不同手术方法治疗胆囊息肉疗效比较

Comparison of the therapeutic effects of different surgical methods on gallbladder polyps

目的比较微创内镜保胆术与腹腔镜胆囊切除术治疗胆囊息肉的疗效。方法回顾性分析2017年1月至2018年3月期间志丹县人民医院收治的160例胆囊息肉患者的临床资料,其中80例接受微创内镜保胆术治疗的患者纳入观察组,80例行腹腔镜胆囊切除术治疗的患者纳入对照组,比较两组患者的手术时间、术中出血量、术后排气时间、术疼痛程度、住院时间及并发症发生情况,其中术后疼痛在术后1 d使用视觉模拟评分法(VAS)评价。比较观察组患者术前及术后1年胆囊壁厚度、胆囊收缩功能。结果观察组患者的手术时间、术中出血量、术后排气时间及住院时间分别为(51.65±5.93)min、(10.42±3.26)mL、(18.93±4.84)h、(4.82±1.67)d,明显少于对照组的(59.87±8.35)min、(16.49±5.37)mL、(25.71±7.26)h、(6.29±2.54)d,术后VAS评分为(2.96±0.74)分,明显低于对照组的(4.64±1.27)分,差异均有统计学意义(P<0.05);观察组患者术后并发症发生率为8.75%,明显低于对照组的18.75%,差异有统计学意义(P<0.05);术后1年,观察组患者胆囊收缩功能为(64.38±14.22)%,明显高于术前的(35.62±11.09)%,胆囊壁厚度为(2.83±0.62)mm,明显低于术前的(3.34±0.96)mm,差异均有统计学意义(P<0.05)。结论微创内镜保胆术治疗胆囊息肉与腹腔镜胆囊切除术比较,具有创伤小、术后疼痛轻、术后康复快及并发症少的优势。

Objective To compare the efficacy of minimally invasive endoscopic cholecystectomy and laparoscopic cholecystectomy in the treatment of gallbladder polyps,and to explore the application value of minimally invasive endoscopic choledochotomy.Methods A total of 160 patients with gallbladder polyps treated in Zhidan County People’s Hospital from January 2017 to March 2018 were selected as the study subjects.The patients underwent minimally invasive endoscopic cholecystectomy were included into the observation group(n=80),and the patients underwent laparoscopic cholecystectomy were included into the control group(n=80).The perioperative indexes including operation time,intraoperative bleeding volume,postoperative exhaust time,degree of pain and hospitalization time of the two groups were compared.The incidence of complications and the postoperative pain were evaluated by Visual Analogue Scale(VAS)one day after operation.The thickness of gallbladder wall and gallbladder contraction function were compared before and one year after operation.Results The operation time,intraoperative bleeding volume,postoperative exhaust time,and hospitalization time of the observation group were(51.65±5.93)min,(10.42±3.26)m L,(18.93±4.84)h,(4.82±1.67)d,respectively,which were significantly less than corresponding(59.87±8.35)min,(16.49±5.37)mL,(25.71±7.26)h,(6.29±2.54)d in the control group;the VAS score was(2.96±0.74),which was significantly lower than(4.64±1.27)in the control group(all P<0.05).The incidence of postoperative complications in the observation group was8.75%,which was significantly lower than 18.75%in the control group(P<0.05).One year after operation,the contractile function of gallbladder in the observation group was(64.38±14.22)%,which was significantly higher than(35.62±11.09)%before operation,and the thickness of gallbladder wall was(2.83±0.62)mm,which was significantly lower than(3.34±0.96)mm before operation(P<0.05).Conclusion Compared with laparoscopic cholecystectomy,minimally invasive endoscopic cholecystectomy has the advantages of less trauma,less pain,faster recovery and fewer complications.