微创保胆取石与腹腔镜手术对胆结石患者胃肠功能及预后的影响

Effect of minimally invasive gallstone removal and laparoscopic surgery on gastrointestinal function and prognosis in patients with gallstone

目的探讨微创保胆取石与腹腔镜手术对胆结石患者的胃肠功能及预后的影响,为患者的临床治疗提供指导。方法选择2018年3月至2019年1月北京市第二医院接诊的114例胆结石患者为研究对象,按随机数表法将患者分为观察组和对照组各57例。对照组患者予以腹腔镜胆囊切除术治疗,观察组患者予以微创保胆取石术治疗。比较两组患者的各项手术指标和治疗前后胃肠功能情况(包括胃动素、胃泌素水平);随访6个月,比较两组患者术后并发症的发生情况。结果观察组和对照组患者的手术时间[(51.35±4.88)min vs(62.51±4.30)min]、术中出血量[(23.32±5.63)mL vs(52.31±5.09)mL]、术后首次排气时间[(13.14±2.52)h vs(22.36±3.21)h]及住院时间[(5.06±1.19)d vs(7.13±1.05)d]比较,观察组明显少于对照组,差异均有统计学意义(P<0.05);治疗后,两组患者的胃动素水平均明显下降,胃泌素水平均明显上升,观察组患者的胃动素水平为(122.71±13.49)ng/L,明显高于对照组的(103.62±10.53)ng/L,胃泌素水平为(92.83±8.39)ng/L,明显低于对照组(105.48±13.90)ng/L,差异均有统计学意义(P<0.05);观察组患者的并发症发生率为3.51%,明显低于对照组的15.79%,差异有统计学意义(P<0.05)。结论相较于腹腔镜胆囊切除术,微创保胆取石术治疗胆结石更能有效促进患者胃肠功能恢复,减少并发症发生,对患者预后康复产生积极影响,值得临床推广应用。

Objective To investigate the effect of minimally invasive gallstone removal and laparoscopic surgery on gastrointestinal function and prognosis of patients with gallstones,and to provide guidance for clinical treatment of patients.Methods A total of 114 patients with gallstones who were admitted to the Second Hospital of Beijing City from March 2018 to January 2019 were selected as subjects.Patients were divided into observation group and control group by random number table method,with 57 patients in each group.Patients in the control group were treated with laparoscopic surgery,and patients in the study group were treated with minimally invasive gallstone removal.The surgical indicators and gastrointestinal function(including motilin and gastrin levels)of the two groups of patients were compared before and after treatment.After 6 mouths of follow-up,the incidence of postoperative complications was compared between the two groups of patients.Results The operation time,intraoperative blood loss,first venting after operation time,and length of hospital stay were(51.35±4.88)min,(23.32±5.63)mL,(13.14±2.52)h,(5.06±1.19)d,significantly less than(62.51±4.30)min,(52.31±5.09)mL,(22.36±3.21)h,(7.13±1.05)d(P<0.05).After treatment,the levels of motilin were significantly decreased in both groups,and the level of gastrin were significantly increased;the motilin level in the observation group was(122.71±13.49)ng/L,which was significantly higher than(103.62±10.53)ng/L in the control group;the gastrin level was(92.83±8.39)ng/L,which was significantly lower than(105.48±13.90)ng/L in the control group(P<0.05).The incidence of complications in the observation group was 3.51%,which was significantly lower than 15.79%in the control group(P<0.05).Conclusion Compared with laparoscopic surgery,minimally invasive gallstone removal can effectively promote gastrointestinal function recovery,reduce the occurrence of complications,and havs a positive impact on the patient's prognosis,which is worthy of clinical promotion and application.