腹腔镜胆囊切除术与开腹胆囊切除术对胆囊结石患者手术疗效、肝肾功能及机体应激的影响

The Effect of Laparoscopic Cholecystectomy and Open Cholecystectomy on the Curative Effect, Liver and Kidney Function and Body Stress in Patients with Cholecystolithiasis

目的:探讨腹腔镜胆囊切除术(LC)与开腹胆囊切除术(OC)对胆囊结石患者手术疗效、肝肾功能及机体应激的影响。方法:选取2015年3月~2018年7月期间我院收治的胆囊结石患者125例为研究对象。根据随机数字表法将患者分为对照组(n=62)和研究组(n=63),对照组给予OC治疗,研究组给予LC治疗,比较两组各项临床指标,检测两组术前、术后肝肾功能指标及机体应激指标水平,记录两组术后并发症发生情况。结果:研究组手术时间、术后住院时间、排气时间均短于对照组,术中出血量少于对照组(P<0.05)。与术前比较,两组患者术后1 d总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸转氨酶(AST)水平均升高,但研究组低于对照组(P<0.05)。与术前比较,两组患者术后1 d Alb/UCr、NAG/UCr升高,且研究组高于对照组(P<0.05);与术后1 d比较,两组患者术后3d白蛋白(Alb)/尿肌酐(UCr)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)/UCr降低(P<0.05),但研究组与对照组比较差异无统计学意义(P>0.05);两组患者术前、术后1d、术后3d血清尿素氮(BUN)、血清肌酐(SCr)比较差异无统计学意义(P>0.05)。与术前比较,两组患者术后1d超氧化物歧化酶(SOD)水平降低,且研究组低于对照组(P<0.05),丙二醛(MDA)、C-反应蛋白(CRP)水平升高,但研究组低于对照组(P<0.05)。研究组并发症发生率低于对照组(P<0.05)。结论:LC治疗胆囊结石患者安全有效,临床相关指标改善程度优于OC术式,术后肾功能恢复更快,且对患者肝功能、机体应激程度影响较轻。

Objective: To investigate the effects of laparoscopic cholecystectomy(LC) and open cholecystectomy(OC) on the operative efficacy, liver and kidney function and body stress in patients with cholecystolithiasis. Methods: 125 cases of patients with cholecystolithiasis who were treated in our hospital from March 2015 to July 2018 were selected as the research subjects. The patients were randomly divided into control group(n=62) and research group(n=63), the control group was treated with OC, and the tresearch group was treated with LC. The clinical indexes of the two groups were compared. The liver and kidney function and body stress indexes of the two groups were compared before and after operation. Postoperative complications were recorded in the two groups. Results: The operation time, postoperative hospital stay and exhaust time of the research group were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group(P<0.05). Compared with before operation, the levels of total bilirubin(TBIL),alanine aminotransferase(ALT) and aspartate transaminase(AST) at 1 d after operation increased in both groups, but the research group was lower than the control group(P<0.05). Compared with before operation, the Alb/UCr and NAG/UCr at 1 d after operation increased in two groups, and the research group was higher than the control group(P<0.05). Compared with 1 d after operation, the albumin(Alb)/creatinine(UCr), N-acetyl-β-D-glucosaminidase(NAG)/UCr at 3 d after operation decreased in both groups(P<0.05). However, there was no significant difference between the research group and the control group(P>0.05). There were no significant differences in serum urea nitrogen(BUN) and creatinine(SCr) between the two groups before operation, 1 d after operation and 3 d after operation(P>0.05).Compared with before operation,the levels of superoxide dismutase(SOD) at 1 d after operation decreased in the two groups, and the research group was lower than the control group(P<0.05). The levels of malondialdehyde(MDA) and C-reactive protein(CRP) increased,but the research group was lower than the control group(P<0.05). The incidence of complications in the research group was lower than that in the control group(P<0.05). Conclusion: LC is better than OC in improving the clinical parameters of patients with cholecystolithiasis. The renal function can be rapidly restored after operation. It has a slight effect on liver function and body stress, it has safe and effective.