钩拉辅助两孔法LC对胆囊结石患者的治疗效果及对T淋巴细胞和应激反应的影响

The therapeutic effect of hook pull assisted two hole LC on patients with gallstone and its effect on T lymphocyte and stress response

目的探讨钩拉辅助两孔法腹腔镜胆囊切除术(LC)对胆囊结石患者的治疗效果及对T淋巴细胞、应激反应的影响。方法回顾性分析2017年8月至2018年8月海军特色医学中心收治的胆囊结石患者78例,按照治疗方法将患者分为对照组和观察组,每组各39例。对照组患者给予小切口胆囊切除术(MC),观察组患者给予钩拉辅助两孔法LC。比较两组患者的手术情况、恢复情况、手术前后T淋巴细胞水平、应激反应指标水平和术后并发症发生情况。结果观察组患者的手术时间、住院时间分别为(45.16±7.08)min、(4.02±0.83)d,与对照组比较差异无统计学意义(P>0.05);观察组患者的术中出血量、胃肠功能恢复时间分别为(42.26±5.70)ml、(15.21±3.89)h,明显低于对照组,差异具有统计学意义(P<0.05)。术后1、3 d,观察组患者的CD3^+水平分别为(57.59±1.72)%、(64.33±2.03)%,CD4^+水平分别为(40.45±3.43)%、(33.72±2.65)%,均低于术前1 d(P<0.05),观察组患者的CD3^+、CD4^+水平明显高于对照组(P<0.05),两组患者的CD8^+水平比较差异无统计学意义(P>0.05);术后1 d,观察组患者的CD8^+水平为(24.57±1.80)%,明显低于术前1 d(P<0.05)。术后1 d,观察组患者的中性粒细胞(NE)、皮质醇(Cor)水平分别为(81.75±18.37)%、(577.42±61.52)mmol/L,明显高于术前1 d,观察组患者的NE、Cor水平明显低于对照组(P<0.05);术后3 d,对照组患者的NE、Cor水平明显高于术前1 d(P<0.05),观察组患者的NE水平明显低于术前1 d和对照组(P<0.05),Cor水平明显低于对照组(P<0.05)。观察组患者的术后并发症发生率明显低于对照组(5.13%vs.20.15%),差异具有统计学意义(P<0.05)。结论与小切口胆囊切除术相比,钩拉辅助两孔法LC治疗胆囊结石能够显著减少术中出血量,缩短胃肠功能恢复时间,对患者的免疫功能、应激反应影响较小,且术后并发症的发生情况也相对较少。

Objective To investigate the therapeutic effect of hook pull assisted two hole laparoscopic cholecystectomy(LC)on patients with gallstone and its effect on T lymphocyte and stress response.Methods From August 2017 to August 2018,78 patients with gallstone were analyzed retrospectively.The patients were divided into control group and observation group,39 cases in each group.Patients in the control group were treated with small incision cholecystectomy(MC),and patients in the observation group were treated with hook pull assisted two hole LC.The status of operation and recovery,T lymphocyte level,stress response index and postoperative complications were compared between the two groups.Results The operation time and hospitalization time of the observation group were(45.16±7.08)min and(4.02±0.83)d,respectively,which had no significant difference compared with those of the control group(P>0.05).The amount of bleeding and the recovery time of gastrointestinal function in the observation group were(42.26±5.70)ml and(15.21±3.89)h,respectively,which were significantly lower than those in the control group(P<0.05).The levels of CD3^+and CD4^+in the observation group were(57.59±1.72)%,(64.33±2.03)%,40.45±3.43%,(33.72±2.65)%,respectively,which were lower than those in the preoperative day(P<0.05).The levels of CD3^+and CD4^+in the observation group were significantly higher than those in the control group(P<0.05),and there was no significant difference between the two groups(P>0.05).The level of CD8^+in the postoperative group was 1 d.The level of CD8^+in the observation group was(24.57±1.80)%,which was significantly lower than that in the first day before operation(P<0.05).The levels of neutrophil(NE)and cortisol(COR)in the observation group were(81.75±18.37)%and(577.42±61.52)mmol/L respectively on the first day after operation,which were significantly higher than that of the first day before operation.The levels of NE and cor in the observation group were significantly lower than that of the control group(P<0.05).On the third day after operation,the levels of NE and cor in the control group were significantly higher than that of the first day before operation D(P<0.05).The NE level of the observation group was significantly lower than that of the control group(P<0.05),and the Cor level was significantly lower than that of the control group(P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group(5.13%vs.20.15%)(P<0.05).Conclusion Compared with small incision cholecystectomy,hook pull assisted two hole LC can significantly reduce the amount of intraoperative bleeding,shorten the recovery time of gastrointestinal function,has less impact on the immune function and stress response of patients,and has less postoperative complications.