statistically significant(χ^2=5.258,P=0.022).Conclusion Laparoscopic cholecystectomy in patients with acute cholecystitis complicated with gallstones can effectively reduce the body damage,shorten the recovery time,reduce the inflammatory response,reduce postoperative complications,and have higher safety.