腹腔镜下逆行次全胆囊切除术治疗急性结石性胆囊炎的临床效果

Clinical effect of laparoscopic retrograde subtotal cholecystectomy in the treatment of acute calculous cholecystitis

目的探讨腹腔镜下逆行次全胆囊切除术治疗急性结石性胆囊炎的临床效果。方法选取2018年1~12月我院收治的80例急性结石性胆囊炎患者作为研究对象,采用随机数字表法分为观察组和对照组,每组各40例。观察组患者行腹腔镜下逆行次全胆囊切除术,对照组患者行腹腔镜逆行全胆囊切除术。比较两组患者的手术相关指标、术后并发症和术后应激指标。结果观察组患者的手术时间短于对照组,术中出血量及术后补液量均少于对照组,差异有统计学意义(P<0.05);两组患者的术后第1天体温、术后引流时间及住院天数比较,差异无统计学意义(P>0.05);观察组患者的术后并发症总发生率低于对照组,差异有统计学意义(P<0.05);术前,两组患者的C-反应蛋白(CRP)、皮质醇比较,差异无统计学意义(P>0.05);术后,两组患者的CRP和皮质醇均高于术前,观察组患者的CRP、皮质醇均低于对照组,差异均有统计学意义(P<0.05)。结论急性结石性胆囊炎患者行腹腔镜逆行次全胆囊切除术,相比较于全胆囊切除术,手术时间短,出血量和术后补液量少,并发症少且应激反应小,效果显著,值得临床推广应用。

Objective To explore the clinical effect of laparoscopic retrograde subtotal cholecystectomy in the treatment of acute calculous cholecystitis.Methods A total of 80 patients with acute calculous cholecystitis treated in our hospital from January to December 2018 were selected as the research subjects,they were divided into the observation group and the control group by random number table method,with 40 cases in each group.The patients in the observation group were treated with laparoscopic retrograde subtotal cholecystectomy,and the patients in the control group were treated with laparoscopic retrograde subtotal cholecystectomy.The operative related indexes,postoperative complications and postoperative stress indexes between the two groups were compared.Results The time of operation in the observation group was shorter than that in the control group,and the amount of bleeding during operation and fluid replenishment after operation were less than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in temperature on the first day after operation,drainage time and hospitalization days between the two groups(P>0.05).The total incidence of postoperative complications in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).Before operation,there were no significant differences between the two groups in C-reactive protein(CRP)and cortisol(P>0.05).After operation,the CRP and cortisol in the two groups were higher than those before operation,and the CRP and cortisol in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion Compared with total cholecystectomy,laparoscopic retrograde subtotal cholecystectomy for patients with acute calculous cholecystitis has the advantages of shorter operation time,less bleeding and fluid supplement,fewer complications and less stress response,which is worthy of clinical application.